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Sample records for hospital episode statistics

  1. Routine hospital data - is it good enough for trials? An example using England's Hospital Episode Statistics in the SHIFT trial of Family Therapy vs. Treatment as Usual in adolescents following self-harm.

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    Wright-Hughes, Alexandra; Graham, Elizabeth; Cottrell, David; Farrin, Amanda

    2018-04-01

    Use of routine data sources within clinical research is increasing and is endorsed by the National Institute for Health Research to increase trial efficiencies; however there is limited evidence for its use in clinical trials, especially in relation to self-harm. One source of routine data, Hospital Episode Statistics, is collated and distributed by NHS Digital and contains details of admissions, outpatient, and Accident and Emergency attendances provided periodically by English National Health Service hospitals. We explored the reliability and accuracy of Hospital Episode Statistics, compared to data collected directly from hospital records, to assess whether it would provide complete, accurate, and reliable means of acquiring hospital attendances for self-harm - the primary outcome for the SHIFT (Self-Harm Intervention: Family Therapy) trial evaluating Family Therapy for adolescents following self-harm. Participant identifiers were linked to Hospital Episode Statistics Accident and Emergency, and Admissions data, and episodes combined to describe participants' complete hospital attendance. Attendance data were initially compared to data previously gathered by trial researchers from pre-identified hospitals. Final comparison was conducted of subsequent attendances collected through Hospital Episode Statistics and researcher follow-up. Consideration was given to linkage rates; number and proportion of attendances retrieved; reliability of Accident and Emergency, and Admissions data; percentage of self-harm episodes recorded and coded appropriately; and percentage of required data items retrieved. Participants were first linked to Hospital Episode Statistics with an acceptable match rate of 95%, identifying a total of 341 complete hospital attendances, compared to 139 reported by the researchers at the time. More than double the proportion of Hospital Episode Statistics Accident and Emergency episodes could not be classified in relation to self-harm (75%) compared

  2. Research Outputs of England's Hospital Episode Statistics (HES) Database: Bibliometric Analysis.

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    Chaudhry, Zain; Mannan, Fahmida; Gibson-White, Angela; Syed, Usama; Ahmed, Shirin; Majeed, Azeem

    2017-12-06

    Hospital administrative data, such as those provided by the Hospital Episode Statistics (HES) database in England, are increasingly being used for research and quality improvement. To date, no study has tried to quantify and examine trends in the use of HES for research purposes. To examine trends in the use of HES data for research. Publications generated from the use of HES data were extracted from PubMed and analysed. Publications from 1996 to 2014 were then examined further in the Science Citation Index (SCI) of the Thompson Scientific Institute for Science Information (Web of Science) for details of research specialty area. 520 studies, categorised into 44 specialty areas, were extracted from PubMed. The review showed an increase in publications over the 18-year period with an average of 27 publications per year, however with the majority of output observed in the latter part of the study period. The highest number of publications was in the Health Statistics specialty area. The use of HES data for research is becoming more common. Increase in publications over time shows that researchers are beginning to take advantage of the potential of HES data. Although HES is a valuable database, concerns exist over the accuracy and completeness of the data entered. Clinicians need to be more engaged with HES for the full potential of this database to be harnessed.

  3. The management of pelvic organ prolapse in England: a 4-year analysis of hospital episode statistics (HES) data.

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    Ismail, S I F

    2014-08-01

    The aim of this study was to establish the number and trend of surgical procedures and pessary management of pelvic organ prolapse in England, using Hospital Episode Statistics (HES) data. An online search ( www.hesonline.nhs.uk ) was carried out. The number of various surgical procedures, as well as pessary insertions and removals for pelvic organ prolapse was obtained. Data were available for the 4-year period March 2002 to June 2005. Over 20,000 procedures performed and 600 pessaries inserted annually. The total number of patients having treatment for pelvic organ prolapse as well as the number of patients having surgery and pessary in English hospitals increased by data sooner and for longer periods as well as the use of more specific codes are needed to provide more useful information.

  4. Variation in rates of breast cancer surgery: A national analysis based on French Hospital Episode Statistics.

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    Rococo, E; Mazouni, C; Or, Z; Mobillion, V; Koon Sun Pat, M; Bonastre, J

    2016-01-01

    Minimum volume thresholds were introduced in France in 2008 to improve the quality of cancer care. We investigated whether/how the quality of treatment decisions in breast cancer surgery had evolved before and after this policy was implemented. We used Hospital Episode Statistics for all women having undergone breast conserving surgery (BCS) or mastectomy in France in 2005 and 2012. Three surgical procedures considered as better treatment options were analyzed: BCS, immediate breast reconstruction (IBR) and sentinel lymph node biopsy (SLNB). We studied the mean rates and variation according to the hospital profile and volume. Between 2005 and 2012, the volume of breast cancer surgery increased by 11% whereas one third of the hospitals no longer performed this type of surgery. In 2012, the mean rate of BCS was 74% and similar in all hospitals whatever the volume. Conversely, IBR and SLNB rates were much higher in cancer centers (CC) and regional teaching hospitals (RTH) [IBR: 19% and 14% versus 8% on average; SLNB: 61% and 47% versus 39% on average]; the greater the hospital volume, the higher the IBR and SLNB rates (p < 0.0001). Overall, whatever the surgical procedure considered, inter-hospital variation in rates declined substantially in CC and RTH. We identified considerable variation in IBR and SLNB rates between French hospitals. Although more complex and less standardized than BCS, most clinical guidelines recommended these procedures. This apparent heterogeneity suggests unequal access to high-quality procedures for women with breast cancer. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Hospital admissions for dental treatment among children with cleft lip and/or palate born between 1997 and 2003: an analysis of Hospital Episode Statistics in England.

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    Fitzsimons, Kate J; Copley, Lynn P; Smallridge, Jacqueline A; Clark, Victoria J; van der Meulen, Jan H; Deacon, Scott A

    2014-05-01

    Children with clefts have an increased tendency for dental anomalies and caries. To determine the pattern of hospital admissions for dental treatment during primary dentition among children with clefts. Cohort study based on Hospital Episode Statistics, an administrative database of all admissions to National Health Service hospitals in England. Patients born alive between 1997 and 2003 who had both a cleft diagnosis and cleft repair were included. The number of hospital admissions for surgical removal of teeth, simple extraction of teeth, and restoration of teeth before the age of seven was examined. Eight hundred and fifty-eight hospital admissions for dental treatment among 6551 children (dental treatment. The presence of additional anomalies, having a more severe cleft type, and living in relatively deprived areas increased the risk of hospital admission. Factors increasing the risk of hospital admission among cleft children should be taken into account when planning services. Efforts to reduce the number of hospital admissions should be focused on disease prevention, particularly among those most at risk of caries. © 2013 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Adolescent inpatient activity 1999-2010: analysis of English Hospital Episode Statistics data.

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    Hargreaves, Dougal S; Viner, Russell M

    2014-09-01

    To investigate patterns and trends of adolescent (10-19 years) inpatient activity in England by sex, disease category, and admitting speciality. 9 632 844 Finished Consultant Episodes (FCEs) from English patients aged 1-19 between 1999/2000 and 2010/2011 (Hospital Episode Statistics data). Age trends by sex and major International Classification of Disease 10 (ICD10) chapter; differences in activity rates by age and sex; inpatient activity trends over the past decade, disaggregated by sex, admitting speciality and ICD10 chapter. Adolescent female patients account for more activity than girls aged 1-9 (139.4 vs 107.2 FCEs/1000). Female inpatient activity increases significantly between age 10 (70.9 FCEs/1000) and 19 (281.7 FCES/1000, of which non-obstetric care accounts for 155.9 FCEs/1000). Male activity increases much less during adolescence, with lower overall rates among adolescents than younger children (93.7 vs 142.9 FCEs/1000). Between 1999 and 2010, total adolescent inpatient activity increased faster among adolescents (10-19 years) (+14.2%) than younger children (1-9 years) (+11.0%). Adolescent FCEs/1000 increased by 12.8%, including higher rates admitted under Paediatrics (+47.5%) and Paediatric Surgery (+23.2%). Adolescents were admitted across a range of specialities. These data challenge the belief that adolescents are a healthy group who rarely use inpatient services. In England, use of inpatient services is higher among female patients aged 10-19 years than those aged 1-9 years, while adolescent activity has increased faster than for younger children over the past 11 years. Improving service quality for adolescents will require engagement of the many different teams that care for them. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. The increasing number of surgical procedures for female genital fistula in England: analysis of Hospital Episode Statistics (HES) data.

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    Ismail, S I M F

    2015-01-01

    The aim of this study was to describe the number and trend of surgical procedures for female genital fistula in England. An online search of Hospital Episode Statistics (HES) data was carried out. Data were available for the 4-year period from 2002-03 until 2005-06. The total number of surgical procedures carried out for female genital fistula steadily increased by 28.7% from 616 in 2002-03 to 793 in 2005-06. The number of surgical procedures performed for rectovaginal fistula exceeded the total number of surgical procedures carried out for vesicovaginal and urethrovaginal fistula in each year of the study period. This pattern needs to be monitored and investigated further.

  8. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.

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    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B

    2017-01-01

    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Pathway for inpatients with depressive episode in Flemish psychiatric hospitals: a qualitative study

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    Simoens Steven R

    2009-10-01

    Full Text Available Abstract Background Within the context of a biopsychosocial model of the treatment of depressive episodes, a multidisciplinary approach is needed. Clinical pathways have been developed and implemented in hospitals to support multidisciplinary teamwork. The aim of this study is to explore current practice for the treatment of depressive episodes in Flemish psychiatric hospitals. Current practice in different hospitals is studied to get an idea of the similarities (outlined as a pathway and the differences in the treatment of depressive episodes. Methods A convenience sample of 11 Flemish psychiatric hospitals participated in this qualitative study. Semi-structured interviews were conducted with different types of health care professionals (n = 43. The websites of the hospitals were searched for information on their approach to treating depressive episodes. Results A flow chart was made including the identified stages of the pathway: pre-admission, admission (observation and treatment, discharge and follow-up care. The characteristics of each stage are described. Although the stages are identified in all hospitals, differences between hospitals on various levels of the pathway exist. Hospitals emphasized the individual approach of each patient. The results point to a biopsychosocial approach to treating depressive episodes. Conclusion This study outlined current practice as a pathway for Flemish inpatients with depressive episodes. Within the context of surveillance of quality and quantity of care, this study may encourage hospitals to consider developing clinical pathways.

  10. Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data.

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    Gibson, W; Wagg, A

    2016-07-01

    To examine the trends in surgical treatment of stress urinary incontinence (SUI) in older women since the introduction of the mid-urethral sling. Analysis of data from Hospital Episode Statistics (HES) between 2000 and 2012. All surgical procedures for SUI in the National Health Service (NHS) in England. Retrospective cohort analysis of Hospital Episode Statistics for England from 2000 to 2012. Number of invasive, less invasive, and urethral bulking procedures performed in women in three age groups. There was a 90% fall in the number of invasive surgical treatments for SUI and a four-fold increase in the number of mid-urethral slings over this time. The total number of surgical procedures for SUI increased from 8458 to 13 219. However, the rise in the number of procedures in women aged over 75 was more modest-a three-fold increase from a low start of 187-and these women now make up a smaller proportion of all women receiving a mid-urethral sling (MUS). Despite the development and wide availability of a less invasive, safe and effective operation for stress urinary incontinence in older women, they do not appear to have benefitted. The reasons for this require prospective investigation. © 2015 Royal College of Obstetricians and Gynaecologists.

  11. Factors associated with hypoglycemia episodes in hospitalized type ...

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    during hospital stay were those admitted due to other causes but subsequently developed hypoglycemia ..... Table 3: Association between causes and severity of hypoglycemia episodes .... An animal study in ... American Diabetes Association.

  12. Vascular disease in women: comparison of diagnoses in hospital episode statistics and general practice records in England

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    Wright F

    2012-10-01

    Full Text Available Abstract Background Electronic linkage to routine administrative datasets, such as the Hospital Episode Statistics (HES in England, is increasingly used in medical research. Relatively little is known about the reliability of HES diagnostic information for epidemiological studies. In the United Kingdom (UK, general practitioners hold comprehensive records for individuals relating to their primary, secondary and tertiary care. For a random sample of participants in a large UK cohort, we compared vascular disease diagnoses in HES and general practice records to assess agreement between the two sources. Methods Million Women Study participants with a HES record of hospital admission with vascular disease (ischaemic heart disease [ICD-10 codes I20-I25], cerebrovascular disease [G45, I60-I69] or venous thromboembolism [I26, I80-I82] between April 1st 1997 and March 31st 2005 were identified. In each broad diagnostic group and in women with no such HES diagnoses, a random sample of about a thousand women was selected for study. We asked each woman’s general practitioner to provide information on her history of vascular disease and this information was compared with the HES diagnosis record. Results Over 90% of study forms sent to general practitioners were returned and 88% of these contained analysable data. For the vast majority of study participants for whom information was available, diagnostic information from general practice and HES records was consistent. Overall, for 93% of women with a HES diagnosis of vascular disease, general practice records agreed with the HES diagnosis; and for 97% of women with no HES diagnosis of vascular disease, the general practitioner had no record of a diagnosis of vascular disease. For severe vascular disease, including myocardial infarction (I21-22, stroke, both overall (I60-64 and by subtype, and pulmonary embolism (I26, HES records appeared to be both reliable and complete. Conclusion Hospital admission data

  13. Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics

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    2012-01-01

    Background In 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs. Methods All live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated. Results We identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007. Conclusions Between 1998 and 2007, cleft services in England were centralised. According to a survey among patients’ parents, the quality of cleft care improved in the same period. Surgical care became more consistent with current

  14. The changing face of urinary continence surgery in England: a perspective from the Hospital Episode Statistics database.

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    Withington, John; Hirji, Sadaf; Sahai, Arun

    2014-08-01

    To quantify changes in surgical practice in the treatment of stress urinary incontinence (SUI), urge urinary incontinence (UUI) and post-prostatectomy stress incontinence (PPI) in England, using the Hospital Episode Statistics (HES) database. We used public domain information from the HES database, an administrative dataset recording all hospital admissions and procedures in England, to find evidence of change in the use of various surgical procedures for urinary incontinence from 2000 to 2012. For the treatment of SUI, a general increase in the use of synthetic mid-urethral tapes, such as tension-free vaginal tape (TVTO) and transobturator tape (TOT), was observed, while there was a significant decrease in colposuspension procedures over the same period. The number of procedures to remove TVT and TOT has also increased in recent years. In the treatment of overactive bladder and UUI, there has been a significant increase in the use of botulinum toxin A and neuromodulation in recent years. This coincided with a steady decline in the recorded use of clam ileocystoplasty. A steady increase was observed in the insertion of artificial urinary sphincter (AUS) devices in men, related to PPI. Mid-urethral synthetic tapes now represent the mainstream treatment of SUI in women, but tape-related complications have led to an increase in procedures to remove these devices. The uptake of botulinum toxin A and sacral neuromodulation has led to fewer clam ileocystoplasty procedures being performed. The steady increase in insertions of AUSs in men is unsurprising and reflects the widespread uptake of radical prostatectomy in recent years. There are limitations to results sourced from the HES database, with potential inaccuracy of coding; however, these data support the trends observed by experts in this field. © 2014 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.

  15. Factors associated with hypoglycemia episodes in hospitalized type ...

    African Journals Online (AJOL)

    Purpose: To determine the factors associated with severity of hypoglycemia in hospitalized type 2 diabetes mellitus patients in a tertiary health facility in Malaysia. Methods: This retrospective study involved 207 hospitalised T2DM patients with hypoglycaemia episodes from January 2008 to December 2012 and was ...

  16. Daylight saving time transitions and hospital treatments due to accidents or manic episodes

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    Lönnqvist Jouko

    2008-02-01

    Full Text Available Abstract Background Daylight saving time affects millions of people annually but its impacts are still widely unknown. Sleep deprivation and the change of circadian rhythm can trigger mental illness and cause higher accident rates. Transitions into and out of daylight saving time changes the circadian rhythm and may cause sleep deprivation. Thus it seems plausible that the prevalence of accidents and/or manic episodes may be higher after transition into and out of daylight saving time. The aim of this study was to explore the effects of transitions into and out of daylight saving time on the incidence of accidents and manic episodes in the Finnish population during the years of 1987 to 2003. Methods The nationwide data were derived from the Finnish Hospital Discharge Register. From the register we obtained the information about the hospital-treated accidents and manic episodes during two weeks before and two weeks after the transitions in 1987–2003. Results The results were negative, as the transitions into or out of daylight saving time had no significant effect on the incidence of accidents or manic episodes. Conclusion One-hour transitions do not increase the incidence of manic episodes or accidents which require hospital treatment.

  17. Daylight saving time transitions and hospital treatments due to accidents or manic episodes

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    Lahti, Tuuli A; Haukka, Jari; Lönnqvist, Jouko; Partonen, Timo

    2008-01-01

    Background Daylight saving time affects millions of people annually but its impacts are still widely unknown. Sleep deprivation and the change of circadian rhythm can trigger mental illness and cause higher accident rates. Transitions into and out of daylight saving time changes the circadian rhythm and may cause sleep deprivation. Thus it seems plausible that the prevalence of accidents and/or manic episodes may be higher after transition into and out of daylight saving time. The aim of this study was to explore the effects of transitions into and out of daylight saving time on the incidence of accidents and manic episodes in the Finnish population during the years of 1987 to 2003. Methods The nationwide data were derived from the Finnish Hospital Discharge Register. From the register we obtained the information about the hospital-treated accidents and manic episodes during two weeks before and two weeks after the transitions in 1987–2003. Results The results were negative, as the transitions into or out of daylight saving time had no significant effect on the incidence of accidents or manic episodes. Conclusion One-hour transitions do not increase the incidence of manic episodes or accidents which require hospital treatment. PMID:18302734

  18. Abstraction and generalization in statistical learning: implications for the relationship between semantic types and episodic tokens

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    2017-01-01

    Statistical approaches to emergent knowledge have tended to focus on the process by which experience of individual episodes accumulates into generalizable experience across episodes. However, there is a seemingly opposite, but equally critical, process that such experience affords: the process by which, from a space of types (e.g. onions—a semantic class that develops through exposure to individual episodes involving individual onions), we can perceive or create, on-the-fly, a specific token (a specific onion, perhaps one that is chopped) in the absence of any prior perceptual experience with that specific token. This article reviews a selection of statistical learning studies that lead to the speculation that this process—the generation, on the basis of semantic memory, of a novel episodic representation—is itself an instance of a statistical, in fact associative, process. The article concludes that the same processes that enable statistical abstraction across individual episodes to form semantic memories also enable the generation, from those semantic memories, of representations that correspond to individual tokens, and of novel episodic facts about those tokens. Statistical learning is a window onto these deeper processes that underpin cognition. This article is part of the themed issue ‘New frontiers for statistical learning in the cognitive sciences’. PMID:27872378

  19. Abstraction and generalization in statistical learning: implications for the relationship between semantic types and episodic tokens.

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    Altmann, Gerry T M

    2017-01-05

    Statistical approaches to emergent knowledge have tended to focus on the process by which experience of individual episodes accumulates into generalizable experience across episodes. However, there is a seemingly opposite, but equally critical, process that such experience affords: the process by which, from a space of types (e.g. onions-a semantic class that develops through exposure to individual episodes involving individual onions), we can perceive or create, on-the-fly, a specific token (a specific onion, perhaps one that is chopped) in the absence of any prior perceptual experience with that specific token. This article reviews a selection of statistical learning studies that lead to the speculation that this process-the generation, on the basis of semantic memory, of a novel episodic representation-is itself an instance of a statistical, in fact associative, process. The article concludes that the same processes that enable statistical abstraction across individual episodes to form semantic memories also enable the generation, from those semantic memories, of representations that correspond to individual tokens, and of novel episodic facts about those tokens. Statistical learning is a window onto these deeper processes that underpin cognition.This article is part of the themed issue 'New frontiers for statistical learning in the cognitive sciences'. © 2016 The Author(s).

  20. Constructing Episodes of Inpatient Care: How to Define Hospital Transfer in Hospital Administrative Health Data?

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    Peng, Mingkai; Li, Bing; Southern, Danielle A; Eastwood, Cathy A; Quan, Hude

    2017-01-01

    Hospital administrative health data create separate records for each hospital stay of patients. Treating a hospital transfer as a readmission could lead to biased results in health service research. This is a cross-sectional study. We used the hospital discharge abstract database in 2013 from Alberta, Canada. Transfer cases were defined by transfer institution code and were used as the reference standard. Four time gaps between 2 hospitalizations (6, 9, 12, and 24 h) and 2 day gaps between hospitalizations [same day (up to 24 h), ≤1 d (up to 48 h)] were used to identify transfer cases. We compared the sensitivity and positive predictive value (PPV) of 6 definitions across different categories of sex, age, and location of residence. Readmission rates within 30 days were compared after episodes of care were defined at the different time gaps. Among the 6 definitions, sensitivity ranged from 93.3% to 98.7% and PPV ranged from 86.4% to 96%. The time gap of 9 hours had the optimal balance of sensitivity and PPV. The time gaps of same day (up to 24 h) and 9 hours had comparable 30-day readmission rates as the transfer indicator after defining episode of care. We recommend the use of a time gap of 9 hours between 2 hospitalizations to define hospital transfer in inpatient databases. When admission or discharge time is not available in the database, a time gap of same day (up to 24 h) can be used to define hospital transfer.

  1. First episode of preschool wheeze requiring hospitalization: a prospective study on the chance of recurrence and associated factors.

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    Chantawarangul, Karaked; Deerojanawong, Jitladda; Sritippayawan, Suchada

    2017-09-17

    Although wheezing is very common in preschoolers, epidemiologic studies in Thailand are quite limited. The likelihood of having a second wheezing episode following the first attack remains unclearly established. This study aims to investigate the incidence of recurrent wheezing in preschool children presenting with first wheezing episode and identify the associated factors. The study is an observational prospective study conducted at the inpatient pediatric department. Patients admitted with first episode of wheezing were followed up as an outpatient approximately one week after hospital discharge and subsequently followed up by telephone 3-monthly with a structured questionnaire seeking information concerning recurrent wheezing, defined as having a second wheezing episode requiring bronchodilator within a 1-year period. The total of 97 patients, aged 6 months to 5 years, were recruited from June 2014 to November 2015. Thirty-five patients were excluded because of inaccessibility for telephone follow-up. Amongst the remaining 62 patients, twenty-eight (45.2%) had recurrent wheezing within one year. The mean lapse duration was 4.7 ± 3.7 months after the first episode. Having an allergic sensitization to aeroallergen was a risk factor for recurrent wheezing (OR 2.48, 95%CI 1.81-3.4). Although not statistically significant, having an allergic sensitization to food seems to be another related factor (OR 2.36, 95%CI 1.75-3.18). The recurrent rate of wheezing was 45%, which was considerably significant. Allergic sensitization to aeroallergen might increase the risk. These patients should be followed up, especially within the first year after their first wheezing episode.

  2. Specialized home treatment versus hospital-based outpatient treatment for first-episode psychosis: a randomized clinical trial.

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    Dewa, Carolyn S; Zipursky, Robert B; Chau, Nancy; Furimsky, Ivana; Collins, April; Agid, Ofer; Goering, Paula

    2009-11-01

    This pilot study compared the effectiveness of specialized care that was home based versus hospital based for individuals experiencing their first psychotic episode. A randomized controlled trial design was used. A total of 29 subjects were interviewed at baseline, 3 and 9 months. Repeated measures analysis of variance was employed to test for statistically significant changes over time within and between groups with regard to community psychosocial functioning and symptom severity. Our findings indicate that subjects in both the home-based and hospital-based programmes significantly improved with regard to symptoms and community functioning over time. However, the rates of change over time were not significantly different between the two programmes. There was a statistically significant difference between programmes with regard to the proportion of subjects with less than two visits (i.e. either did not attend their first assessment or attended follow-up visits after their assessment). This was a modest pilot study and the sample was too small to allow definitive conclusions to be drawn. However, the results raise questions about differences in initial treatment engagement. They suggest the need for additional research focusing on interventions that promote initial treatment seeking. © 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Asia Pty Ltd.

  3. Hospital Episode Statistics data analysis of postoperative venous thromboembolus in patients undergoing urological surgery: a review of 126,891 cases.

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    Dyer, J; Wyke, S; Lynch, C

    2013-01-01

    Current guidelines on venous thromboembolism (VTE) prevention do not reflect the potential varying risk for patients undergoing different urological procedures. Our study aimed to establish the procedure specific rate of postoperative VTE in patients undergoing urological surgery. Hospital Episode Statistics were obtained for all patients undergoing common urological procedures between April 2009 and April 2010. This cohort was followed up to identify all patients reattending with either deep vein thrombosis (DVT) or pulmonary embolism (PE) within 12 months. A total of 126,891 individuals underwent urological surgery during the study period. This included 89,628 men (70.6%) and 37,236 women (29.3%) with a mean age of 65.2 years. At the 12-month follow-up, 839 patients (0.66%) were readmitted with VTE. Of these, 373 (0.29%) were admitted with DVT and 466 (0.37%) with PE. The procedure-specific rate of VTE varied significantly between 2.86% following cystectomy and 0.23% following urethral dilatation. Procedures performed in the lithotomy position carried a significantly lower risk of VTE than those performed in the supine position (0.60% vs 1.28%, p <0.0001). Furthermore, of all procedures performed in the lithotomy position, those performed on benign conditions carried a significantly lower risk than those performed on malignant disease (0.52% vs 0.79%, p <0.0001). Procedure specific rates of postoperative VTE vary widely among patients undergoing urological procedures. These findings suggest the potential benefit of prolonging the use of thromboprophylaxis in high-risk patients but also exploring the apparent lack of need for routine thromboprophylaxis in patients undergoing low-risk procedures.

  4. A cost-benefit analysis of the immunisation of children against respiratory syncytial virus (RSV) using the English Hospital Episode Statistics (HES) data set.

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    Thomas, Gareth

    2018-03-01

    Respiratory syncytial virus (RSV) is a common cause of respiratory infection that is highly prevalent in infants, particularly those with underlying medical conditions. Severe cases of RSV require hospitalisation as well as admission to intensive care and may even result in death. The objective of the study was to measure the net benefits that could arise from an immunisation programme of infants that may well eradicate RSV to a high degree and save the direct and indirect medical care costs from hospitalisation, morbidity and the gain from potential life-time earnings by reducing the probability of mortality. In this context, the majority of existing empirical investigations are based on data from clinical trials, and where relevant facts are not available, a series of strong assumptions is derived from the published literature, whereas in this study, for the first time, the hospital episode statistics database is used to calculate the cost-benefit ratios. The methodology of the analysis adopts a cost-benefit approach to assess the impact of the immunisation and whether it is beneficial to society. The underlying assumptions of the basic model are assessed by adopting a sensitivity analysis. The results show that a number of categories are cost-effective with the use of the passive drug, which means benefits by raising the life expectancy and quality as well as reducing the resource burden on society.

  5. Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models.

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    Tsai, Thomas C; Greaves, Felix; Zheng, Jie; Orav, E John; Zinner, Michael J; Jha, Ashish K

    2016-09-01

    US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9 percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care. Project HOPE—The People-to-People Health Foundation, Inc.

  6. [Continuity of hospital identifiers in hospital discharge data - Analysis of the nationwide German DRG Statistics from 2005 to 2013].

    Science.gov (United States)

    Nimptsch, Ulrike; Wengler, Annelene; Mansky, Thomas

    2016-11-01

    In Germany, nationwide hospital discharge data (DRG statistics provided by the research data centers of the Federal Statistical Office and the Statistical Offices of the 'Länder') are increasingly used as data source for health services research. Within this data hospitals can be separated via their hospital identifier ([Institutionskennzeichen] IK). However, this hospital identifier primarily designates the invoicing unit and is not necessarily equivalent to one hospital location. Aiming to investigate direction and extent of possible bias in hospital-level analyses this study examines the continuity of the hospital identifier within a cross-sectional and longitudinal approach and compares the results to official hospital census statistics. Within the DRG statistics from 2005 to 2013 the annual number of hospitals as classified by hospital identifiers was counted for each year of observation. The annual number of hospitals derived from DRG statistics was compared to the number of hospitals in the official census statistics 'Grunddaten der Krankenhäuser'. Subsequently, the temporal continuity of hospital identifiers in the DRG statistics was analyzed within cohorts of hospitals. Until 2013, the annual number of hospital identifiers in the DRG statistics fell by 175 (from 1,725 to 1,550). This decline affected only providers with small or medium case volume. The number of hospitals identified in the DRG statistics was lower than the number given in the census statistics (e.g., in 2013 1,550 IK vs. 1,668 hospitals in the census statistics). The longitudinal analyses revealed that the majority of hospital identifiers persisted in the years of observation, while one fifth of hospital identifiers changed. In cross-sectional studies of German hospital discharge data the separation of hospitals via the hospital identifier might lead to underestimating the number of hospitals and consequential overestimation of caseload per hospital. Discontinuities of hospital

  7. Drought episodes over Greece as simulated by dynamical and statistical downscaling approaches

    Science.gov (United States)

    Anagnostopoulou, Christina

    2017-07-01

    Drought over the Greek region is characterized by a strong seasonal cycle and large spatial variability. Dry spells longer than 10 consecutive days mainly characterize the duration and the intensity of Greek drought. Moreover, an increasing trend of the frequency of drought episodes has been observed, especially during the last 20 years of the 20th century. Moreover, the most recent regional circulation models (RCMs) present discrepancies compared to observed precipitation, while they are able to reproduce the main patterns of atmospheric circulation. In this study, both a statistical and a dynamical downscaling approach are used to quantify drought episodes over Greece by simulating the Standardized Precipitation Index (SPI) for different time steps (3, 6, and 12 months). A statistical downscaling technique based on artificial neural network is employed for the estimation of SPI over Greece, while this drought index is also estimated using the RCM precipitation for the time period of 1961-1990. Overall, it was found that the drought characteristics (intensity, duration, and spatial extent) were well reproduced by the regional climate models for long term drought indices (SPI12) while ANN simulations are better for the short-term drought indices (SPI3).

  8. Social deprivation, population dependency ratio and an extended hospital episode - Insights from acute medicine.

    Science.gov (United States)

    Cournane, Seán; Dalton, Ann; Byrne, Declan; Conway, Richard; O'Riordan, Deirdre; Coveney, Seamus; Silke, Bernard

    2015-11-01

    Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission; this study aimed to investigate the extent to which Deprivation status and the population Dependency Ratio influenced extended hospital episodes. All Emergency Medical admissions (75,018 episodes of 41,728 patients) over 12 years (2002-2013) categorized by quintile of Deprivation Index and Population Dependency Rates (proportion of non-working/working) were evaluated against length of stay (LOS). Patients with an Extended LOS (ELOS), >30 days, were investigated, by Deprivation status, Illness Severity and Co-morbidity status. Univariate and multi-variable risk estimates (Odds Rates or Incidence Rate Ratios) were calculated, using truncated Poisson regression. Hospital episodes with ELOS had a frequency of 11.5%; their median LOS (IQR) was 55.0 (38.8, 97.6) days utilizing 57.6% of all bed days by all 75,018 emergency medical admissions. The Deprivation Index independently predicted the rate of such ELOS admissions; these increased approximately five-fold (rate/1000 population) over the Deprivation Quintiles with model adjusted predicted admission rates of for Q1 0.93 (95% CI: 0.86, 0.99), Q22.63 (95% CI: 2.55, 2.71), Q3 3.84 (95% CI: 3.77, 3.91), Q4 3.42 (95% CI: 3.37, 3.48) and Q5 4.38 (95% CI: 4.22, 4.54). Similarly the Population Dependency Ratio Quintiles (dependent to working structure of the population by small area units) independently predicted extended LOS admissions. The admission of patients with an ELOS is strongly influenced by the Deprivation status and the population Dependency Ratio of the catchment area. These factors interact, with both high deprivation and Dependency cohorts having a major influence on the numbers of emergency medical admission patients with an extended hospital episode. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  9. Fulfilling the needs for statistical expertise at Aalborg Hospital

    DEFF Research Database (Denmark)

    Dethlefsen, Claus

    In 2005, the first statistician was employed at Aalborg Hospital due to expanding research activities as part of Aarhus University Hospital. Since then, there has been an increased demand for statistical expertise at all levels. In the talk, I will give an overview of the current staff...... of statisticians and the organisation. I will give examples from our statistical consultancy and illustrate some of the challenges that have led to research projects with heavy statistical involvement....

  10. Variation in payments for spine surgery episodes of care: implications for episode-based bundled payment.

    Science.gov (United States)

    Kahn, Elyne N; Ellimoottil, Chandy; Dupree, James M; Park, Paul; Ryan, Andrew M

    2018-05-25

    OBJECTIVE Spine surgery is expensive and marked by high variation across regions and providers. Bundled payments have potential to reduce unwarranted spending associated with spine surgery. This study is a cross-sectional analysis of commercial and Medicare claims data from January 2012 through March 2015 in the state of Michigan. The objective was to quantify variation in payments for spine surgery in adult patients, document sources of variation, and determine influence of patient-level, surgeon-level, and hospital-level factors. METHODS Hierarchical regression models were used to analyze contributions of patient-level covariates and influence of individual surgeons and hospitals. The primary outcome was price-standardized 90-day episode payments. Intraclass correlation coefficients-measures of variability accounted for by each level of a hierarchical model-were used to quantify sources of spending variation. RESULTS The authors analyzed 17,436 spine surgery episodes performed by 195 surgeons at 50 hospitals. Mean price-standardized 90-day episode payments in the highest spending quintile exceeded mean payments for episodes in the lowest cost quintile by $42,953 (p accounting for patient-level covariates, the remaining hospital-level and surgeon-level effects accounted for 2.0% (95% CI 1.1%-3.8%) and 4.0% (95% CI 2.9%-5.6%) of total variation, respectively. CONCLUSIONS Significant variation exists in total episode payments for spine surgery, driven mostly by variation in post-discharge and facility payments. Hospital and surgeon effects account for relatively little of the observed variation.

  11. Herbal medicine for hospitalized patients with severe depressive episode: a retrospective controlled study.

    Science.gov (United States)

    Liu, Lan-Ying; Feng, Bin; Chen, Jiong; Tan, Qing-Rong; Chen, Zheng-Xin; Chen, Wen-Song; Wang, Pei-Rong; Zhang, Zhang-Jin

    2015-01-01

    Herbal medicine is increasingly used in depressed patients. The purpose of this retrospective controlled study was to evaluate the efficacy and safety of herbal medicine treatment of severe depressive episode. A total of 146 severely depressed subjects were selected from patients who were admitted to the Department of Psychosomatics of Tongde Hospital at Hangzhou, China between 1st September 2009 and 30th November 2013. While all were medicated with psychotropic drugs, 78 received additional individualized herbal medicine. The severity of depressive symptoms was measured using 24-item Hamilton Rating Scale for Depression (HAMD-24) at admission and thereafter once weekly during hospital stay. The proportion of patients achieving clinical response and remission and incidence of adverse events were compared. The two groups had similar average length of hospital stay for approximately 28 days and were not different in the use of psychotropic medications. Survival analysis revealed that patients with herbal medicine had significantly higher chance of achieving clinical response [relative risk (RR)=2.179, Pherbal medicine. Patients with herbal medicine experienced remarkably fewer incidences of physical tiredness, headache, palpitation, dry mouth and constipation, but had a significantly higher incidence of digestive discomfort compared to patients without herbal medicine. These results indicate that additional treatment with individualized herbal medicine enhances antidepressant response and reduces certain side effects associated with psychotropic medications. Herbal medicine is an effective and relatively safe therapy for severe depressive episode (Trial Registration: ChiCTR-OCH-13003864). Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Incidence, treatment and recurrence of endometriosis in a UK-based population analysis using data from The Health Improvement Network and the Hospital Episode Statistics database.

    Science.gov (United States)

    Cea Soriano, Lucia; López-Garcia, Esther; Schulze-Rath, Renate; Garcia Rodríguez, Luis A

    2017-10-01

    This retrospective study used medical records from The Health Improvement Network (THIN) and Hospital Episode Statistics (HES) database to evaluate endometriosis (incidence, treatment and need for recurrent invasive procedures) in the general UK population. Women aged 12-54 years between January 2000 and December 2010, with a Read code for endometriosis, were identified in THIN. Cases were validated by manual review of free-text comments in medical records and responses to physician questionnaires. False-negative cases were identified among women with Read codes for hysterectomy or dysmenorrhea. Prescriptions of medical therapies for endometriosis were identified in THIN. Cases of single and recurrent invasive procedures were identified in women with medical records in both THIN and HES. Overall, 5087 women had a Read code for endometriosis, corresponding to an incidence of 1.02 (95% confidence interval [CI]: 0.99-1.05) per 1000 person-years. After case validation, the estimate was 1.46 (95% CI: 1.43-1.50) per 1000 person-years. Medical therapy was prescribed to 55.5% of women with endometriosis in the first year after diagnosis. In total, 48.3% of women received invasive treatment during the study period; approximately one-fifth of these women required further invasive treatment, mainly in the 3 years after the index procedure. Using Read codes as the only method to identify women with endometriosis underestimates incidence. Over half of women with recorded endometriosis are prescribed medical therapy in the first year after diagnosis. Women with diagnosed endometriosis are at risk of requiring recurrent invasive procedures.

  13. Recovery from episodes during the course of affective disorder

    DEFF Research Database (Denmark)

    Kessing, L V; Mortensen, P B

    1999-01-01

    OBJECTIVE: The aim of the study was to investigate whether the duration of treated episodes changes during the course of unipolar and bipolar affective disorder. METHOD: The rate of recovery from successive hospitalized episodes was estimated with survival analyses in a case-register study...... including all hospital admissions with primary affective disorder in Denmark during the period 1971-1993. RESULTS: A total of 9174 patients with recurrent episodes were followed from their first admission. The rate of recovery from hospitalized episodes did not change with the number of episodes in unipolar...... or bipolar disorder. Furthermore, the rate of recovery was constant across episodes, regardless of the combination of age, gender and type of disorder. Initially in the course of the illness, the rate was a little faster for bipolar than for unipolar patients, but later in the course of the illness the rate...

  14. Order-specific fertility estimates based on perinatal statistics and statistics on out-of-hospital births

    OpenAIRE

    Kreyenfeld, Michaela; Peters, Frederik; Scholz, Rembrandt; Wlosnewski, Ines

    2014-01-01

    Until 2008, German vital statistics has not provided information on biological birth order. We have tried to close part of this gap by providing order-specific fertility rates generated from Perinatal Statistics and statistics on out-of-hospital births for the period 2001-2008. This investigation has been published in Comparative Population Studies (CPoS) (see Kreyenfeld, Scholz, Peters and Wlosnewski 2010). The CPoS-paper describes how data from the Perinatal Statistics and statistics on out...

  15. Impact of PCA Strategies on Pain Intensity and Functional Assessment Measures in Adults with Sickle Cell Disease during Hospitalized Vaso-Occlusive Episodes

    Science.gov (United States)

    Dampier, Carlton D.; Wager, Carrie G.; Harrison, Ryan; Hsu, Lewis L.; Minniti, Caterina P.; Smith, Wally R.

    2012-01-01

    Clinical trials of sickle cell disease (SCD) pain treatment usually observe only small decrements in pain intensity during the course of hospitalization. Sub-optimal analgesic management and inadequate pain assessment methods are possible explanations for these findings. In a search for better methods for assessing inpatient SCD pain in adults, we examined several pain intensity and interference measures in both arms of a randomized controlled trial comparing two different opioid PCA therapies. Based upon longitudinal analysis of pain episodes, we found that scores from daily average Visual Analogue Scales (VAS) and several other measures, especially the Brief Pain Inventory (BPI), were sensitive to change in daily improvements in pain intensity associated with resolution of vaso-occlusive pain. In this preliminary trial, the low demand, high basal infusion (LDHI) strategy demonstrated faster, larger improvements in various measures of pain than the high demand, low basal infusion (HDLI) strategy for opioid PCA dosing, however, verification in larger studies is required. The measures and statistical approaches used in this analysis may facilitate design, reduce sample size, and improve analyses of treatment response in future SCD clinical trials of vaso-occlusive episodes. PMID:22886853

  16. Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer.

    Directory of Open Access Journals (Sweden)

    Tjibbe Donker

    Full Text Available Hospital-acquired infections (HAI are often seen as preventable incidents that result from unsafe practices or poor hospital hygiene. This however ignores the fact that transmissibility is not only a property of the causative organisms but also of the hosts who can translocate bacteria when moving between hospitals. In an epidemiological sense, hospitals become connected through the patients they share. We here postulate that the degree of hospital connectedness crucially influences the rates of infections caused by hospital-acquired bacteria. To test this hypothesis, we mapped the movement of patients based on the UK-NHS Hospital Episode Statistics and observed that the proportion of patients admitted to a hospital after a recent episode in another hospital correlates with the hospital-specific incidence rate of MRSA bacteraemia as recorded by mandatory reporting. We observed a positive correlation between hospital connectedness and MRSA bacteraemia incidence rate that is significant for all financial years since 2001 except for 2008-09. All years combined, this correlation is positive and significantly different from zero (partial correlation coefficient r = 0.33 (0.28 to 0.38. When comparing the referral pattern for English hospitals with referral patterns observed in the Netherlands, we predict that English hospitals more likely see a swifter and more sustained spread of HAIs. Our results indicate that hospitals cannot be viewed as individual units but rather should be viewed as connected elements of larger modular networks. Our findings stress the importance of cooperative effects that will have a bearing on the planning of health care systems, patient management and hospital infection control.

  17. Supporting statistics in the workplace: experiences with two hospitals

    Directory of Open Access Journals (Sweden)

    M. Y. Mortlock

    2003-01-01

    Full Text Available This paper provides some reflections on the promotion of lifelong learning in statistics in the workplace. The initiative from which the reflections are drawn is a collaboration between a university and two public hospitals, of which one of the stated aims is to develop statistical skills among the hospitals' researchers. This is realized in the provision of ‘biostatistical clinics’ in which workplace teaching and learning of statistics takes place in one-on-one or small group situations. The central issue that is identified is the need to accommodate diversity: in backgrounds, motivations and learning needs of workplace learners (in this case medical researchers, in the workplace environments themselves and in the projects encountered. Operational issues for the statistician in providing such training are addressed. These considerations may reflect the experiences of the wider community of statisticians involved in service provision within a larger organization.

  18. [Effects of long-term fluoride in drinking water on risks of hip fracture of the elderly: an ecologic study based on database of hospitalization episodes].

    Science.gov (United States)

    Park, Eun Young; Hwang, Seung Sik; Kim, Jai Yong; Cho, Soo Hun

    2008-05-01

    Fluoridation of drinking water is known to decrease dental caries, particularly in children. However, the effects of fluoridated water on bone over several decades are still in controversy. To assess the risk of hip fracture related to water fluoridation, we evaluated the hip fracture-related hospitalizations of the elderly between a fluoridated city and non-fluoridated cities in Korea. Cheongju as a fluoridated area and Chungju, Chuncheon, Suwon, Wonju as non-fluoridated areas were chosen for the study. We established a database of hip fracture hospitalization episode based on the claims data submitted to the Health Insurance Review Agency from January 1995 to December 2002. The hip fracture hospitalization episodes that satisfied the conditions were those that occurred in patients over 65 years old, the injuries had a hip fracture code (ICD-9 820, ICD-10 S72) and the patients were hospitalized for at least 7days. A total of 80,558 cases of hip fracture hospitalization episodes were analyzed. The admission rates for hip fracture increased with the age of the men and women in both a fluoridated city and the non-fluoridated cities (phip fracture increased significantly both for men and women as their age increased. However, any difference in the hip fracture admission rates was not consistently observed between the fluoridated city and the nonfluoridated cities. We cannot conclude that fluoridation of drinking water increases the risk of hip fracture in the elderly.

  19. Using statistical process control for monitoring the prevalence of hospital-acquired pressure ulcers.

    Science.gov (United States)

    Kottner, Jan; Halfens, Ruud

    2010-05-01

    Institutionally acquired pressure ulcers are used as outcome indicators to assess the quality of pressure ulcer prevention programs. Determining whether quality improvement projects that aim to decrease the proportions of institutionally acquired pressure ulcers lead to real changes in clinical practice depends on the measurement method and statistical analysis used. To examine whether nosocomial pressure ulcer prevalence rates in hospitals in the Netherlands changed, a secondary data analysis using different statistical approaches was conducted of annual (1998-2008) nationwide nursing-sensitive health problem prevalence studies in the Netherlands. Institutions that participated regularly in all survey years were identified. Risk-adjusted nosocomial pressure ulcers prevalence rates, grade 2 to 4 (European Pressure Ulcer Advisory Panel system) were calculated per year and hospital. Descriptive statistics, chi-square trend tests, and P charts based on statistical process control (SPC) were applied and compared. Six of the 905 healthcare institutions participated in every survey year and 11,444 patients in these six hospitals were identified as being at risk for pressure ulcers. Prevalence rates per year ranged from 0.05 to 0.22. Chi-square trend tests revealed statistically significant downward trends in four hospitals but based on SPC methods, prevalence rates of five hospitals varied by chance only. Results of chi-square trend tests and SPC methods were not comparable, making it impossible to decide which approach is more appropriate. P charts provide more valuable information than single P values and are more helpful for monitoring institutional performance. Empirical evidence about the decrease of nosocomial pressure ulcer prevalence rates in the Netherlands is contradictory and limited.

  20. Frequency, duration and predictors of bronchiolitis episodes of care among infants ≥32 weeks gestation in a large integrated healthcare system: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Flaherman Valerie J

    2012-06-01

    Full Text Available Abstract Background Bronchiolitis is common in the first two years of life and is the most frequent cause of hospitalization in this age group. No previous studies have used an episode-of-care analysis to describe the frequency, duration, and predictors of bronchiolitis episodes of care during the first two years. Methods We conducted a retrospective cohort study of 123,264 infants ≥32 weeks gestation born at 6 Northern California Kaiser Permanente hospitals between 1996 and 2002. We used electronic medical records to concatenate hospital, emergency department and outpatient health care encounters for bronchiolitis into discrete episodes of care. We used descriptive statistics to report frequency and duration of bronchiolitis episodes and used logistic regression to assess the effect of gestational age and other clinical and demographic predictors on the outcome of bronchiolitis episodes. Results Among all infants, the rate of bronchiolitis episodes was 162 per 1000 children during the first 2 years of life; approximately 40% required >1 day of medical attention with a mean duration of 7.0 ± 5.9 days. Prematurity was associated with increased risk of bronchiolitis episodes and longer duration. Bronchiolitis episodes rates per 1000 infants were 246 for 32–33 weeks gestational age, 204 for 34–36 weeks, and 148–178 for >36 weeks. Male gender, African-American and Hispanic race/ethnicity, and parental history of asthma were associated with an increased risk of having a bronchiolitis episode and/or longer duration. Conclusions Bronchiolitis episodes of care are frequent during the first two years of life and the duration ranges from 1 to 27 days. Prematurity was associated with more frequent and longer duration of bronchiolitis episodes of care, which may reflect illness severity and/or perceived vulnerability.

  1. Intermittent or daily montelukast versus placebo for episodic asthma in children.

    Science.gov (United States)

    Valovirta, Erkka; Boza, Maria L; Robertson, Colin F; Verbruggen, Nadia; Smugar, Steven S; Nelsen, Linda M; Knorr, Barbara A; Reiss, Theodore F; Philip, George; Gurner, Deborah M

    2011-06-01

    No standard, optimal treatment exists for severe intermittent (ie, episodic) asthma in children. However, evidence suggests that both daily and episode-driven montelukast are effective for this phenotype. To assess the regimen-related efficacy of montelukast in treating pediatric episodic asthma. A multicenter, randomized, double-blind, double-dummy, parallel-group, 52-week study was performed in children 6 months to 5 years of age comparing placebo with two regimens of montelukast 4 mg: (1) daily; or (2) episode-driven for 12 days beginning with signs/symptoms consistent with imminent cold or breathing problem. The main outcome measure was the number of asthma episodes (symptoms requiring treatment) culminating in an asthma attack (symptoms requiring physician visit, emergency room visit, corticosteroids, or hospitalization). Five hundred eighty-nine patients were randomized to daily montelukast, 591 to intermittent montelukast, and 591 to placebo. Compared with placebo, no significant difference was seen between daily montelukast (P = .510) or intermittent montelukast (P = .884) in the number of asthma episodes culminating in an asthma attack over 1 year. Daily montelukast reduced symptoms over the 12-day treatment period of asthma episodes compared with placebo (P = .045). Beta-agonist use was reduced with both daily (P = .048) and intermittent montelukast (P = .028) compared with placebo. However, because of prespecified rules for multiplicity adjustments (requiring a positive primary endpoint), statistical significance for secondary endpoints cannot be concluded. All treatments were well tolerated. Montelukast did not reduce the number of asthma episodes culminating in an asthma attack over 1 year in children 6 months to 5 years of age, although numerical improvements occurred in some endpoints. Copyright © 2011 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  2. Episodic payments (bundling): PART I.

    Science.gov (United States)

    Jacofsky, D J

    2017-10-01

    Episodic, or bundled payments, is a concept now familiar to most in the healthcare arena, but the models are often misunderstood. Under a traditional fee-for-service model, each provider bills separately for their services which creates financial incentives to maximise volumes. Under a bundled payment, a single entity, often referred to as a convener (maybe the hospital, the physician group, or a third party) assumes the risk through a payer contract for all services provided within a defined episode of care, and receives a single (bundled) payment for all services provided for that episode. The time frame around the intervention is variable, but defined in advance, as are included and excluded costs. Timing of the actual payment in a bundle may either be before the episode occurs (prospective payment model), or after the end of the episode through a reconciliation (retrospective payment model). In either case, the defined costs over the defined time frame are borne by the convener. Cite this article: Bone Joint J 2017;99-B:1280-5. ©2017 The British Editorial Society of Bone & Joint Surgery.

  3. Linkage of Maternity Hospital Episode Statistics data to birth registration and notification records for births in England 2005-2014: Quality assurance of linkage of routine data for singleton and multiple births.

    Science.gov (United States)

    Harper, Gillian

    2018-03-01

    To quality assure a Trusted Third Party linked data set to prepare it for analysis. Birth registration and notification records from the Office for National Statistics for all births in England 2005-2014 linked to Maternity Hospital Episode Statistics (HES) delivery records by NHS Digital using mothers' identifiers. All 6 676 912 births that occurred in England from 1 January 2005 to 31 December 2014. Every link between a registered birth and an HES delivery record for the study period was categorised as either the same baby or a different baby to the same mother, or as a wrong link, by comparing common baby data items and valid values in key fields with stepwise deterministic rules. Rates of preserved and discarded links were calculated and which features were more common in each group were assessed. Ninety-eight per cent of births originally linked to HES were left with one preserved link. The majority of discarded links were due to duplicate HES delivery records. Of the 4854 discarded links categorised as wrong links, clerical checks found 85% were false-positives links, 13% were quality assurance false negatives and 2% were undeterminable. Births linked using a less reliable stage of the linkage algorithm, births at home and in the London region, and with birth weight or gestational age values missing in HES were more likely to have all links discarded. Linkage error, data quality issues, and false negatives in the quality assurance procedure were uncovered. The procedure could be improved by allowing for transposition in date fields, and more discrimination between missing and differing values. The availability of identifiers in the datasets supported clerical checking. Other research using Trusted Third Party linkage should not assume the linked dataset is error-free or optimised for their analysis, and allow sufficient resources for this. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved

  4. Substance abuse and gender differences in first episode psychosis: Impact on hospital readmissions.

    Science.gov (United States)

    Crosas, Josep M; Cobo, Jesus; Ahuir, Maribel; Hernández, Carla; García, Rebeca; Pousa, Esther; Oliva, Joan-Carles; Monreal, José-Antonio; Palao, Diego J

    There have been controversial results in the study of gender differences in first episode psychosis (FEP). Substance abuse is the main existing comorbidity in FEP, and has been associated with worse prognosis and greater symptom severity. To explore gender differences in FEP in relation to drug abuse, and their relationship with hospital readmissions. Descriptive and prospective study (18 months). We included 141 patients (31.2% women), aged 26.1 years on average, mostly diagnosed with schizophreniform disorder (32.6%). A percentage of 58.9 had problematic use of drugs. Gender significant differences were found in age of onset, age at entry to the programme, marital status and cohabitation, and percentage differences were revealed in current drug abuse and frequency of consumption. Gender, duration of untreated psychosis, psychiatric history, age of onset and previous drug use were not predictors of re-entry. Hospital readmission rate was 24.8%, with no gender differences. The most common reasons for admission were abandonment of treatment (66.7%) and drug abuse (44.4%). Drug abuse was higher in the men than in the women as a reason for re-admission. There are gender differences in FEP. Men have an earlier onset of symptoms and have worse functional outcomes. Drug abuse in men is higher and represents a major cause of hospital readmission. Therapeutic interventions to prevent the effects of drug abuse are necessary from the early stages of the illness. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Familial Hemiplegic Migraine and Recurrent Episodes of Psychosis

    DEFF Research Database (Denmark)

    LaBianca, Sonja; Jensen, Rigmor; van den Maagdenberg, Arn M J M

    2015-01-01

    Familial hemiplegic migraine (FHM) is a rare autosomal dominant form of migraine with motor aura. We present a case report of a father and son with very similar attacks of hemiplegic migraine and recurrent episodes of accompanying psychoses. Previously, such episodes led to hospitalization...... and extended clinical examinations, which further worsened the psychoses. Since the episodes were recognized as related to the hemiplegic migraine, a treatment strategy combining sleep and sedation was initiated and progression onto psychosis was almost completely avoided in both father and son. Genetic...

  6. Electroconvulsive therapy in single manic episodes: a case series ...

    African Journals Online (AJOL)

    Objective: To evaluate the effectiveness of electroconvulsive therapy in the treatment of Bipolar I Disorder patients with a single manic episode. Method: In a retrospective study, we reviewed medical records of inpatients who had been admitted to treat a single manic episode of Bipolar I Disorder at Noor University Hospital, ...

  7. Linkage of Maternity Hospital Episode Statistics data to birth registration and notification records for births in England 2005–2014: Quality assurance of linkage of routine data for singleton and multiple births

    Science.gov (United States)

    2018-01-01

    Objectives To quality assure a Trusted Third Party linked data set to prepare it for analysis. Setting Birth registration and notification records from the Office for National Statistics for all births in England 2005–2014 linked to Maternity Hospital Episode Statistics (HES) delivery records by NHS Digital using mothers’ identifiers. Participants All 6 676 912 births that occurred in England from 1 January 2005 to 31 December 2014. Primary and secondary outcome measures Every link between a registered birth and an HES delivery record for the study period was categorised as either the same baby or a different baby to the same mother, or as a wrong link, by comparing common baby data items and valid values in key fields with stepwise deterministic rules. Rates of preserved and discarded links were calculated and which features were more common in each group were assessed. Results Ninety-eight per cent of births originally linked to HES were left with one preserved link. The majority of discarded links were due to duplicate HES delivery records. Of the 4854 discarded links categorised as wrong links, clerical checks found 85% were false-positives links, 13% were quality assurance false negatives and 2% were undeterminable. Births linked using a less reliable stage of the linkage algorithm, births at home and in the London region, and with birth weight or gestational age values missing in HES were more likely to have all links discarded. Conclusions Linkage error, data quality issues, and false negatives in the quality assurance procedure were uncovered. The procedure could be improved by allowing for transposition in date fields, and more discrimination between missing and differing values. The availability of identifiers in the datasets supported clerical checking. Other research using Trusted Third Party linkage should not assume the linked dataset is error-free or optimised for their analysis, and allow sufficient resources for this. PMID:29500200

  8. Open radical cystectomy in England: the current standard of care - an analysis of the British Association of Urological Surgeons (BAUS) cystectomy audit and Hospital Episodes Statistics (HES) data.

    Science.gov (United States)

    Jefferies, Edward R; Cresswell, Joanne; McGrath, John S; Miller, Catherine; Hounsome, Luke; Fowler, Sarah; Rowe, Edward W

    2018-01-23

    To establish the current standard for open radical cystectomy (ORC) in England, as data entry by surgeons performing RC to the British Association of Urological Surgeons (BAUS) database was mandated in 2013 and combining this with Hospital Episodes Statistics (HES) data has allowed comprehensive outcome analysis for the first time. All patients were included in this analysis if they were uploaded to the BAUS data registry and reported to have been performed in the 2 years between 1 January 2014 and 31 December 2015 in England (from mandate onwards) and had been documented as being performed in an open fashion (not laparoscopic, robot assisted or the technique field left blank). The HES data were accessed via the HES website. Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures version 4 (OPCS-4) Code M34 was searched during the same 2-year time frame (not including M34.4 for simple cystectomy or with additional minimal access codes Y75.1-9 documenting a laparoscopic or robotic approach was used) to assess data capture. A total of 2 537 ORCs were recorded in the BAUS registry and 3 043 in the HES data. This indicates a capture rate of 83.4% of all cases. The median operative time was 5 h, harvesting a median of 11-20 lymph nodes, with a median blood loss of 500-1 000 mL, and a transfusion rate of 21.8%. The median length of stay was 11 days, with a 30-day mortality rate of 1.58%. This is the largest, contemporary cohort of ORCs in England, encompassing >80% of all performed operations. We now know the current standard for ORC in England. This provides the basis for individual surgeons and units to compare their outcomes and a standard with which future techniques and modifications can be compared. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

  9. A pilot study: the effect of healing touch on anxiety, stress, pain, pain medication usage, and physiological measures in hospitalized sickle cell disease adults experiencing a vaso-occlusive pain episode.

    Science.gov (United States)

    Thomas, Linda S; Stephenson, Nancy; Swanson, Mel; Jesse, D Elizabeth; Brown, Sylvia

    2013-12-01

    This pilot study was conducted to determine the effectiveness of Healing Touch on anxiety, stress, pain, pain medication usage, and selected physiological measures of hospitalized adults with sickle cell disease experiencing a vaso-occlusive pain episode. Healing Touch sessions were administered for 30 minutes on four consecutive days, and the self-reported data on anxiety, stress, pain, and the selected physiological data were collected while controlling for music and presence. A parallel-group randomized control trial comparing the effects of Healing Touch with Music (HTM) to Attention Control with Music (ACM). Due to the small sample size, there were no statistically significant changes in any between-group comparisons, except for present pain on Day 4 for the ACM group. For both groups, the within-group comparison showed a nonsignificant reduction in physiological parameters, a statistically significant reduction in anxiety and stress for the ACM group after Day 4, and a statistically significant reduction in stress in the HTM group after Days 2 and 4. The pre- to postintervention reductions in present pain were greater in the HTM group across all 4 days, but the only statistically significant within groups findings were in the HTM group (p < .01) on Day 1. Further research is needed.

  10. The Burden of Repeated Mood Episodes in Bipolar I Disorder: Results From the National Epidemiological Survey on Alcohol and Related Conditions.

    Science.gov (United States)

    Peters, Amy T; West, Amy E; Eisner, Lori; Baek, Jihyun; Deckersbach, Thilo

    2016-02-01

    The aim of this study was to examine the association between previous mood episodes and clinical course/functioning in a community sample (National Epidemiological Survey on Alcohol and Related Conditions [NESARC]). Subjects (n = 909) met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for bipolar I disorder and provided data on number of previous episode recurrences. Number of previous mood episodes was used to predict outcomes at wave 1 and wave 2 of the NESARC. Previous mood episodes accounted for small but unique variance in outcomes. Recurrence was associated with poorer functioning, psychiatric and medical comorbidity, and increased odds of suicidality, disability, unemployment, and hospitalization at wave 1. Recurrences were associated with greater risk for new onset suicidality, psychiatric comorbidity, disability, unemployment, and poor functioning by wave 2. The course of bipolar disorder does worsen with progressive mood episodes but is attenuated in community, relative to clinical samples. Interventions to prevent future relapse may be particularly important to implement early in the course of illness.

  11. The McLean-Harvard First-Episode Project: Early Course in 114 Cases of First-Episode Nonaffective Psychoses.

    Science.gov (United States)

    Tohen, Mauricio; Khalsa, Hari-Mandir K; Salvatore, Paola; Zarate, Carlos A; Strakowski, Stephen M; Sanchez-Toledo, Jesús Pérez; Baldessarini, Ross J

    2016-06-01

    Early course in contemporary, clinically treated, nonaffective psychotic disorders other than schizophrenia remains incompletely defined. We prospectively, repeatedly, and systematically assessed 114 patients hospitalized for a first episode of DSM-IV-TR nonaffective psychotic illness for ≥ 2 years (1989-1996) using structured (Structured Clinical Interview for DSM-III-R, Patient Edition; Clinical Global Impressions scale; Scale for the Assessment of Negative Symptoms; Scale for the Assessment of Positive Symptoms; and the expanded version of the Brief Psychiatric Rating Scale) and unstructured (best-estimate procedure, life charting) naturalistic follow-up procedures and survival analysis. Duration of untreated psychosis (22 ± 38 months) was longest with schizophrenia. Within 2 years, syndromal remission sustained for ≥ 8 weeks (recovery) was attained by 75 subjects (65.8%); median latency to syndromal recovery was 9.4 (95% CI, 5.7-13.3) weeks and was shorter with cycloid features, initial diagnosis of brief psychosis or schizophreniform disorder, and shorter initial hospitalization. Functional recovery within 2 years was achieved by 28 of 68 subjects (41.2%), more often without initial mood-psychomotor instability or homicidal ideation. New episodes occurred in 52 of 114 subjects (45.6%) and were more likely with less affective flattening, younger age, and white race. Median time to new episodes (43.7 [27.9-70.6] weeks) was earlier with initial first-rank auditory hallucinations, substance abuse, and functional nonrecovery. Diagnosis changed to other nonaffective, schizoaffective, or affective disorders within 2 years in 62 of 108 cases (57.4%). Three-quarters of patients presenting in first lifetime, nonaffective psychotic episodes achieved recovery within 2 years, but only 41% returned to baseline functioning, and nearly half experienced new episodes. Patients with schizophrenia had the longest duration of untreated psychosis. A majority changed diagnosis

  12. Potentially avoidable hospitalizations in five European countries in 2009 and time trends from 2002 to 2009 based on administrative data

    DEFF Research Database (Denmark)

    Thygesen, Lau C; Christiansen, Terkel; Garcia-Armesto, Sandra

    2015-01-01

    INTRODUCTION: Potentially avoidable hospitalizations in chronic conditions are used to evaluate health-care performance. However, evidence comparing different countries at small geographical areas is still scarce. The aim of the present study is to describe and discuss differences in rates and time......-trends across health-care areas from five European countries. METHODS: Observational, ecological study, on virtually all discharges produced in five European countries between 2002 and 2009. Potentially avoidable hospitalizations were operationally defined as a joint indicator composed of six chronic conditions....... Episodes flagged as potentially avoidable were allocated to 913 geographical health-care areas. Age-sex standardized rates and standardized hospitalization ratios, as well as several statistics of variation, were estimated. RESULTS: Four hundred sixty-two thousand seven hundred and ninety-two episodes were...

  13. The Statistical Analysis of the Consumer Attitudes toward the Hospitality Services from Romania

    OpenAIRE

    Vasilescu Ramona; Saierli Olivia

    2010-01-01

    In this paper, we have statistical analyze the consumer attitudes toward the hospitality services from Romania. We have developed a questionnaire which was answered by 83 people. Based on these responses we have made a top of the hospitality services in terms of respondent. Then, we applied the Helmert univariante test to show that these results can be generalized. Also, we asked respondents to give a note for each service of hospitality from our country (for the past two years). We calculate...

  14. Variation in Bariatric Surgery Episode Costs in the Commercially Insured: Implications for Bundled Payments in the Private Sector.

    Science.gov (United States)

    Kelsall, Alexander C; Cassidy, Ruth; Ghaferi, Amir A

    2017-08-01

    To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan. Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally. We used data from a state-wide quality collaborative to calculate the average risk and price-adjusted 30-day episode payment for patients undergoing RYGB and SG procedures at Michigan hospitals between January 2009 and October 2014. We organized hospitals into quintiles and compared the variation in payments between highest and lowest-cost quintiles, and also the payment categories that drove this variation. We identified 9035 patients undergoing RYGB (n = 4194) or SG (n = 4841) procedures at 31 hospitals. The average price and risk-adjusted episode payment ranged from $11,874 in the lowest hospital quintile to $13,394 in the highest quintile, representing a difference of $1519 (12.8%). Payments for the index hospitalization accounted for the largest share of total episode costs for both procedure types. Despite representing 2.7% to 6.0% of payments across quintiles, postdischarge payments explained 22.6% of hospital variation in SG. Similarly, readmissions explained 24.5% of payment variation for SG episodes, despite representing between 1.2% and 4.4% of payments. Collectively, our findings suggest that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. SG may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and postdischarge payments, components of episode payment more

  15. Smog episodes, fine particulate pollution and mortality in China.

    Science.gov (United States)

    Zhou, Maigeng; He, Guojun; Fan, Maoyong; Wang, Zhaoxi; Liu, Yang; Ma, Jing; Ma, Zongwei; Liu, Jiangmei; Liu, Yunning; Wang, Linhong; Liu, Yuanli

    2015-01-01

    Starting from early January 2013, northern China was hit by multiple prolonged and severe smog events which were characterized by extremely high-level concentrations of ambient fine particulate matter (PM2.5) with hourly peaks of PM2.5 over 800 µg/m(3). However, the consequences of this severe air pollution are largely unknown. This study investigates the acute effect of the smog episodes and PM2.5 on mortality for both urban and rural areas in northern China. We collected PM2.5, mortality, and meteorological data for 5 urban city districts and 2 rural counties in Beijing, Tianjin and Hebei Province of China from January 1, 2013 through December 31, 2013. We employed the generalized additive models to estimate the associations between smog episodes or PM2.5 and daily mortality for each district/county. Without any meteorological control, the smog episodes are positively and statistically significantly associated with mortality in 5 out of 7 districts/counties. However, the findings are sensitive to the meteorological factors. After controlling for temperature, humidity, dew point and wind, the statistical significance disappears in all urban districts. In contrast, the smog episodes are consistently and statistically significantly associated with higher total mortality and mortality from cardiovascular/respiratory diseases in the two rural counties. In Ji County, a smog episode is associated with 6.94% (95% Confidence Interval, -0.20 to 14.58) increase in overall mortality, and in Ci County it is associated with a 19.26% (95% CI, 6.66-33.34) increase in overall mortality. The smog episodes kill people primarily through its impact on cardiovascular and respiratory diseases. On average, a smog episode is associated with 11.66% (95% CI, 3.12-20.90) increase in cardiovascular and respiratory mortality in Ji County, and it is associated with a 22.23% (95% CI, 8.11-38.20) increase in cardiovascular and respiratory mortality in Ci County. A 10 μg/m(3) increase in PM2

  16. Differences in hospital casemix, and the relationship between casemix and hospital costs.

    Science.gov (United States)

    Söderlund, N; Milne, R; Gray, A; Raftery, J

    1995-03-01

    The aim of the study was to examine the relationship between hospital costs and casemix, and after adjustment for casemix differences, between cost and institutional size, number of specialties, occupancy and teaching status. A retrospective analysis of all admissions to nine acute-care NHS hospitals in the Oxford region during the 1991-1992 financial year was undertaken. All episodes were assigned to a diagnosis-related group (DRG) and a cost weight assigned accordingly. Costs per finished consultant episode, before and after adjustment for casemix differences, were analysed at the hospital and specialty level. Casemix differences were significant, and accounted for approximately 77 per cent of the difference in costs between providers. Costs per casemix-adjusted episode were not significantly associated with differences in hospital size, scope, occupancy levels or teaching status, but sample size was insufficient to investigate these relationships adequately. Specialty costs were poorly correlated with specialty casemix. This was probably due to poor apportionment of specialty costs in hospital accounting returns. Casemix differences need to be taken into account when comparing providers for the purposes of contracting, as unadjusted unit costs may be misleading. Although the methods used may currently be applied to most NHS hospitals, widespread use would be greatly facilitated by the development of indigenous cost weights and better routine hospital data coding and collection.

  17. Phonetic measures of reduced tongue movement correlate with negative symptom severity in hospitalized patients with first-episode schizophrenia-spectrum disorders.

    Science.gov (United States)

    Covington, Michael A; Lunden, S L Anya; Cristofaro, Sarah L; Wan, Claire Ramsay; Bailey, C Thomas; Broussard, Beth; Fogarty, Robert; Johnson, Stephanie; Zhang, Shayi; Compton, Michael T

    2012-12-01

    Aprosody, or flattened speech intonation, is a recognized negative symptom of schizophrenia, though it has rarely been studied from a linguistic/phonological perspective. To bring the latest advances in computational linguistics to the phenomenology of schizophrenia and related psychotic disorders, a clinical first-episode psychosis research team joined with a phonetics/computational linguistics team to conduct a preliminary, proof-of-concept study. Video recordings from a semi-structured clinical research interview were available from 47 first-episode psychosis patients. Audio tracks of the video recordings were extracted, and after review of quality, 25 recordings were available for phonetic analysis. These files were de-noised and a trained phonologist extracted a 1-minute sample of each patient's speech. WaveSurfer 1.8.5 was used to create, from each speech sample, a file of formant values (F0, F1, F2, where F0 is the fundamental frequency and F1 and F2 are resonance bands indicating the moment-by-moment shape of the oral cavity). Variability in these phonetic indices was correlated with severity of Positive and Negative Syndrome Scale negative symptom scores using Pearson correlations. A measure of variability of tongue front-to-back position-the standard deviation of F2-was statistically significantly correlated with the severity of negative symptoms (r=-0.446, p=0.03). This study demonstrates a statistically significant and meaningful correlation between negative symptom severity and phonetically measured reductions in tongue movements during speech in a sample of first-episode patients just initiating treatment. Further studies of negative symptoms, applying computational linguistics methods, are warranted. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Inter-regional competition and quality in hospital care.

    Science.gov (United States)

    Aiura, Hiroshi

    2013-06-01

    This study analyzes the effect of episode-of-care payment and patient choice on waiting time and the comprehensive quality of hospital care. The study assumes that two hospitals are located in two cities with different population sizes and compete with each other. We find that the comprehensive quality of hospital care as well as waiting time of both hospitals improve with an increase in payment per episode of care. However, we also find that the extent of these improvements differs according to the population size of the cities where the hospitals are located. Under the realistic assumptions that hospitals involve significant labor-intensive work, we find the improvements in comprehensive quality and waiting time in a hospital located in a small city to be greater than those in a hospital located in a large city. The result implies that regional disparity in the quality of hospital care decreases with an increase in payment per episode of care.

  19. The German Birth Order Register - order-specific data generated from perinatal statistics and statistics on out-of-hospital births 2001-2008

    OpenAIRE

    Michaela Kreyenfeld; Rembrandt D. Scholz; Frederik Peters; Ines Wlosnewski

    2010-01-01

    Until 2008, Germany’s vital statistics did not include information on the biological order of each birth. This resulted in a dearth of important demographic indicators, such as the mean age at first birth and the level of childlessness. Researchers have tried to fill this gap by generating order-specific birth rates from survey data, and by combining survey data with vital statistics. This paper takes a different approach by using hospital statistics on births to generate birth order-specific...

  20. Reliability of hospital cost profiles in inpatient surgery.

    Science.gov (United States)

    Grenda, Tyler R; Krell, Robert W; Dimick, Justin B

    2016-02-01

    With increased policy emphasis on shifting risk from payers to providers through mechanisms such as bundled payments and accountable care organizations, hospitals are increasingly in need of metrics to understand their costs relative to peers. However, it is unclear whether Medicare payments for surgery can reliably compare hospital costs. We used national Medicare data to assess patients undergoing colectomy, pancreatectomy, and open incisional hernia repair from 2009 to 2010 (n = 339,882 patients). We first calculated risk-adjusted hospital total episode payments for each procedure. We then used hierarchical modeling techniques to estimate the reliability of total episode payments for each procedure and explored the impact of hospital caseload on payment reliability. Finally, we quantified the number of hospitals meeting published reliability benchmarks. Mean risk-adjusted total episode payments ranged from $13,262 (standard deviation [SD] $14,523) for incisional hernia repair to $25,055 (SD $22,549) for pancreatectomy. The reliability of hospital episode payments varied widely across procedures and depended on sample size. For example, mean episode payment reliability for colectomy (mean caseload, 157) was 0.80 (SD 0.18), whereas for pancreatectomy (mean caseload, 13) the mean reliability was 0.45 (SD 0.27). Many hospitals met published reliability benchmarks for each procedure. For example, 90% of hospitals met reliability benchmarks for colectomy, 40% for pancreatectomy, and 66% for incisional hernia repair. Episode payments for inpatient surgery are a reliable measure of hospital costs for commonly performed procedures, but are less reliable for lower volume operations. These findings suggest that hospital cost profiles based on Medicare claims data may be used to benchmark efficiency, especially for more common procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Depression screening in stroke: a comparison of alternative measures with the structured diagnostic interview for the diagnostic and statistical manual of mental disorders, fourth edition (major depressive episode) as criterion standard.

    Science.gov (United States)

    Turner, Alyna; Hambridge, John; White, Jennifer; Carter, Gregory; Clover, Kerrie; Nelson, Louise; Hackett, Maree

    2012-04-01

    Screening tools for depression and psychological distress commonly used in medical settings have not been well validated in stroke populations. We aimed to determine the accuracy of common screening tools for depression or distress in detecting caseness for a major depressive episode compared with a clinician-administered structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition as the gold standard. Seventy-two participants ≥3 weeks poststroke underwent a diagnostic interview for major depressive episode and completed the Patient Health Questionnaire-2 and -9, Hospital Anxiety and Depression Scale, Beck Depression Inventory-II, Distress Thermometer, and Kessler-10. Internal consistency, sensitivity, specificity, likelihood ratios, and posttest probabilities were calculated. Each measure was validated against the gold standard using receiver operating characteristic curves with comparison of the area under the curve for all measures. Internal consistency ranged from acceptable to excellent for all measures (Cronbach α=0.78-0.94). Areas under the curve (95% CI) for the Patient Health Questionnaire-2, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale depression and total score, Beck Depression Inventory-II, and Kessler-10 ranged from 0.80 (0.69-0.89) for the Kessler-10 to 0.89 (0.79-0.95) for the Beck Depression Inventory-II with no significant differences between measures. The Distress Thermometer had an area under the curve (95% CI) of 0.73 (0.61-0.83), significantly smaller than the Beck Depression Inventory-II (P<0.05). Apart from the Distress Thermometer, selected scales performed adequately in a stroke population with no significant difference between measures. The Patient Health Questionnaire-2 would be the most useful single screen given free availability and the shortest number of items.

  2. The effect of antipsychotic drugs on nonspecific inflammation markers in the first episode of schizophrenia

    Directory of Open Access Journals (Sweden)

    Stefanović Vesna

    2015-01-01

    Full Text Available Background/Aim. Immune system disorder, including inflammation, takes a significant place when considering still unclear etiology of schizophrenia. The aim of this study was to determine the blood levels of nonspecific inflammation markers in the first episode of schizophrenia and their relation to the therapy response. Methods. In this study we determined the blood levels of nonspecific inflammation markers: white blood cells count (WBC, C-reactive protein (CRP, erythrocytes sedimentation rate (ESR and the elements of differential white blood cell counts (or the leukocyte formula: granulocytes (Gra, lymphocytes (Lym and monocytes (Mon, in the first episode of schizofrenia, in 78 patients hospitalized at the Clinic for Psychiatric Disorders “Dr Laza Lazarević” in Belgrade. The levels were measured at admission to the clinic, as well as after 4 weeks of antipsychotic treatment. The Positive and negative syndrome scale for schizophrenia (PANSS was applied to measure the severity of psychopathology and response to the treatment. Results. During the first episode of schizophrenia, before initiation of antipsychotic treatment, the frequency of abnormal values was high (≥ 25% of the patients for the following non-specific inflammation markers: WBC, CRP, ESR and Gra, in the leukocyte formula, but dropped after 4 weeks of antipsychotic treatment at the level of high statistical significance for WBC and Gra (p < 0.001. The ESR remained unchanged in as many as 50% of the patients even after 4-week antipsychotic treatment, at the level of statistical significance in the non-responders compared to the responders (p = 0.045. Conclusion. The obtained results indicate that in the first episode of schizophrenia the blood levels of non-specific inflammation markers (WBS, CRP, ESR and Gra from the leukocyte formula were high in the subpopulation of patients with the tendency towards normalization of inflammation parameters after a 4-week antipsychotic

  3. Acute manic episode is associated with an increased risk of lower limb edema.

    Science.gov (United States)

    Hochman, Eldar; Krivoy, Amir; Shoval, Gal; Valevski, Avi; Weizman, Abraham; Fischel, Tsvi

    2013-12-02

    Lower limb edema (LLE) was suggested to be associated with the use of psychotropic drugs among patients suffering from severe mental illnesses; however no direct mechanism was found. Therefore, we examined the association between the occurrence of LLE and acute untreated episode leading to hospitalization. A retrospective cross-sectional study was conducted using medical charts of 2529 patients admitted to Geha Mental Health Center between 2002 and 2012. Incident cases of LLE, demographic and clinical data were retrieved. Admission clinical status was modeled as three non-overlapping groups of patients: (i) Patients with a non-affective psychosis (NAP) episode (n = 1563), (ii) patients with a manic episode (n = 366), and (iii) patients with a depressive episode (n = 600). We performed a logistic regression analysis with LLE as the dependent variable controlling for the demographic and clinical variables that may be associated with LLE. LLE was diagnosed in 3.8% (n = 95) of the study population. The rate of LLE was 3-fold higher (χ(2) = 51.9, df = 2, p<0.001) in patients admitted with a manic episode (n = 38; 10.4%) compared to patients admitted with a NAP episode (n = 41; 2.6%) and patients admitted with a depressive episode (n = 16; 2.7%). Manic episode was associated with an increased risk for LLE compared to depressive episode (OR 8.72, 95% CI: 3.53-21.52, p<0.001) or NAP episode (OR 3.96, 95% CI: 2.16-7.26, p<0.001) after controlling for relevant confounders. Acute manic episode, leading to hospitalization, is associated with an increased risk of LLE, compared to NAP or depressive episode, suggesting causal relationship between mood and fluid imbalance. Yet, future prospective studies are needed to rule out the contribution of physical agitation and lithium treatment. © 2013.

  4. Perspectives on Episodic-Like and Episodic Memory

    Science.gov (United States)

    Pause, Bettina M.; Zlomuzica, Armin; Kinugawa, Kiyoka; Mariani, Jean; Pietrowsky, Reinhard; Dere, Ekrem

    2013-01-01

    Episodic memory refers to the conscious recollection of a personal experience that contains information on what has happened and also where and when it happened. Recollection from episodic memory also implies a kind of first-person subjectivity that has been termed autonoetic consciousness. Episodic memory is extremely sensitive to cerebral aging and neurodegenerative diseases. In Alzheimer’s disease deficits in episodic memory function are among the first cognitive symptoms observed. Furthermore, impaired episodic memory function is also observed in a variety of other neuropsychiatric diseases including dissociative disorders, schizophrenia, and Parkinson disease. Unfortunately, it is quite difficult to induce and measure episodic memories in the laboratory and it is even more difficult to measure it in clinical populations. Presently, the tests used to assess episodic memory function do not comply with even down-sized definitions of episodic-like memory as a memory for what happened, where, and when. They also require sophisticated verbal competences and are difficult to apply to patient populations. In this review, we will summarize the progress made in defining behavioral criteria of episodic-like memory in animals (and humans) as well as the perspectives in developing novel tests of human episodic memory which can also account for phenomenological aspects of episodic memory such as autonoetic awareness. We will also define basic behavioral, procedural, and phenomenological criteria which might be helpful for the development of a valid and reliable clinical test of human episodic memory. PMID:23616754

  5. Estimating rotavirus gastroenteritis hospitalisations by using hospital episode statistics before and after the introduction of rotavirus vaccine in Australia.

    Science.gov (United States)

    Jayasinghe, Sanjay; Macartney, Kristine

    2013-01-30

    Hospital discharge records and laboratory data have shown a substantial early impact from the rotavirus vaccination program that commenced in 2007 in Australia. However, these assessments are affected by the validity and reliability of hospital discharge coding and stool testing to measure the true incidence of hospitalised disease. The aim of this study was to assess the validity of these data sources for disease estimation, both before and after, vaccine introduction. All hospitalisations at a major paediatric centre in children aged <5 years from 2000 to 2009 containing acute gastroenteritis (AGE) ICD 10 AM diagnosis codes were linked to hospital laboratory stool testing data. The validity of the rotavirus-specific diagnosis code (A08.0) and the incidence of hospitalisations attributable to rotavirus by both direct estimation and with adjustments for non-testing and miscoding were calculated for pre- and post-vaccination periods. A laboratory record of stool testing was available for 36% of all AGE hospitalisations (n=4948) the rotavirus code had high specificity (98.4%; 95% CI, 97.5-99.1%) and positive predictive value (96.8%; 94.8-98.3%), and modest sensitivity (61.6%; 58-65.1%). Of all rotavirus test positive hospitalisations only a third had a rotavirus code. The estimated annual average number of rotavirus hospitalisations, following adjustment for non-testing and miscoding was 5- and 6-fold higher than identified, respectively, from testing and coding alone. Direct and adjusted estimates yielded similar percentage reductions in annual average rotavirus hospitalisations of over 65%. Due to the limited use of stool testing and poor sensitivity of the rotavirus-specific diagnosis code routine hospital discharge and laboratory data substantially underestimate the true incidence of rotavirus hospitalisations and absolute vaccine impact. However, this data can still be used to monitor vaccine impact as the effects of miscoding and under-testing appear to be

  6. The use of the temporal scan statistic to detect methicillin-resistant Staphylococcus aureus clusters in a community hospital.

    Science.gov (United States)

    Faires, Meredith C; Pearl, David L; Ciccotelli, William A; Berke, Olaf; Reid-Smith, Richard J; Weese, J Scott

    2014-07-08

    In healthcare facilities, conventional surveillance techniques using rule-based guidelines may result in under- or over-reporting of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks, as these guidelines are generally unvalidated. The objectives of this study were to investigate the utility of the temporal scan statistic for detecting MRSA clusters, validate clusters using molecular techniques and hospital records, and determine significant differences in the rate of MRSA cases using regression models. Patients admitted to a community hospital between August 2006 and February 2011, and identified with MRSA>48 hours following hospital admission, were included in this study. Between March 2010 and February 2011, MRSA specimens were obtained for spa typing. MRSA clusters were investigated using a retrospective temporal scan statistic. Tests were conducted on a monthly scale and significant clusters were compared to MRSA outbreaks identified by hospital personnel. Associations between the rate of MRSA cases and the variables year, month, and season were investigated using a negative binomial regression model. During the study period, 735 MRSA cases were identified and 167 MRSA isolates were spa typed. Nine different spa types were identified with spa type 2/t002 (88.6%) the most prevalent. The temporal scan statistic identified significant MRSA clusters at the hospital (n=2), service (n=16), and ward (n=10) levels (P ≤ 0.05). Seven clusters were concordant with nine MRSA outbreaks identified by hospital staff. For the remaining clusters, seven events may have been equivalent to true outbreaks and six clusters demonstrated possible transmission events. The regression analysis indicated years 2009-2011, compared to 2006, and months March and April, compared to January, were associated with an increase in the rate of MRSA cases (P ≤ 0.05). The application of the temporal scan statistic identified several MRSA clusters that were not detected by hospital

  7. The relationship between the C-statistic of a risk-adjustment model and the accuracy of hospital report cards: a Monte Carlo Study.

    Science.gov (United States)

    Austin, Peter C; Reeves, Mathew J

    2013-03-01

    Hospital report cards, in which outcomes following the provision of medical or surgical care are compared across health care providers, are being published with increasing frequency. Essential to the production of these reports is risk-adjustment, which allows investigators to account for differences in the distribution of patient illness severity across different hospitals. Logistic regression models are frequently used for risk adjustment in hospital report cards. Many applied researchers use the c-statistic (equivalent to the area under the receiver operating characteristic curve) of the logistic regression model as a measure of the credibility and accuracy of hospital report cards. To determine the relationship between the c-statistic of a risk-adjustment model and the accuracy of hospital report cards. Monte Carlo simulations were used to examine this issue. We examined the influence of 3 factors on the accuracy of hospital report cards: the c-statistic of the logistic regression model used for risk adjustment, the number of hospitals, and the number of patients treated at each hospital. The parameters used to generate the simulated datasets came from analyses of patients hospitalized with a diagnosis of acute myocardial infarction in Ontario, Canada. The c-statistic of the risk-adjustment model had, at most, a very modest impact on the accuracy of hospital report cards, whereas the number of patients treated at each hospital had a much greater impact. The c-statistic of a risk-adjustment model should not be used to assess the accuracy of a hospital report card.

  8. Effects of short-term inpatient treatment on sensitivity to a size contrast illusion in first-episode psychosis and multiple-episode schizophrenia.

    Science.gov (United States)

    Silverstein, Steven M; Keane, Brian P; Wang, Yushi; Mikkilineni, Deepthi; Paterno, Danielle; Papathomas, Thomas V; Feigenson, Keith

    2013-01-01

    In the Ebbinghaus illusion, a shape appears larger than its actual size when surrounded by small shapes and smaller than its actual size when surrounded by large shapes. Resistance to this visual illusion has been previously reported in schizophrenia, and linked to disorganized symptoms and poorer prognosis in cross-sectional studies. It is unclear, however, when in the course of illness this resistance first emerges or how it varies longitudinally with illness phase. We addressed these issues by having first-episode psychosis patients, multiple-episode schizophrenia patients and healthy controls complete a psychophysical task at two different time points, corresponding to hospital admission and discharge for patients. The task required judging the relative size of two circular targets centered on either side of the screen. Targets were presented without context (baseline), or were surrounded by shapes that made the size judgment harder or easier (misleading and helpful contexts, respectively). Context sensitivity was operationalized as the amount of improvement relative to baseline in the helpful condition minus the amount of decrement relative to baseline in the misleading condition. At hospital admission, context sensitivity was lower in the multiple-episode group than in the other groups, and was marginally less in the first episode than in the control group. In addition, schizophrenia patients were significantly more and less accurate than the other groups in the misleading and helpful conditions, respectively. At discharge, all groups exhibited similar context sensitivity. In general, poorer context sensitivity was related to higher levels of disorganized symptoms, and lower level of depression, excitement, and positive symptoms. Resistance to the Ebbinghaus illusion, as a characteristic of the acute phase of illness in schizophrenia, increases in magnitude after the first episode of psychosis. This suggests that visual context processing is a state-marker in

  9. Perspectives on Episodic-like and Episodic Memory

    OpenAIRE

    Bettina M Pause; Armin eZlomuzica; Kiyoka eKinugawa; Jean eMariani; Reinhard ePietrowsky; Ekrem eDere

    2013-01-01

    Episodic memory refers to the conscious recollection of a personal experience that contains information on what has happened and also where and when it happened. Recollection from episodic memory also implies a kind of first-person subjectivity that has been termed autonoetic consciousness. Episodic memory is extremely sensitive to cerebral aging and neurodegenerative diseases. In Alzheimer’s disease deficits in episodic memory function are among the first cognitive symptoms observed. Further...

  10. The Longitudinal Study of Computer Simulation in Learning Statistics for Hospitality College Students

    Science.gov (United States)

    Huang, Ching-Hsu

    2014-01-01

    The class quasi-experiment was conducted to determine whether using computer simulation teaching strategy enhanced student understanding of statistics concepts for students enrolled in an introductory course. One hundred and ninety-three sophomores in hospitality management department were invited as participants in this two-year longitudinal…

  11. Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders

    DEFF Research Database (Denmark)

    Nordentoft, Merete; Øhlenschlæger, Johan; Thorup, Anne Amalie Elgaard

    2010-01-01

    BACKGROUND: The effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect...... in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation. RESULTS: It was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards...

  12. Episode cycles with increasing recurrences in first-episode bipolar-I disorder patients.

    Science.gov (United States)

    Baldessarini, R J; Salvatore, P; Khalsa, H-M K; Imaz-Etxeberria, H; Gonzalez-Pinto, A; Tohen, M

    2012-01-01

    Preliminary review of a century of studies of the course of manic-depressive syndromes produced 40 reports, of which approximately one-third report evidence of shortening wellness intervals or cycle-lengths with more recurrences, and two-thirds did not. We evaluated inter-episode intervals (cycle-length) in 128 clinically-treated, DSM-IV bipolar-I disorder patients followed prospectively and systematically over 5.7 years, with 6.5 episodes/person. As expected, cycle-length varied inversely with total cycle-count/person; however, multivariate linear regression found only longer initial hospitalization and fewer total cycles to be associated with cycle-length, whereas cycle-number (1, 2, 3, etc.), sex, intake-age, and first-episode polarity were not. Regression of within-subject cycle-length versus cycle-number yielded individual slope-functions with pseudo-random distribution (28% fell within ±1 month/cycle of the null [zero-slope]). Mean duration of early and late euthymic intervals (cycles 2 vs. 5) in patients with matched recurrence-counts was nearly identical. The course of bipolar-I disorder from onset was largely random or chaotic over nearly 6 years from onset. Only a minority of patients showed either cycle-acceleration or slowing, without changes in wellness intervals. The findings may be influenced by treatment-effects, but seem to indicate that most current bipolar-I disorder patients are unlikely to show progressive shortening of recurrence-cycles. Copyright © 2011 Elsevier B.V. All rights reserved.

  13. Daylight Savings Time Transitions and the Incidence Rate of Unipolar Depressive Episodes.

    Science.gov (United States)

    Hansen, Bertel T; Sønderskov, Kim M; Hageman, Ida; Dinesen, Peter T; Østergaard, Søren D

    2017-05-01

    Daylight savings time transitions affect approximately 1.6 billion people worldwide. Prior studies have documented associations between daylight savings time transitions and adverse health outcomes, but it remains unknown whether they also cause an increase in the incidence rate of depressive episodes. This seems likely because daylight savings time transitions affect circadian rhythms, which are implicated in the etiology of depressive disorder. Therefore, we investigated the effects of daylight savings time transitions on the incidence rate of unipolar depressive episodes. Using time series intervention analysis of nationwide data from the Danish Psychiatric Central Research Register from 1995 to 2012, we compared the observed trend in the incidence rate of hospital contacts for unipolar depressive episodes after the transitions to and from summer time to the predicted trend in the incidence rate. The analyses were based on 185,419 hospital contacts for unipolar depression and showed that the transition from summer time to standard time were associated with an 11% increase (95% CI = 7%, 15%) in the incidence rate of unipolar depressive episodes that dissipated over approximately 10 weeks. The transition from standard time to summer time was not associated with a parallel change in the incidence rate of unipolar depressive episodes. This study shows that the transition from summer time to standard time was associated with an increase in the incidence rate of unipolar depressive episodes. Distress associated with the sudden advancement of sunset, marking the coming of a long period of short days, may explain this finding. See video abstract at, http://links.lww.com/EDE/B179.

  14. [The epidemiology of suicide in bipolar disorder in the manic episode--preliminary reports].

    Science.gov (United States)

    Wierzbiński, Piotr; Zdanowicz, Anna; Klekowska, Justyna; Broniarczyk-Czarniak, Marta; Zboralski, Krzysztof

    2014-04-01

    Suicide is among ten leading causes of death in each country and the third most common cause of death in the age group 16-35. The presence of mental illness is the most important risk factor for suicide. Affective disorders contribute to 15-25% of deaths due to suicide attempts. Depression is the most likely cause of the patients attempt on his life. Contrary to popular opinion, manic episode can also increase the risk of suicide, especially if the patient dominates by productive symptoms in the form of delusions. The aim of study was to determine the frequency of suicide attempts and their determinants in an episode of mania in bipolar disorder. The study included 16 people with a diagnosed bipolar disorder, hospitalized with manic episode at the age of 28-76. Patients hospitalized in the Department of Adult Psychiatry were selected randomly. The number of suicide attempts, comorbid conditions, and basic epidemiological data were estimated. Five patients declared suicide attempt, one of which wanted to make more than one attempt at suicide. 3 people took it during an episode of depression, two in an episode of mania. The methods of suicide were associated with an overdose of medication and this was accompanied by a greater amount of alcohol intake. 11 persons did not declare any willingness to attempt suicide. A mania episode did not increase the risk of suicide in bipolar disorder compared to an episode of depression in the study conducted. The importance of somatic illness in patients with bipolar disorder is increased if the suicide attempt occurs in an episode of depression. Alcohol abuse showed no negative effects on suicidal behavior of patients. During abuse was the most common way of commit suicide.

  15. Multimodal Feature Integration in the Angular Gyrus during Episodic and Semantic Retrieval

    Science.gov (United States)

    Bonnici, Heidi M.; Richter, Franziska R.; Yazar, Yasemin

    2016-01-01

    Much evidence from distinct lines of investigation indicates the involvement of angular gyrus (AnG) in the retrieval of both episodic and semantic information, but the region's precise function and whether that function differs across episodic and semantic retrieval have yet to be determined. We used univariate and multivariate fMRI analysis methods to examine the role of AnG in multimodal feature integration during episodic and semantic retrieval. Human participants completed episodic and semantic memory tasks involving unimodal (auditory or visual) and multimodal (audio-visual) stimuli. Univariate analyses revealed the recruitment of functionally distinct AnG subregions during the retrieval of episodic and semantic information. Consistent with a role in multimodal feature integration during episodic retrieval, significantly greater AnG activity was observed during retrieval of integrated multimodal episodic memories compared with unimodal episodic memories. Multivariate classification analyses revealed that individual multimodal episodic memories could be differentiated in AnG, with classification accuracy tracking the vividness of participants' reported recollections, whereas distinct unimodal memories were represented in sensory association areas only. In contrast to episodic retrieval, AnG was engaged to a statistically equivalent degree during retrieval of unimodal and multimodal semantic memories, suggesting a distinct role for AnG during semantic retrieval. Modality-specific sensory association areas exhibited corresponding activity during both episodic and semantic retrieval, which mirrored the functional specialization of these regions during perception. The results offer new insights into the integrative processes subserved by AnG and its contribution to our subjective experience of remembering. SIGNIFICANCE STATEMENT Using univariate and multivariate fMRI analyses, we provide evidence that functionally distinct subregions of angular gyrus (An

  16. Multimodal Feature Integration in the Angular Gyrus during Episodic and Semantic Retrieval.

    Science.gov (United States)

    Bonnici, Heidi M; Richter, Franziska R; Yazar, Yasemin; Simons, Jon S

    2016-05-18

    Much evidence from distinct lines of investigation indicates the involvement of angular gyrus (AnG) in the retrieval of both episodic and semantic information, but the region's precise function and whether that function differs across episodic and semantic retrieval have yet to be determined. We used univariate and multivariate fMRI analysis methods to examine the role of AnG in multimodal feature integration during episodic and semantic retrieval. Human participants completed episodic and semantic memory tasks involving unimodal (auditory or visual) and multimodal (audio-visual) stimuli. Univariate analyses revealed the recruitment of functionally distinct AnG subregions during the retrieval of episodic and semantic information. Consistent with a role in multimodal feature integration during episodic retrieval, significantly greater AnG activity was observed during retrieval of integrated multimodal episodic memories compared with unimodal episodic memories. Multivariate classification analyses revealed that individual multimodal episodic memories could be differentiated in AnG, with classification accuracy tracking the vividness of participants' reported recollections, whereas distinct unimodal memories were represented in sensory association areas only. In contrast to episodic retrieval, AnG was engaged to a statistically equivalent degree during retrieval of unimodal and multimodal semantic memories, suggesting a distinct role for AnG during semantic retrieval. Modality-specific sensory association areas exhibited corresponding activity during both episodic and semantic retrieval, which mirrored the functional specialization of these regions during perception. The results offer new insights into the integrative processes subserved by AnG and its contribution to our subjective experience of remembering. Using univariate and multivariate fMRI analyses, we provide evidence that functionally distinct subregions of angular gyrus (AnG) contribute to the retrieval of

  17. Experimental Effects of Acute Exercise on Iconic Memory, Short-Term Episodic, and Long-Term Episodic Memory.

    Science.gov (United States)

    Yanes, Danielle; Loprinzi, Paul D

    2018-06-11

    The present experiment evaluated the effects of acute exercise on iconic memory and short- and long-term episodic memory. A two-arm, parallel-group randomized experiment was employed ( n = 20 per group; M age = 21 year). The experimental group engaged in an acute bout of moderate-intensity treadmill exercise for 15 min, while the control group engaged in a seated, time-matched computer task. Afterwards, the participants engaged in a paragraph-level episodic memory task (20 min delay and 24 h delay recall) as well as an iconic memory task, which involved 10 trials (at various speeds from 100 ms to 800 ms) of recalling letters from a 3 × 3 array matrix. For iconic memory, there was a significant main effect for time (F = 42.9, p memory scores at both the baseline (19.22 vs. 17.20) and follow-up (18.15 vs. 15.77), but these results were not statistically significant. These findings provide some suggestive evidence hinting towards an iconic memory and episodic benefit from acute exercise engagement.

  18. Private patients in NHS hospitals: comparison of two sources of information.

    Science.gov (United States)

    Williams, B T; Pearson, J

    1999-03-01

    The use of National Health Service (NHS) hospitals to treat private patients is debatable on the grounds of equity of access. Hospital Episodes Statistics (HES) annual reports are the only routine source of information on the scale of this activity. The accuracy of the information is doubted. This enquiry tested the completeness of HES data against information obtained directly from private patient unit managers. Managers of the 71 pay bed units in NHS hospitals in England were asked to supply from local registers and accounts the numbers of in-patients and day cases admitted in 1995-1996. Their reports were matched with the numbers of first consultant episodes for private in-patients and day cases shown for those hospitals in the HES data file for that year. Of the 71 units 62 responded; 53 of these gave usable data. The 53 included, and 18 excluded from the comparison, matched on median and range of bed numbers. Managers identified 16 per cent more total admissions than did HES, 62,572 against 54,131; 13 per cent more in-patient admissions, 39,776 against 35,319; and 21 per cent more day cases, 22,796 against 18,812. More total admissions were reported by managers of 38 pay bed units than were recorded in HES, fewer by 12, and equal numbers by three. Similar sized discrepancies were noted for in-patient admissions and day cases. Reasons for the under-reporting of private patients in HES included the use of separate patient administration systems for private patients with a failure to feed data to HES, and the omission of some provider units altogether by a minority of trusts from the returns made to the Department of Health. Overall, HES underestimates the amount of private patient activity reported directly by NHS hospitals. No method of validating private patient data is currently available. An amendment to an existing statistical return would provide a check on numbers. Central guidance on the inclusion of private patient activity in data transmitted by

  19. Experimental Effects of Acute Exercise on Iconic Memory, Short-Term Episodic, and Long-Term Episodic Memory

    Directory of Open Access Journals (Sweden)

    Danielle Yanes

    2018-06-01

    Full Text Available The present experiment evaluated the effects of acute exercise on iconic memory and short- and long-term episodic memory. A two-arm, parallel-group randomized experiment was employed (n = 20 per group; Mage = 21 year. The experimental group engaged in an acute bout of moderate-intensity treadmill exercise for 15 min, while the control group engaged in a seated, time-matched computer task. Afterwards, the participants engaged in a paragraph-level episodic memory task (20 min delay and 24 h delay recall as well as an iconic memory task, which involved 10 trials (at various speeds from 100 ms to 800 ms of recalling letters from a 3 × 3 array matrix. For iconic memory, there was a significant main effect for time (F = 42.9, p < 0.001, η2p = 0.53 and a trend towards a group × time interaction (F = 2.90, p = 0.09, η2p = 0.07, but no main effect for group (F = 0.82, p = 0.37, η2p = 0.02. The experimental group had higher episodic memory scores at both the baseline (19.22 vs. 17.20 and follow-up (18.15 vs. 15.77, but these results were not statistically significant. These findings provide some suggestive evidence hinting towards an iconic memory and episodic benefit from acute exercise engagement.

  20. The real world cost and health resource utilization associated to manic episodes: The MANACOR study.

    Science.gov (United States)

    Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnín, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduard

    2015-01-01

    Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables. Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations. One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost. Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  1. Detection of Clostridium difficile infection clusters, using the temporal scan statistic, in a community hospital in southern Ontario, Canada, 2006-2011.

    Science.gov (United States)

    Faires, Meredith C; Pearl, David L; Ciccotelli, William A; Berke, Olaf; Reid-Smith, Richard J; Weese, J Scott

    2014-05-12

    In hospitals, Clostridium difficile infection (CDI) surveillance relies on unvalidated guidelines or threshold criteria to identify outbreaks. This can result in false-positive and -negative cluster alarms. The application of statistical methods to identify and understand CDI clusters may be a useful alternative or complement to standard surveillance techniques. The objectives of this study were to investigate the utility of the temporal scan statistic for detecting CDI clusters and determine if there are significant differences in the rate of CDI cases by month, season, and year in a community hospital. Bacteriology reports of patients identified with a CDI from August 2006 to February 2011 were collected. For patients detected with CDI from March 2010 to February 2011, stool specimens were obtained. Clostridium difficile isolates were characterized by ribotyping and investigated for the presence of toxin genes by PCR. CDI clusters were investigated using a retrospective temporal scan test statistic. Statistically significant clusters were compared to known CDI outbreaks within the hospital. A negative binomial regression model was used to identify associations between year, season, month and the rate of CDI cases. Overall, 86 CDI cases were identified. Eighteen specimens were analyzed and nine ribotypes were classified with ribotype 027 (n = 6) the most prevalent. The temporal scan statistic identified significant CDI clusters at the hospital (n = 5), service (n = 6), and ward (n = 4) levels (P ≤ 0.05). Three clusters were concordant with the one C. difficile outbreak identified by hospital personnel. Two clusters were identified as potential outbreaks. The negative binomial model indicated years 2007-2010 (P ≤ 0.05) had decreased CDI rates compared to 2006 and spring had an increased CDI rate compared to the fall (P = 0.023). Application of the temporal scan statistic identified several clusters, including potential outbreaks not detected by hospital

  2. Brain germinoma presenting as a first psychotic episode in an adolescent male

    OpenAIRE

    2010-01-01

    Brain germinoma presenting as a first psychotic episode in an adolescent male phone: +34-93-2275477 (Undurraga, Juan) (Undurraga, Juan) Department of Psychiatry, Institute of Neuroscience, Hospital Clinic de Barcelona - Servicio de Psiquiatria (Escalera 9, Planta 6), Calle Villarroel, 170 - 08036 - Barcelona - SPAIN (Undurraga, Juan) Department of Child and Adolescent Psychology and Psychiatry, Institute of Neuroscience, Hospital Clinic de Barcelona - Barc...

  3. Geographic variation in expenditures for Workers' Compensation hospitalized claims.

    Science.gov (United States)

    Miller, T R; Levy, D T

    1999-02-01

    Past literature finds considerable variation in the cost of physician care and in the utilization of medical procedures. Variation in the cost of hospitalized care has received little attention. We examine injury costs of hospitalized claims across states. Multivariate regression analysis is used to isolate state variations, while controlling for personal and injury characteristics, and state characteristics. Injuries to workers filing Workers' Compensation lost workday claims. About 35,000 randomly sampled Workers' Compensation claims from 17 states filed between 1979 and 1988. Medical payments per episode of three injury groups: upper and lower extremity fractures and dislocations, other upper extremity injuries, and back strains and sprains. Statistical analyses reveal considerable variation in expenditures for hospitalized injuries across states, even after controlling for case mix and state characteristics. A substantial portion of the variation is explained by state rate regulations; regulated states have lower costs. The large variation in costs suggests a potential to affect the costs of hospitalized care. Efforts should be directed at those areas that have higher costs without sufficient input price, quality, or case mix justification.

  4. What Factors are Associated With 90-day Episode-of-care Payments for Younger Patients With Total Joint Arthroplasty?

    Science.gov (United States)

    Pathak, Shweta; Ganduglia, Cecilia M; Awad, Samir S; Chan, Wenyaw; Swint, John M; Morgan, Robert O

    2017-11-01

    Total joint arthroplasty (TJA) has been identified as a procedure with substantial variations in inpatient and postacute care payments. Most studies in this area have focused primarily on the Medicare population and rarely have characterized the younger commercially insured populations. Understanding the inpatient and postdischarge care service-component differences across 90-day episodes of care and factors associated with payments for younger patients is crucial for successful implementation of bundled payments in TJA in non-Medicare populations. (1) To assess the mean total payment for a 90-day primary TJA episode, including the proportion attributable to postdischarge care, and (2) to evaluate the role of procedure, patient, and hospital-level factors associated with 90-day episode-of-care payments in a non-Medicare patient population younger than 65 years. Claims data for 2008 to 2013 from Blue Cross Blue Shield of Texas were obtained for primary TJAs. A total of 11,131 procedures were examined by aggregating payments for the index hospital stay and any postacute care including rehabilitation services and unplanned readmissions during the 90-day postdischarge followup period. A three-level hierarchical model was developed to determine procedure-, patient-, and hospital-level factors associated with 90-day episode-of-care payments. The mean total payment for a 90-day episode for TJA was USD 47,700 adjusted to 2013 USD. Only 14% of 90-day episode payments in our population was attributable to postdischarge-care services, which is substantially lower than the percentage estimated in the Medicare population. A prolonged length of stay (rate ratio [RR], 1.19; 95% CI, 1.15-1.23; p ≤ 0.001), any 90-day unplanned readmission (RR, 1.64; 95% CI, 1.57-1.71; p ≤ 0.001), computer-assisted surgery (RR, 1.031; 95% CI, 1.004-1.059; p ≤ 0.05), initial home discharge with home health component (RR, 1.029; 95% CI, 1.013-1.046; p ≤ 0.001), and very high patient morbidity

  5. Verbal episodic memory in young hypothyroid patients

    Directory of Open Access Journals (Sweden)

    Vatsal Priyadarshi Pandey

    2017-01-01

    Full Text Available Context: Hypothyroidism affects cognitive functions especially memory. However, most of the previous studies have generally evaluated older hypothyroid patients and sample size of these studies varied in terms of age range. Aims: To see whether hypothyroidism affects memory in young patients. Settings and Design: The sample consisted of 11 hypothyroid patients with an age of 18–49 and 8 healthy controls matched on age and education. Subjects and Methods: Verbal episodic memory was assessed using Hindi adaptation of Rey-Auditory Verbal Learning Test. Statistical Analysis Used: An independent t-test was used to see the difference between mean performance of the patient group and healthy control on memory measures. Results: Results indicated nonsignificant difference between verbal episodic memory of patient group and healthy controls. Conclusions: On the basis of these findings, it was concluded that hypothyroidism may not affect younger patients in terms of episodic verbal memory the same way as it does in the older patients.

  6. [A new assessment for episodic memory. Episodic memory test and caregiver's episodic memory test].

    Science.gov (United States)

    Ojea Ortega, T; González Álvarez de Sotomayor, M M; Pérez González, O; Fernández Fernández, O

    2013-10-01

    The purpose of the episodic memory test and the caregiver's episodic memory test is to evaluate episodic memory according to its definition in a way that is feasible for families and achieves high degrees of sensitivity and specificity. We administered a test consisting of 10 questions about episodic events to 332 subjects, of whom 65 had Alzheimer's disease (AD), 115 had amnestic MCI (aMCI) and 152 showed no cognitive impairment according to Reisberg's global deterioration scale (GDS). We calculated the test's sensitivity and specificity to distinguish AD from episodic aMCI and from normal ageing. The area under the ROC curve for the diagnosis of aMCI was 0.94 and the best cut-off value was 20; for that value, sensitivity was 89% and specificity was 82%. For a diagnosis of AD, the area under the ROC curve was 0.99 and the best cut-off point was 17, with a sensitivity of 98% and a specificity of 91%. A subsequent study using similar methodology yielded similar results when the test was administered directly by the caregiver. The episodic memory test and the caregiver's episodic memory test are useful as brief screening tools for identifying patients with early-stage AD. It is suitable for use by primary care medical staff and in the home, since it can be administered by a caregiver. The test's limitations are that it must be administered by a reliable caregiver and the fact that it measures episodic memory only. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  7. Dissociative fugue: Recurrent episodes in a young adult

    Directory of Open Access Journals (Sweden)

    Chintan Madhusudan Raval

    2015-01-01

    Full Text Available Dissociative fugue is a rare disorder which has been described as sudden, unexpected, travel away from home or one′s customary place of daily activities, with the inability to recall some or all of one′s past. There is no systematic data existing on it and very few cases reported in the literature. Here we report a case of fugue in a young adult male who travelled 8 times away from his home during last 1΍ year. He has a loss of memory for episodes with patchy recall of few events. Longest duration of fugue episode was of 1-month. The case describes mode of presentation to hospital and treatment given to restore his identity and reunite him in society and family.

  8. Episodic future thinking and episodic counterfactual thinking: intersections between memory and decisions.

    Science.gov (United States)

    Schacter, Daniel L; Benoit, Roland G; De Brigard, Felipe; Szpunar, Karl K

    2015-01-01

    This article considers two recent lines of research concerned with the construction of imagined or simulated events that can provide insight into the relationship between memory and decision making. One line of research concerns episodic future thinking, which involves simulating episodes that might occur in one's personal future, and the other concerns episodic counterfactual thinking, which involves simulating episodes that could have happened in one's personal past. We first review neuroimaging studies that have examined the neural underpinnings of episodic future thinking and episodic counterfactual thinking. We argue that these studies have revealed that the two forms of episodic simulation engage a common core network including medial parietal, prefrontal, and temporal regions that also supports episodic memory. We also note that neuroimaging studies have documented neural differences between episodic future thinking and episodic counterfactual thinking, including differences in hippocampal responses. We next consider behavioral studies that have delineated both similarities and differences between the two kinds of episodic simulation. The evidence indicates that episodic future and counterfactual thinking are characterized by similarly reduced levels of specific detail compared with episodic memory, but that the effects of repeatedly imagining a possible experience have sharply contrasting effects on the perceived plausibility of those events during episodic future thinking versus episodic counterfactual thinking. Finally, we conclude by discussing the functional consequences of future and counterfactual simulations for decisions. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Episodic Memories

    Science.gov (United States)

    Conway, Martin A.

    2009-01-01

    An account of episodic memories is developed that focuses on the types of knowledge they represent, their properties, and the functions they might serve. It is proposed that episodic memories consist of "episodic elements," summary records of experience often in the form of visual images, associated to a "conceptual frame" that provides a…

  10. Estimation of hospital efficiency--do different definitions and casemix measures for hospital output affect the results?

    Science.gov (United States)

    Vitikainen, Kirsi; Street, Andrew; Linna, Miika

    2009-02-01

    Hospital efficiency has been the subject of numerous health economics studies, but there is little evidence on how the chosen output and casemix measures affect the efficiency results. The aim of this study is to examine the robustness of efficiency results due to these factors. Comparison is made between activities and episode output measures, and two different output grouping systems (Classic and FullDRG). Non-parametric data envelopment analysis is used as an analysis technique. The data consist of all public acute care hospitals in Finland in 2005 (n=40). Efficiency estimates were not found to be highly sensitive to the choice between episode and activity descriptions of output, but more so to the choice of DRG grouping system. Estimates are most sensitive to scale assumptions, with evidence of decreasing returns to scale in larger hospitals. Episode measures are generally to be preferred to activity measures because these better capture the patient pathway, while FullDRGs are preferred to Classic DRGs particularly because of the better description of outpatient output in the former grouping system. Attention should be paid to reducing the extent of scale inefficiency in Finland.

  11. Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

    DEFF Research Database (Denmark)

    Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel

    2010-01-01

    is difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... rebleeding were not statistically different. CONCLUSION: Our study shows that patients with BOV are more likely to receive therapy according to guidelines when hospitalized in a specialized unit compared with a community hospital. This however did not affect mortality.......OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice...

  12. Validating the use of Hospital Episode Statistics data and comparison of costing methodologies for economic evaluation: an end-of-life case study from the Cluster randomised triAl of PSA testing for Prostate cancer (CAP).

    Science.gov (United States)

    Thorn, Joanna C; Turner, Emma L; Hounsome, Luke; Walsh, Eleanor; Down, Liz; Verne, Julia; Donovan, Jenny L; Neal, David E; Hamdy, Freddie C; Martin, Richard M; Noble, Sian M

    2016-04-29

    To evaluate the accuracy of routine data for costing inpatient resource use in a large clinical trial and to investigate costing methodologies. Final-year inpatient cost profiles were derived using (1) data extracted from medical records mapped to the National Health Service (NHS) reference costs via service codes and (2) Hospital Episode Statistics (HES) data using NHS reference costs. Trust finance departments were consulted to obtain costs for comparison purposes. 7 UK secondary care centres. A subsample of 292 men identified as having died at least a year after being diagnosed with prostate cancer in Cluster randomised triAl of PSA testing for Prostate cancer (CAP), a long-running trial to evaluate the effectiveness and cost-effectiveness of prostate-specific antigen (PSA) testing. Both inpatient cost profiles showed a rise in costs in the months leading up to death, and were broadly similar. The difference in mean inpatient costs was £899, with HES data yielding ∼8% lower costs than medical record data (differences compatible with chance, p=0.3). Events were missing from both data sets. 11 men (3.8%) had events identified in HES that were all missing from medical record review, while 7 men (2.4%) had events identified in medical record review that were all missing from HES. The response from finance departments to requests for cost data was poor: only 3 of 7 departments returned adequate data sets within 6 months. Using HES routine data coupled with NHS reference costs resulted in mean annual inpatient costs that were very similar to those derived via medical record review; therefore, routinely available data can be used as the primary method of costing resource use in large clinical trials. Neither HES nor medical record review represent gold standards of data collection. Requesting cost data from finance departments is impractical for large clinical trials. ISRCTN92187251; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use

  13. Episodic and Semantic Memory Contribute to Familiar and Novel Episodic Future Thinking.

    Science.gov (United States)

    Wang, Tong; Yue, Tong; Huang, Xi Ting

    2016-01-01

    Increasing evidence indicates that episodic future thinking (EFT) relies on both episodic and semantic memory; however, event familiarity may importantly affect the extent to which episodic and semantic memory contribute to EFT. To test this possibility, two behavioral experiments were conducted. In Experiment 1, we directly compared the proportion of episodic and semantic memory used in an EFT task. The results indicated that more episodic memory was used when imagining familiar future events compared with novel future events. Conversely, significantly more semantic memory was used when imagining novel events compared with familiar events. Experiment 2 aimed to verify the results of Experiment 1. In Experiment 2, we found that familiarity moderated the effect of priming the episodic memory system on EFT; particularly, it increased the time required to construct a standard familiar episodic future event, but did not significantly affect novel episodic event reaction time. Collectively, these findings support the hypothesis that event familiarity importantly moderates episodic and semantic memory's contribution to EFT.

  14. The Episodic Nature of Episodic-Like Memories

    Science.gov (United States)

    Easton, Alexander; Webster, Lisa A. D.; Eacott, Madeline J.

    2012-01-01

    Studying episodic memory in nonhuman animals has proved difficult because definitions in humans require conscious recollection. Here, we assessed humans' experience of episodic-like recognition memory tasks that have been used with animals. It was found that tasks using contextual information to discriminate events could only be accurately…

  15. Human metapneumovirus and respiratory syncytial virus in hospitalized danish children with acute respiratory tract infection

    DEFF Research Database (Denmark)

    von Linstow, Marie-Louise; Larsen, Hans Henrik; Eugen-Olsen, Jesper

    2004-01-01

    The newly discovered human metapneumovirus (hMPV) has been shown to be associated with respiratory illness. We determined the frequencies and clinical features of hMPV and respiratory syncytial virus (RSV) infections in 374 Danish children with 383 episodes of acute respiratory tract infection...... children 1-6 months of age. Asthmatic bronchitis was diagnosed in 66.7% of hMPV and 10.6% of RSV-infected children (p infected children required respiratory support. hMPV is present in young.......6%) ARTI episodes by real-time reverse transcription-polymerase chain reaction using primers targeting the hMPV N gene and the RSV L gene. Two children were co-infected with hMPV and RSV. They were excluded from statistical analysis. Hospitalization for ARTI caused by hMPV was restricted to very young...

  16. Episodic and Semantic Memory Contribute to Familiar and Novel Episodic Future Thinking

    OpenAIRE

    Tong Wang; Tong Yue; Xi ting Huang

    2016-01-01

    Abstract Increasing evidence indicates that episodic future thinking (EFT) relies on both episodic and semantic memory; however, event familiarity may importantly affect the extent to which episodic and semantic memory contribute to EFT. To test this possibility, two behavioral experiments were conducted. In Experiment 1, we directly compared the proportion of episodic and semantic memory used in an EFT task. The results indicated that more episodic memory was used when imagining familiar fut...

  17. Case report of novel CACNA1A gene mutation causing episodic ataxia type 2

    Directory of Open Access Journals (Sweden)

    David Alan Isaacs

    2017-05-01

    Full Text Available Background: Episodic ataxia type 2 (OMIM 108500 is an autosomal dominant channelopathy characterized by paroxysms of ataxia, vertigo, nausea, and other neurologic symptoms. More than 50 mutations of the CACNA1A gene have been discovered in families with episodic ataxia type 2, although 30%–50% of all patients with typical episodic ataxia type 2 phenotype have no detectable mutation of the CACNA1A gene. Case: A 46-year-old Caucasian man, with a long history of bouts of imbalance, vertigo, and nausea, presented to our hospital with 2 weeks of ataxia and headache. Subsequent evaluation revealed a novel mutation in the CACNA1A gene: c.1364 G > A Arg455Gln. Acetazolamide was initiated with symptomatic improvement. Conclusion: This case report expands the list of known CACNA1A mutations associated with episodic ataxia type 2.

  18. The Role of Episodic and Semantic Memory in Episodic Foresight

    Science.gov (United States)

    Martin-Ordas, Gema; Atance, Cristina M.; Louw, Alyssa

    2012-01-01

    In this paper we describe a special form of future thinking, termed "episodic foresight" and its relation with episodic and semantic memory. We outline the methodologies that have largely been developed in the last five years to assess this capacity in young children and non-human animals. Drawing on Tulving's definition of episodic and semantic…

  19. Development of a Statistical Model for Forecasting Episodes of Visibility Degradation in the Denver Metropolitan Area.

    Science.gov (United States)

    Reddy, P. J.; Barbarick, D. E.; Osterburg, R. D.

    1995-03-01

    In 1990, the State of Colorado implemented a visibility standard of 0.076 km1 of beta extinction for the Denver metropolitan area. Meteorologists with Colorado's Air Pollution Control Division forecast high pollution days associated with visibility impairment as well as those due to high levels of the federal criteria pollutants. Visibility forecasts are made from a few hours up to about 26 h in advance of the period of interest. Here we discuss the key microscale, mesoscale, and synoptic-scale features associated with episodes of visibility impairment. Data from special studies, case studies, and the 22 NOAA Program for Regional Observing and Forecasting Services mesonet sites have been invaluable in identifying patterns associated with extremes in visibility conditions. A preliminary statistical forecast model has been developed using variables that represent many of these patterns. Six variables were selected from an initial pool of 27 to be used in a model based on linear logistic regression. These six variables include forecast measures of snow cover, surface pressures and a surface pressure gradient in eastern Colorado, relative humidity, and 500-mb ridge position. The initial testing of the model has been encouraging. The model correctly predicted 76% of the good visibility days and 67% of the poor visibility days for a test set of 171 days.

  20. Right lateralized white matter abnormalities in first-episode, drug-naive paranoid schizophrenia.

    Science.gov (United States)

    Guo, Wenbin; Liu, Feng; Liu, Zhening; Gao, Keming; Xiao, Changqing; Chen, Huafu; Zhao, Jingping

    2012-11-30

    Numerous studies in first-episode schizophrenia suggest the involvement of white matter (WM) abnormalities in multiple regions underlying the pathogenesis of this condition. However, there has never been a neuroimaging study in patients with first-episode, drug-naive paranoid schizophrenia by using tract-based spatial statistics (TBSS) method. Here, we used diffusion tensor imaging (DTI) with TBSS method to investigate the brain WM integrity in patients with first-episode, drug-naive paranoid schizophrenia. Twenty patients with first-episode, drug-naive paranoid schizophrenia and 26 healthy subjects matched with age, gender, and education level were scanned with DTI. An automated TBSS approach was employed to analyze the data. Voxel-wise statistics revealed that patients with paranoid schizophrenia had decreased fractional anisotropy (FA) values in the right superior longitudinal fasciculus (SLF) II, the right fornix, the right internal capsule, and the right external capsule compared to healthy subjects. Patients did not have increased FA values in any brain regions compared to healthy subjects. There was no correlation between the FA values in any brain regions and patient demographics and the severity of illness. Our findings suggest right-sided alterations of WM integrity in the WM tracts of cortical and subcortical regions may play an important role in the pathogenesis of paranoid schizophrenia. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Outcomes of Peritonitis in Children on Peritoneal Dialysis: A 25-Year Experience at Severance Hospital

    Science.gov (United States)

    Lee, Kyong Ok; Park, Se Jin; Kim, Ji Hong; Lee, Jae Seung; Kim, Pyung Kil

    2013-01-01

    Purpose Relatively little is known on the microbiology, risk factors and outcomes of peritoneal dialysis (PD)-associated peritonitis in Korean children. We performed this study in order to evaluate the incidence, treatment and clinical outcomes of peritonitis in pediatric PD patients at Severance Hospital. Materials and Methods We analyzed data from 57 PD patients younger than 18 years during the period between June 1, 1986 and December 31, 2011. The collected data included gender, age at commencement of PD, age at peritonitis, incidence of peritonitis, underlying causes of end stage renal disease, microbiology of peritonitis episodes, antibiotics sensitivity, modality and outcomes of PD. Results We found 56 episodes of peritonitis in 23 of the 57 PD patients (0.43 episodes/patient-year). Gram-positive bacteria were the most commonly isolated organisms (40 episodes, 71.4%). Peritonitis developed in 17 patients during the first 6 months following initiation of PD (73.9%). Peritonitis episodes rarely resulted in relapse or the need for permanent hemodialysis and no patient deaths were directly attributable to peritonitis. Antibiotic regimens included cefazolin+tobramycin from the years of 1986 to 2000 and cefazolin+ceftazidime from the years of 2001 to 2011. While antibiotic therapy was successful in 48 episodes (85.7%), the treatment was ineffective in 8 episodes (14.3%). The rate of continuous ambulatory PD (CAPD) peritonitis was statistically higher than that of automated PD (APD) (p=0.025). Conclusion Peritonitis was an important complication of PD therapy and we observed a higher incidence of PD peritonitis in patients with CAPD when compared to APD. PMID:23709435

  2. Mismatch negativity in chronic schizophrenia and first-episode schizophrenia.

    Science.gov (United States)

    Salisbury, Dean F; Shenton, Martha E; Griggs, Carlye B; Bonner-Jackson, Aaron; McCarley, Robert W

    2002-08-01

    Mismatch negativity (MMN) is an event-related brain potential that is sensitive to stimulus deviation from a repetitive pattern. The MMN is thought primarily to reflect the activity of sensory memory, with, at most, moderate influences of higher-level cognitive processes, such as attention. The MMN is reported to be reduced in patients with chronic schizophrenia. However, it is unknown whether MMN is reduced in patients with first-episode schizophrenia (at first hospitalization). Subject groups comprised patients with chronic schizophrenia (n = 16) and older control subjects (n = 13), and patients with first-episode schizophrenia (n = 21) and younger control subjects (n = 27). The MMN was visualized by subtracting the averaged event-related brain potential to standard tones (1 kHz [95% of all tones]) from the event-related brain potential to pitch-deviant tones (1.2 kHz [5% of all tones]). The MMN voltage was the mean voltage from 100 to 200 milliseconds. Pitch-deviant MMN was reduced by approximately 47% in patients with chronic illness along the sagittal midline relative to controls. The MMN was not reduced in patients with first-episode schizophrenia. All 4 groups showed approximately 64% larger MMN to pitch-deviant tones over the right hemisphere compared with the left hemisphere. The pitch-deviant MMN reductions present in patients with chronic schizophrenia are not present at first hospitalization. The sensory, echoic memory functions indexed by MMN seem unaffected early in the schizophrenia disease process. Reductions in MMN amplitude may develop over time and index the progression of the disorder, although that can only be definitively determined by longitudinal assessments.

  3. Does hospital ownership affect patient experience? An investigation into public-private sector differences in England.

    Science.gov (United States)

    Pérotin, Virginie; Zamora, Bernarda; Reeves, Rachel; Bartlett, Will; Allen, Pauline

    2013-05-01

    Using patient experience survey data, the paper investigates whether hospital ownership affects the level of quality reported by patients whose care is funded by the National Health Service in areas other than clinical quality. We estimate a switching regression model that accounts for (i) some observable characteristics of the patient and the hospital episode; (ii) selection into private hospitals; and (iii) unmeasured hospital characteristics captured by hospital fixed effects. We find that the experience reported by patients in public and private hospitals is different, i.e. most dimensions of quality are delivered differently by the two types of hospitals, with each sector offering greater quality in certain specialties or to certain groups of patients. However, the sum of all ownership effects is not statistically different from zero at sample means. In other words, hospital ownership in and of itself does not affect the level of quality of the average patient's reported experience. Differences in mean reported quality levels between the private and public sectors are entirely attributable to patient characteristics, the selection of patients into public or private hospitals and unobserved characteristics specific to individual hospitals, rather than to hospital ownership. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. Children's episodic memory.

    Science.gov (United States)

    Ghetti, Simona; Lee, Joshua

    2011-07-01

    Episodic memory develops during childhood and adolescence. This trajectory depends on several underlying processes. In this article, we first discuss the development of the basic binding processes (e.g., the processes by which elements are bound together to form a memory episode) and control processes (e.g., reasoning and metamemory processes) involved in episodic remembering. Then, we discuss the role of these processes in false-memory formation. In the subsequent sections, we examine the neural substrates of the development of episodic memory. Finally, we discuss atypical development of episodic memory. As we proceed through the article, we suggest potential avenues for future research. WIREs Cogni Sci 2011 2 365-373 DOI: 10.1002/wcs.114 For further resources related to this article, please visit the WIREs website. Copyright © 2010 John Wiley & Sons, Ltd.

  5. Temperament and personality in bipolar I patients with and without mixed episodes.

    Science.gov (United States)

    Röttig, Dörthe; Röttig, Stephan; Brieger, Peter; Marneros, Andreas

    2007-12-01

    Personality and temperament are supposed to have an impact on the clinical expression and course of an affective disorder. There is some indication, that mixed episodes result from an admixture of inverse temperamental factors to a manic syndrome. In a preliminary report [Brieger, P., Roettig, S., Ehrt, U., Wenzel, A., Bloink, R., Marneros, A., 2003. TEMPS-a scale in 'mixed' and 'pure' manic episodes: new data and methodological considerations on the relevance of joint anxious-depressive temperament traits. J. Affect. Disord. 73, 99-104] we reported support for this assumption. The present study completes the preliminary results and compares patients with and without mixed episodes with respect to personality and personality disorders in addition. Patients who had been hospitalized for bipolar I disorder were reassessed after 4.8 years. We examined temperament (TEMPS-A), personality (NEO-FFI) and frequency of personality disorders (SCID-II). Furthermore, illness-related parameters like age at first treatment, depressive and manic symptomatology, frequency and type of episodes and level of functioning were obtained and patients with and without mixed episodes were compared. Patients with (n=49) and without mixed episodes (n=86) did not differ significantly with regard to the illness-related parameters and personality dimensions. The frequency of personality disorders was significantly higher in patients with prior mixed episodes. With respect to temperament, scores of the depressive, cyclothymic, irritable and anxious temperament were significantly higher in patients with mixed episodes. We were not able to assess premorbid temperament and premorbid personality. The findings of the present study support the assumption of Akiskal [Akiskal, H.S., 1992b. The distinctive mixed states of bipolar I, II, and III. Clin. Neuropharmacol. 15 Suppl 1 Pt A, 632-633.] that mixed episodes are more frequent in subjects with inverse temperament.

  6. 38.4 PREVALENCE OF ANTI-NEURONAL ANTIBODIES IN PATIENTS ADMITTED WITH FIRST EPISODE OF PSYCHOSIS AND THEIR CLINICAL OUTCOMES

    Science.gov (United States)

    Scott, James; Gillis, David; Ryan, Alex; Hargovan, Hethal; Blum, Stefan

    2018-01-01

    Abstract Background Anti-neuronal antibodies are associated with psychosis although their clinical significance in first episode of psychosis (FEP) is undetermined. This study examined the prevalence of anti-neuronal antibodies in patients admitted to hospital for treatment of their first episode of psychosis and described clinical presentations and treatment outcomes of those who were antibody positive. Methods Between July 2013 and May 2015, all consenting patients aged between 12 and 50 admitted for their first episode of psychosis to three mental health hospitals in Queensland, Australia, were tested for anti-neuronal antibodies in serum. Antibody positive patients were referred for neurological and immunological consultation and treatment. Results During the study, 154 FEP patients were admitted with their first episode of psychosis and 113 consented to participate. Six patients were found to have anti-neuronal antibodies; (anti-NMDAR antibodies [n = 4], VGKC antibody [n = 1], antibody against uncharacterised antigen [n = 1]). Of these, five received immunotherapy, leading to complete resolution of psychosis in four. Discussion A small, but significant subgroup of patients with first episode psychosis have anti-neuronal antibodies detectable in serum and evidence of central nervous system autoimmune pathology. Early identification of these patients and referral for appropriate treatment is critical to optimise recovery.

  7. Effects of Short-Term Inpatient Treatment on Sensitivity to a Size Contrast Illusion in First-Episode Psychosis and Multiple-Episode Schizophrenia

    Directory of Open Access Journals (Sweden)

    Steven M Silverstein

    2013-07-01

    Full Text Available Introduction: In the Ebbinghaus illusion, a shape appears larger than its actual size when surrounded by small shapes and smaller than its actual size when surrounded by large shapes. Resistance to this illusion has been previously reported in schizophrenia, and linked to disorganized symptoms and poorer prognosis in cross-sectional studies. It is unclear, however, when in the course of illness this resistance first emerges or how it varies longitudinally with illness phase. Method: First-episode psychosis patients, multiple-episode schizophrenia patients and healthy controls completed a psychophysical task at two different time points, corresponding to hospital admission and discharge for patients. The task required judging the relative size of two circles centered on either side of the screen. Targets were presented without context (baseline, or were surrounded by shapes that made the size judgment harder or easier (misleading and helpful contexts, respectively. Context sensitivity was operationalized as improvement relative to baseline in the helpful condition minus the amount of decrement (relative to baseline in the misleading condition. Results: At admission, context sensitivity was lower in the multiple-episode group than in the other groups, and was marginally less in the first episode than in the control group. In addition, schizophrenia patients were significantly more and less accurate than the other groups in the misleading and helpful conditions, respectively. At discharge, all groups exhibited similar context sensitivity. Poorer context sensitivity was related to higher levels of disorganized symptoms, and lower level of depression, excitement, and positive symptoms. Discussion: Resistance to the Ebbinghaus illusion, as a characteristic of the acute phase of schizophrenia, emerges after the first episode of psychosis. This suggests that visual context processing is a state-marker in schizophrenia and a biomarker of relapse and

  8. Imagining the personal past: Episodic counterfactuals compared to episodic memories and episodic future projections

    DEFF Research Database (Denmark)

    Özbek, Müge; Bohn, Annette; Berntsen, Dorthe

    2017-01-01

    Episodic counterfactuals are imagined events that could have happened, but did not happen, in a person’s past. Such imagined past events are important aspects of mental life, affecting emotions, decisions, and behaviors. However, studies examining their phenomenological characteristics and content...... are few. Here we introduced a new method to systematically compare self-generated episodic counterfactuals to self-generated episodic memories and future projections with regard to their phenomenological characteristics (e.g., imagery, emotional valence, rehearsal) and content (e.g., reference to cultural...... distance. The findings show that imagined events are phenomenologically different from memories of experienced events, consistent with reality monitoring theory, and that imagined future events are different from both actual and imagined past events, consistent with some theories of motivation....

  9. How do episodic and semantic memory contribute to episodic foresight in young children?

    Science.gov (United States)

    Martin-Ordas, Gema; Atance, Cristina M; Caza, Julian S

    2014-01-01

    Humans are able to transcend the present and mentally travel to another time, place, or perspective. Mentally projecting ourselves backwards (i.e., episodic memory) or forwards (i.e., episodic foresight) in time are crucial characteristics of the human memory system. Indeed, over the past few years, episodic memory has been argued to be involved both in our capacity to retrieve our personal past experiences and in our ability to imagine and foresee future scenarios. However, recent theory and findings suggest that semantic memory also plays a significant role in imagining future scenarios. We draw on Tulving's definition of episodic and semantic memory to provide a critical analysis of their role in episodic foresight tasks described in the developmental literature. We conclude by suggesting future directions of research that could further our understanding of how both episodic memory and semantic memory are intimately connected to episodic foresight.

  10. HOW DO EPISODIC AND SEMANTIC MEMORY CONTRIBUTE TO EPISODIC FORESIGHT IN YOUNG CHILDREN?

    Directory of Open Access Journals (Sweden)

    Gema eMartin Ordas

    2014-07-01

    Full Text Available Humans are able to transcend the present and mentally travel to another time, place, or perspective. Mentally projecting ourselves backwards (i.e., episodic memory or forwards (i.e., episodic foresight in time are crucial characteristics of the human memory system. Indeed, over the past few years, episodic memory has been argued to be involved both in our capacity to retrieve our personal past experiences and in our ability to imagine and foresee future scenarios. However, recent theory and findings suggest that semantic memory also plays a significant role in imagining future scenarios. We draw on Tulving’s definition of episodic and semantic memory to provide a critical analysis of their role in episodic foresight tasks described in the developmental literature. We conclude by suggesting future directions of research that could further our understanding of how both episodic memory and semantic memory are intimately connected to episodic foresight.

  11. How do episodic and semantic memory contribute to episodic foresight in young children?

    Science.gov (United States)

    Martin-Ordas, Gema; Atance, Cristina M.; Caza, Julian S.

    2014-01-01

    Humans are able to transcend the present and mentally travel to another time, place, or perspective. Mentally projecting ourselves backwards (i.e., episodic memory) or forwards (i.e., episodic foresight) in time are crucial characteristics of the human memory system. Indeed, over the past few years, episodic memory has been argued to be involved both in our capacity to retrieve our personal past experiences and in our ability to imagine and foresee future scenarios. However, recent theory and findings suggest that semantic memory also plays a significant role in imagining future scenarios. We draw on Tulving’s definition of episodic and semantic memory to provide a critical analysis of their role in episodic foresight tasks described in the developmental literature. We conclude by suggesting future directions of research that could further our understanding of how both episodic memory and semantic memory are intimately connected to episodic foresight. PMID:25071690

  12. Cognitive dissonance resolution depends on episodic memory.

    Science.gov (United States)

    Chammat, Mariam; Karoui, Imen El; Allali, Sébastien; Hagège, Joshua; Lehongre, Katia; Hasboun, Dominique; Baulac, Michel; Epelbaum, Stéphane; Michon, Agnès; Dubois, Bruno; Navarro, Vincent; Salti, Moti; Naccache, Lionel

    2017-01-23

    The notion that past choices affect preferences is one of the most influential concepts of social psychology since its first report in the 50 s, and its theorization within the cognitive dissonance framework. In the free-choice paradigm (FCP) after choosing between two similarly rated items, subjects reevaluate chosen items as more attractive and rejected items as less attractive. However the relations prevailing between episodic memory and choice-induced preference change (CIPC) remain highly debated: is this phenomenon dependent or independent from memory of past choices? We solve this theoretical debate by demonstrating that CIPC occurs exclusively for items which were correctly remembered as chosen or rejected during the choice stage. We used a combination of fMRI and intra-cranial electrophysiological recordings to reveal a modulation of left hippocampus activity, a hub of episodic memory retrieval, immediately before the occurrence of CIPC during item reevaluation. Finally, we show that contrarily to a previous influential report flawed by a statistical artifact, this phenomenon is absent in amnesic patients for forgotten items. These results demonstrate the dependence of cognitive dissonance on conscious episodic memory. This link between current preferences and previous choices suggests a homeostatic function of this regulative process, aiming at preserving subjective coherence.

  13. Probabilistic linkage to enhance deterministic algorithms and reduce data linkage errors in hospital administrative data.

    Science.gov (United States)

    Hagger-Johnson, Gareth; Harron, Katie; Goldstein, Harvey; Aldridge, Robert; Gilbert, Ruth

    2017-06-30

     BACKGROUND: The pseudonymisation algorithm used to link together episodes of care belonging to the same patients in England (HESID) has never undergone any formal evaluation, to determine the extent of data linkage error. To quantify improvements in linkage accuracy from adding probabilistic linkage to existing deterministic HESID algorithms. Inpatient admissions to NHS hospitals in England (Hospital Episode Statistics, HES) over 17 years (1998 to 2015) for a sample of patients (born 13/28th of months in 1992/1998/2005/2012). We compared the existing deterministic algorithm with one that included an additional probabilistic step, in relation to a reference standard created using enhanced probabilistic matching with additional clinical and demographic information. Missed and false matches were quantified and the impact on estimates of hospital readmission within one year were determined. HESID produced a high missed match rate, improving over time (8.6% in 1998 to 0.4% in 2015). Missed matches were more common for ethnic minorities, those living in areas of high socio-economic deprivation, foreign patients and those with 'no fixed abode'. Estimates of the readmission rate were biased for several patient groups owing to missed matches, which was reduced for nearly all groups. CONCLUSION: Probabilistic linkage of HES reduced missed matches and bias in estimated readmission rates, with clear implications for commissioning, service evaluation and performance monitoring of hospitals. The existing algorithm should be modified to address data linkage error, and a retrospective update of the existing data would address existing linkage errors and their implications.

  14. Negative symptoms in first episode non-affective psychosis.

    Science.gov (United States)

    Malla, Ashok K; Takhar, Jatinder J; Norman, Ross M G; Manchanda, Rahul; Cortese, Leonard; Haricharan, Raj; Verdi, Mary; Ahmed, Rashid

    2002-06-01

    To determine the prevalence of negative symptoms and to examine secondary sources of influence on negative symptoms and the role of specific negative symptoms in delay associated with seeking treatment in first episode non-affective psychosis. One hundred and ten patients who met Diagnostic Statistical Manual-IV (DSM-IV) criteria for a first episode of schizophrenia spectrum psychoses were rated for assessment of negative, positive, depressive and extrapyramidal symptoms, the premorbid adjustment scale and assessment of demographic and clinical characteristics including duration of untreated psychosis (DUP). Alogia/flat affect and avolition/anhedonia were strongly influenced by parkinsonian and depressive symptoms, respectively. A substantial proportion (26.8%) of patients showed at a least moderate level of negative symptoms not confounded by depression and Parkinsonism. DUP was related only to avolition/anhedonia while flat affect/alogia was related to male gender, diagnosis of schizophrenia, age of onset and the length of the prodrome. Negative symptoms that are independent of the influence of positive symptoms, depression and extra pyramidal symptoms (EPS) are present in a substantial proportion of first episode psychosis patients and delay in seeking treatment is associated mainly with avolition and anhedonia.

  15. Rates of First Episode of Psychosis in a Defined Catchment Area in Greece

    OpenAIRE

    Peritogiannis, Vaios; Mantas, Christos; Tatsioni, Athina; Mavreas, Venetsanos

    2013-01-01

    This is the first Greek study presenting epidemiologic data on first-episode psychosis (FEP) patients in a defined catchment area. Data for first episode psychotic patients during a two-year period (2008 and 2009) were obtained by all the mental health providers in the area, public or private. A total of 132 FEP patients were examined in the 2-year period in the catchment area. Most of the patients (61.4%) were diagnosed and treated by private practicing psychiatrists. Statistical analysis sh...

  16. Episodic Specificity in Acquiring Thematic Knowledge of Novel Words from Descriptive Episodes.

    Science.gov (United States)

    Zhang, Meichao; Chen, Shuang; Wang, Lin; Yang, Xiaohong; Yang, Yufang

    2017-01-01

    The current study examined whether thematic relations of the novel words could be acquired via descriptive episodes, and if yes, whether it could be generalized to thematically related words in a different scenario. In Experiment 1, a lexical decision task was used where the novel words served as primes for target words in four conditions: (1) corresponding concepts of the novel words, (2) thematically related words in the same episodes as that in learning condition, (3) thematically related words in different episodes, or (4) unrelated words served as targets. Event related potentials elicited by the targets revealed that compared to the unrelated words, the corresponding concepts and thematically related words in the same episodes elicited smaller N400s with a frontal-central distribution, whereas the thematically related words in different episodes elicited an enhanced late positive component. Experiment 2 further showed a priming effect of the corresponding concepts on the thematically related words in the same episodes as well as in a different episode, indicating that the absence of a priming effect of the learned novel words on the thematically related words in different episode could not be attributed to inappropriate selection of thematically related words in the two conditions. These results indicate that only the corresponding concepts and the thematically related words in the learning episodes were successfully primed, whereas the thematic association between the novel words and the thematically related words in different scenarios could only be recognized in a late processing stage. Our findings suggest that thematic knowledge of novel words is organized via separate scenarios, which are represented in a clustered manner in the semantic network.

  17. The influence of comorbid personality disorder and neuroticism on treatment outcome in first episode depression

    DEFF Research Database (Denmark)

    Bock, Camilla; Bukh, Jens Drachmann; Vinberg, Maj

    2010-01-01

    setting were consecutively sampled from the Danish Psychiatric Central Research Register. The patients participated in an extensive interview including the Schedules for Clinical Assessment in Neuropsychiatry, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders and a detailed...... of antidepressant treatment, and (2) 2 trials of antidepressant treatment. Further personality traits were assessed by means of the Eysenck Personality Questionnaire. RESULTS: Among a total of 301 patients with a single depressive episode, 31.9% fulfilled diagnostic criteria for at least 1 personality disorder......BACKGROUND: It has never been investigated whether comorbid personality disorder or neuroticism predicts a poor treatment outcome in first episode depression. METHODS: Medically treated patients discharged with a diagnosis of a single depressive episode from a psychiatric in- or outpatient hospital...

  18. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

    Science.gov (United States)

    2017-01-03

    This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

  19. Do stressful life events predict medical treatment outcome in first episode of depression?

    DEFF Research Database (Denmark)

    Bock, Camilla; Bukh, Jens Drachmann; Vinberg, Maj

    2009-01-01

    BACKGROUND: It is unclear whether medical treatment outcome in first episode depression differ for patients with and without stressful life events prior to onset of depression. METHODS: Patients discharged with a diagnosis of a single depressive episode from a psychiatric in- or outpatient hospital......-II) and the interview of recent life events (IRLE). Medical treatment history was assessed in detail using standardised procedures (TRAQ). Remission was defined as a score or= 4 on TRAQ following (1) first trial of antidepressant treatment (2) two adequate trials of antidepressant treatment. RESULTS: A total of 399...... patients participated in the interview and among these 301 patients obtained a SCAN diagnosis of a single depressive episode. A total of 62.8% of the 301 patients experienced at least one moderate to severe stressful life event in a 6 months period prior to symptom onset. The presence of a stressful life...

  20. Are P values and statistical assessments in poster abstracts presented at annual meetings of Taiwan Society of Anesthesiologists relative to the characteristics of hospitals?

    Science.gov (United States)

    Lee, Fu-Jung; Wu, Chih-Cheng; Peng, Shih-Yen; Fan, Kuo-Tung

    2007-09-01

    Many anesthesiologists in medical centers (MC) or in anesthesiologist-training hospitals (ATH) are accustomed to present their research data in the form of poster abstracts at the annual meetings of Taiwan Society of Anesthesiologists (TSA) to represent their academic gainings in a designated period of time. However, an orphaned P value without mentioning the related specified statistical test has frequently been found in these articles. The difference in presentation of statistical test after P value between MC/ATH and non-MC/non-ATH in recent three TSA consecutive annual meetings was explored in this article. We collected the proceedings handbooks of TSA annual meetings in a period spanning 3 yrs (2003 to 2005) and analyzed the hospital characteristic of first institute-byliner in the poster abstract. Data were analyzed with Fisher's exact test and statistical significance was assumed if P poster abstracts with byliners of 20 hospitals. Only 2 of the 20 hospitals were accredited as non-ATH and 4 as non-MC. There were 64 (63%) abstracts without specified statistical test after P value and no significant difference was found among each category. (P = 0.47 in ATH vs. non-ATH and P = 0.07 in MC vs. non-MC). The basic concept of P value with specified statistical test was not applicable comprehensively in poster abstracts of the annual conferences. Based on our wishful intention, we suggest that the anesthesia administrators and senior anesthesiologists at ATH or MC, and the members of the committee responsible for running academic affairs in TSA, should pay attention to this prodigy and work together to improve our basic statistics in poster presentation.

  1. The evolution of episodic memory

    Science.gov (United States)

    Allen, Timothy A.; Fortin, Norbert J.

    2013-01-01

    One prominent view holds that episodic memory emerged recently in humans and lacks a “(neo)Darwinian evolution” [Tulving E (2002) Annu Rev Psychol 53:1–25]. Here, we review evidence supporting the alternative perspective that episodic memory has a long evolutionary history. We show that fundamental features of episodic memory capacity are present in mammals and birds and that the major brain regions responsible for episodic memory in humans have anatomical and functional homologs in other species. We propose that episodic memory capacity depends on a fundamental neural circuit that is similar across mammalian and avian species, suggesting that protoepisodic memory systems exist across amniotes and, possibly, all vertebrates. The implication is that episodic memory in diverse species may primarily be due to a shared underlying neural ancestry, rather than the result of evolutionary convergence. We also discuss potential advantages that episodic memory may offer, as well as species-specific divergences that have developed on top of the fundamental episodic memory architecture. We conclude by identifying possible time points for the emergence of episodic memory in evolution, to help guide further research in this area. PMID:23754432

  2. Gauging Skills of Hospital Security Personnel: a Statistically-driven, Questionnaire-based Approach.

    Science.gov (United States)

    Rinkoo, Arvind Vashishta; Mishra, Shubhra; Rahesuddin; Nabi, Tauqeer; Chandra, Vidha; Chandra, Hem

    2013-01-01

    This study aims to gauge the technical and soft skills of the hospital security personnel so as to enable prioritization of their training needs. A cross sectional questionnaire based study was conducted in December 2011. Two separate predesigned and pretested questionnaires were used for gauging soft skills and technical skills of the security personnel. Extensive statistical analysis, including Multivariate Analysis (Pillai-Bartlett trace along with Multi-factorial ANOVA) and Post-hoc Tests (Bonferroni Test) was applied. The 143 participants performed better on the soft skills front with an average score of 6.43 and standard deviation of 1.40. The average technical skills score was 5.09 with a standard deviation of 1.44. The study avowed a need for formal hands on training with greater emphasis on technical skills. Multivariate analysis of the available data further helped in identifying 20 security personnel who should be prioritized for soft skills training and a group of 36 security personnel who should receive maximum attention during technical skills training. This statistically driven approach can be used as a prototype by healthcare delivery institutions worldwide, after situation specific customizations, to identify the training needs of any category of healthcare staff.

  3. The prognostic ability of the STarT Back Tool was affected by episode duration

    DEFF Research Database (Denmark)

    Morsø, Lars; Kongsted, Alice; Hestbæk, Lise

    2016-01-01

    were not systematically affected by SBT risk subgroup (non-stratified care). Using generalised estimating equations, we investigated statistical interactions between SBT risk subgroups and potentially influential factors on the prognostic ability of the SBT subgroups, when Roland Morris Disability...... Questionnaire scores were the outcome. RESULTS: SBT risk subgroup, age, care setting, and episode duration were all independent prognostic factors. The only investigated factor that modified the prognostic ability of the SBT subgroups was episode duration. CONCLUSIONS: These results indicate that the prognostic...

  4. Incidence and Risk Factors of Childhood Pneumonia-Like Episodes in Biliran Island, Philippines--A Community-Based Study.

    Directory of Open Access Journals (Sweden)

    Hisato Kosai

    Full Text Available Pneumonia is a leading cause of deaths in infants and young children in developing countries, including the Philippines. However, data at the community level remains limited. Our study aimed to estimate incidence and mortality rates and to evaluate risk factors and health-seeking behavior for childhood pneumonia. A household level interview survey was conducted in Biliran Island, the Philippines. Caregivers were interviewed using a semi-structured questionnaire to check if children had symptoms suggesting pneumonia-like episodes from June 2011 to May 2012. Of 3,327 households visited in total, 3,302 (99.2% agreed to participate, and 5,249 children less than 5 years of age were included in the study. Incidence rates of pneumonia-like episodes, severe pneumonia-like episodes, and pneumonia-associated mortality were 105, 61, and 0.9 per 1,000 person-years, respectively. History of asthma [hazard ratio (HR: 5.85, 95% confidence interval (CI: 4.83-7.08], low socioeconomic status (SES (HR: 1.11, 95% CI: 1.02-1.20, and long travel time to the healthcare facility estimated by cost distance analysis (HR: 1.32, 95% CI: 1.09-1.61 were significantly associated with the occurrence of pneumonia-like episodes by the Cox proportional hazards model. For severe pneumonia-like episodes, a history of asthma (HR: 8.39, 95% CI: 6.54-10.77 and low SES (HR: 1.30, 95% CI: 1.17-1.45 were significant risk factors. Children who had a long travel time to the hospital were less likely to seek hospital care (Odds ratio: 0.32, 95% CI: 0.19-0.54 when they experienced severe pneumonia-like episodes. Incidence of pediatric pneumonia-like episodes was associated with a history of asthma, SES, and the travel time to healthcare facilities. Travel time was also identified as a strong indicator for health-seeking behavior. Improved access to healthcare facilities is important for early and effective management. Further studies are warranted to understand the causal relationship

  5. Incidence and Risk Factors of Childhood Pneumonia-Like Episodes in Biliran Island, Philippines—A Community-Based Study

    Science.gov (United States)

    Kosai, Hisato; Tamaki, Raita; Saito, Mayuko; Tohma, Kentaro; Alday, Portia Parian; Tan, Alvin Gue; Inobaya, Marianette Tawat; Suzuki, Akira; Kamigaki, Taro; Lupisan, Soccoro; Tallo, Veronica; Oshitani, Hitoshi

    2015-01-01

    Pneumonia is a leading cause of deaths in infants and young children in developing countries, including the Philippines. However, data at the community level remains limited. Our study aimed to estimate incidence and mortality rates and to evaluate risk factors and health-seeking behavior for childhood pneumonia. A household level interview survey was conducted in Biliran Island, the Philippines. Caregivers were interviewed using a semi-structured questionnaire to check if children had symptoms suggesting pneumonia-like episodes from June 2011 to May 2012. Of 3,327 households visited in total, 3,302 (99.2%) agreed to participate, and 5,249 children less than 5 years of age were included in the study. Incidence rates of pneumonia-like episodes, severe pneumonia-like episodes, and pneumonia-associated mortality were 105, 61, and 0.9 per 1,000 person-years, respectively. History of asthma [hazard ratio (HR): 5.85, 95% confidence interval (CI): 4.83–7.08], low socioeconomic status (SES) (HR: 1.11, 95% CI: 1.02–1.20), and long travel time to the healthcare facility estimated by cost distance analysis (HR: 1.32, 95% CI: 1.09–1.61) were significantly associated with the occurrence of pneumonia-like episodes by the Cox proportional hazards model. For severe pneumonia-like episodes, a history of asthma (HR: 8.39, 95% CI: 6.54–10.77) and low SES (HR: 1.30, 95% CI: 1.17–1.45) were significant risk factors. Children who had a long travel time to the hospital were less likely to seek hospital care (Odds ratio: 0.32, 95% CI: 0.19–0.54) when they experienced severe pneumonia-like episodes. Incidence of pediatric pneumonia-like episodes was associated with a history of asthma, SES, and the travel time to healthcare facilities. Travel time was also identified as a strong indicator for health-seeking behavior. Improved access to healthcare facilities is important for early and effective management. Further studies are warranted to understand the causal relationship

  6. Dike intrusions during rifting episodes obey scaling relationships similar to earthquakes

    Science.gov (United States)

    L., Passarelli; E., Rivalta; A., Shuler

    2014-01-01

    As continental rifts evolve towards mid-ocean ridges, strain is accommodated by repeated episodes of faulting and magmatism. Discrete rifting episodes have been observed along two subaerial divergent plate boundaries, the Krafla segment of the Northern Volcanic Rift Zone in Iceland and the Manda-Hararo segment of the Red Sea Rift in Ethiopia. In both cases, the initial and largest dike intrusion was followed by a series of smaller intrusions. By performing a statistical analysis of these rifting episodes, we demonstrate that dike intrusions obey scaling relationships similar to earthquakes. We find that the dimensions of dike intrusions obey a power law analogous to the Gutenberg-Richter relation, and the long-term release of geodetic moment is governed by a relationship consistent with the Omori law. Due to the effects of magma supply, the timing of secondary dike intrusions differs from that of the aftershocks. This work provides evidence of self-similarity in the rifting process. PMID:24469260

  7. Building information for systematic improvement of the prevention of hospital-acquired pressure ulcers with statistical process control charts and regression.

    Science.gov (United States)

    Padula, William V; Mishra, Manish K; Weaver, Christopher D; Yilmaz, Taygan; Splaine, Mark E

    2012-06-01

    To demonstrate complementary results of regression and statistical process control (SPC) chart analyses for hospital-acquired pressure ulcers (HAPUs), and identify possible links between changes and opportunities for improvement between hospital microsystems and macrosystems. Ordinary least squares and panel data regression of retrospective hospital billing data, and SPC charts of prospective patient records for a US tertiary-care facility (2004-2007). A prospective cohort of hospital inpatients at risk for HAPUs was the study population. There were 337 HAPU incidences hospital wide among 43 844 inpatients. A probit regression model predicted the correlation of age, gender and length of stay on HAPU incidence (pseudo R(2)=0.096). Panel data analysis determined that for each additional day in the hospital, there was a 0.28% increase in the likelihood of HAPU incidence. A p-chart of HAPU incidence showed a mean incidence rate of 1.17% remaining in statistical control. A t-chart showed the average time between events for the last 25 HAPUs was 13.25 days. There was one 57-day period between two incidences during the observation period. A p-chart addressing Braden scale assessments showed that 40.5% of all patients were risk stratified for HAPUs upon admission. SPC charts complement standard regression analysis. SPC amplifies patient outcomes at the microsystem level and is useful for guiding quality improvement. Macrosystems should monitor effective quality improvement initiatives in microsystems and aid the spread of successful initiatives to other microsystems, followed by system-wide analysis with regression. Although HAPU incidence in this study is below the national mean, there is still room to improve HAPU incidence in this hospital setting since 0% incidence is theoretically achievable. Further assessment of pressure ulcer incidence could illustrate improvement in the quality of care and prevent HAPUs.

  8. First episode of consciousness loss: setting new standards in acute care management

    Directory of Open Access Journals (Sweden)

    Cuciureanu Dan Iulian

    2017-12-01

    Full Text Available There is a high prevalence of patients addressed to the emergency department presenting a first episode of consciousness loss. The high prevalence of patients admitted to the emergency departments (ED with a first episode of consciousness loss (ECL is well established. Although there are studies assessing acute management in these patients, there is still need for more data on clinical and paraclinical characteristics which may prompt early etiological diagnosis, especially in countries where integrated medical procedures are lacking and access to specialized medical care is still limited. Sudden death syndrome, early cerebral morphological changes emerging in chronic epilepsy is the main motivation for an early diagnosis of epilepsy. The aim of our study was to evaluate demographic, clinical and paraclinical data in adult patients referred to our emergency hospital presenting a first episode of consciousness loss, in order to avoid misdiagnosis (with personal and social high impact and unnecessary anti-epileptic treatment versus underestimation of epilepsy diagnosis. Conclusion: There is a clear need to improve multidisciplinary circuits in patients with a first episode of consciousness loss at a local level, in order to promote accurate and prompt diagnosis. We consider necessary to build a unitary online platform in order to establish an early and complete diagnosis.

  9. A Nearly Lethal Screw: An Unusual Cause of Recurrent Bradycardia and Asystole Episodes after Fixation of the Cervical Spine

    Directory of Open Access Journals (Sweden)

    Amit Frenkel

    2017-01-01

    Full Text Available We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR. Initially, these episodes were attributed to the high cervical spine injury, but, later on, CT scan suggested that a fixation screw abutted on the esophagus and activated the vagus nerve by direct pressure. After repositioning of the cervical fixation, the bradycardia and asystole episodes were no longer observed and the patient was released to a rehabilitation ward. This case is presented in order to alert practitioners to the possibility that, after operative fixation of cervical spine injuries, recurrent episodes of bradyarrhythmia can be caused by incorrect placement of the fixation screws and might be confused with the natural history of the high cervical cord injury.

  10. A STUDY OF THE CLINICAL MANIFESTATIONS, BIOCHEMICAL FINDINGS, PRECIPITATING FACTORS AND COMPLICATIONS IN 56 EPISODES OF DIABETIC KETOACIDOSIS

    OpenAIRE

    M. Rafii

    1998-01-01

    Fifty six episodes of DKA occurred in 33 patients during the period between 1998 -96. These patients were admitted and treated in Bahrami children hospital, a Tehran University teaching medical center. The most frequent clinical manifestations consisted of polyuria and polydipsia (66%), nausea and vomiting (64%), reduction in consciousness (53%), and Kussmaul respiration (53.5%). 54.6% of DKA episodes showed a pH below 7.1. There was a relationship between the severity of acidosis and the tim...

  11. Impact of Neuromuscular Electrical Stimulation (NMES) on 90-Day Episode Costs and Post-Acute Care Utilization in Total Knee Replacement Patients with Disuse Atrophy.

    Science.gov (United States)

    Pal, Sarmistha; Chughtai, Morad; Sultan, Assem A; Khlopas, Anton; Sodhi, Nipun; George, Nicole E; Etcheson, Jennifer I; Gwam, Chukwuweike U; Newman, Jared M; Samuel, Linsen T; Bhave, Anil; DaVanzo, Joan E; Mont, Michael A

    2017-12-22

    This study evaluated differences in: 1) total episode payments, 2) probability of hospital readmission, 3) probability of inpatient rehab facility (IRF) and utilization, and 4) probability of skilled nursing care facility (SNF) utilization in patients who had disuse atrophy and underwent a total knee arthroplasty (TKA) and either did, or did not, receive preoperative home-based neuromuscular electrical stimulation (NMES) therapy. We used the Medicare limited dataset for a 5% sample of beneficiaries from 2014 and 2015 to construct episodes-of-care for TKA (DRG-470) patients with disuse atrophy who underwent a TKA during the 30 days prior to hospital admission and 90 days post-discharge. Patients were stratified into those who either did or did not receive pre- and postoperative NMES therapy. An ordinary least square (OLS) model was used to estimate the impact of NMES on total episode. Linear probability models were used to estimate the impact of NMES on SNF or IRF utilization and readmission. A $3,274 reduction in episode payments for patients who used preoperative NMES versus those who did not (ptotal episode payments and SNF utilization for TKA patients with disuse atrophy who had NMES therapy was demonstrated.

  12. The cost of Clostridium difficile infection (CDI in hospital in Italy

    Directory of Open Access Journals (Sweden)

    Nicola Petrosillo

    2017-04-01

    Full Text Available The cost of Clostridium difficile infection (CDI in hospital in ItalyObjectiveTo describe characteristics, resource utilization and cost for patients experiencing a primary episode of CDI and recurrent CDI.MethodsA retrospective observational cohort study was conducted. CDI data were collected with an electronic case report form (CRF from five Hospitals in Italy. Hospitals collected all resource use attributable to CDI during the period 2011-2014. All resource use from initial presentation to the healthcare provider for CDI symptoms, until resolution of infection attributable to CDI in each enrolled patient was included. The patient cohort was analysed both as a whole and in stratified subgroups (by age, gender and co-morbidities. The impact of CDI on hospital length of stay (LOS was used to calculate CDI-attributable costs. The total cost of a CDI episode was estimated by multiplying each resource used by its unit cost (national tariffs and market prices; finally, the mean cost/patient was calculated across the cohort.ResultsIn total, data were collected for 488 adult infected patients (mean age 76.0 years [SD ± 15.48]; female 56.6%. Five hundred and three (503 episodes were evaluated (mean number per patient: 1.03 [SD ± 0.23]. LOS attributable to CDI was 14.6 days (SD ± 13.14. Attributable cost per adult patient was €10,224.08 (SD ± €8,963.86, with the majority of the cost being due to hospitalization. The mean cost of a recurrent episode of CDI was €9,504.87 [SD ± €8,614.11].ConclusionsThese findings show that the economic burden of CDI is considerable in Italy. The most important cost driver was the LOS attributable to CDI.

  13. Are previous episodes of bacterial vaginosis a predictor for vaginal symptoms in breast cancer patients treated with aromatase inhibitors?

    DEFF Research Database (Denmark)

    Gade, Malene R; Goukasian, Irina; Panduro, Nathalie

    2018-01-01

    Objective To estimate the prevalence of vaginal symptoms in postmenopausal women with breast cancer exposed to aromatase inhibitors, and to investigate if the risk of vaginal symptoms is associated with previous episodes of bacterial vaginosis. Methods Patients from Rigshospitalet and Herlev...... University Hospital, Denmark, were identified through the register of Danish Breast Cancer Cooperation Group and 78 patients participated in the study. Semiquantitave questionnaires and telephone interview were used to assess the prevalence of vaginal symptoms and previous episode(s) of bacterial vaginosis....... Multivariable logistic regression models were used to assess the association between vaginal symptoms and previous episodes of bacterial vaginosis. Results Moderate to severe symptoms due to vaginal itching/irritation were experienced by 6.4% (95% CI: 2.8-14.1%), vaginal dryness by 28.4% (95% CI: 19...

  14. SYMPTOM AND FUNCTIONAL TRAITS OF BRIEF MAJOR DEPRESSIVE EPISODES AND DISCRIMINATION OF BEREAVEMENT.

    Science.gov (United States)

    McCabe, Patrick J; Christopher, Paul P

    2016-02-01

    Despite the removal of the bereavement exclusion from DSM-5, clinicians may feel uncertain on how to proceed when caring for a patient who presents with depressive symptoms following the death of someone close. The ability to better distinguish, on a symptom and functional level, between patients who experience depression in the context of bereavement and those with nonbereavement-related depression, could help guide clinical decision making. Individual and clustered depressive symptom and impairment measures were used for modeling bereavement status within a nationally representative longitudinal cohort. Deviance, linear shrinkage factor, and bias-corrected c-statistic were used for identifying a well-calibrated and discriminating final model. Of the 450 (1.2%) respondents with a single brief major depressive episode, 162 (38.4%) reported the episode as bereavement-related. The bereaved were less likely to endorse worthlessness (P depressive episodes following the death of a loved one from other brief episodes. These differences can help guide clinical care of patients who present with depressive symptoms shortly after a loved one's death. © 2015 Wiley Periodicals, Inc.

  15. ECG-derived Cheyne-Stokes respiration and periodic breathing in healthy and hospitalized populations.

    Science.gov (United States)

    Tinoco, Adelita; Drew, Barbara J; Hu, Xiao; Mortara, David; Cooper, Bruce A; Pelter, Michele M

    2017-11-01

    Cheyne-Stokes respiration (CSR) has been investigated primarily in outpatients with heart failure. In this study we compare CSR and periodic breathing (PB) between healthy and cardiac groups. We compared CSR and PB, measured during 24 hr of continuous 12-lead electrocardiographic (ECG) Holter recording, in a group of 90 hospitalized patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome (ACS) to a group of 100 healthy ambulatory participants. We also examined CSR and PB in the 90 patients presenting with ACS symptoms, divided into a group of 39 (43%) with confirmed ACS, and 51 (57%) with a cardiac diagnosis but non-ACS. SuperECG software was used to derive respiration and then calculate CSR and PB episodes from the ECG Holter data. Regression analyses were used to analyze the data. We hypothesized SuperECG software would differentiate between the groups by detecting less CSR and PB in the healthy group than the group of patients presenting to the emergency department with ACS symptoms. Hospitalized patients with suspected ACS had 7.3 times more CSR episodes and 1.6 times more PB episodes than healthy ambulatory participants. Patients with confirmed ACS had 6.0 times more CSR episodes and 1.3 times more PB episodes than cardiac non-ACS patients. Continuous 12-lead ECG derived CSR and PB appear to differentiate between healthy participants and hospitalized patients. © 2017 Wiley Periodicals, Inc.

  16. Incidence of antibiotics resistance among uropathogens in Omani children presenting with a single episode of urinary tract infection.

    Science.gov (United States)

    Sharef, Sharef W; El-Naggari, Mohamed; Al-Nabhani, Dana; Al Sawai, Ali; Al Muharrmi, Zakaria; Elnour, Ibtisam

    2015-01-01

    Urinary tract infection (UTI) is one of the most common community-acquired infections. Different organisms can be the cause of UTI in children, with resistance to antibiotics becoming a significant problem in the choice of treatment. Worldwide studies have documented the prevalence of uropathogens in different countries. However, there is no previous study documenting the incidence of different uropathogens in Oman. We aim to report the most common uropathogens and their antibiotic sensitivity patterns in children presenting with documented, single episode UTI at a tertiary hospital in Oman. A retrospective analysis of all Omani children below 14 years who presented with a case of first documented UTI to SQUH between September 2008 and August 2012 was conducted. Data were obtained from the patients' electronic records in the hospital information system. Data were then analyzed using SSPS (Statistical Package for Social Sciences program, Version 20, IBM, Chicago, IL, USA). In the retrospective review of all urine cultures, 438 positive urine cultures were identified. Out of those, 208 (47.5%) belonged to children with their first episode of UTI. Thirty-three patients were excluded and 75 patients were included in the final analysis. Escherichia coli was the most frequently encountered uropathogen in our cohort (69%), followed by Klebsiella pneumoniae infection (17%). Nearly half (46.6%) of these two common organism were resistant to Cotrimoxazole, while 31% of them were resistant to Augmentin. Twenty-four percent of the E. coli and K. pneumoniae strains were resistant to Cefuroxime, and only 10% were resistant to nitrofurantoin. Both Augmentin and Cotrimoxazole should not be the first line antibiotics to treat UTI. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  17. Moral judgment in episodic amnesia.

    Science.gov (United States)

    Craver, Carl F; Keven, Nazim; Kwan, Donna; Kurczek, Jake; Duff, Melissa C; Rosenbaum, R Shayna

    2016-08-01

    To investigate the role of episodic thought about the past and future in moral judgment, we administered a well-established moral judgment battery to individuals with hippocampal damage and deficits in episodic thought (insert Greene et al. 2001). Healthy controls select deontological answers in high-conflict moral scenarios more frequently when they vividly imagine themselves in the scenarios than when they imagine scenarios abstractly, at some personal remove. If this bias is mediated by episodic thought, individuals with deficits in episodic thought should not exhibit this effect. We report that individuals with deficits in episodic memory and future thought make moral judgments and exhibit the biasing effect of vivid, personal imaginings on moral judgment. These results strongly suggest that the biasing effect of vivid personal imagining on moral judgment is not due to episodic thought about the past and future. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  18. Time-based analysis of total cost of patient episodes: a case study of hip replacement.

    Science.gov (United States)

    Peltokorpi, Antti; Kujala, Jaakko

    2006-01-01

    Healthcare in the public and private sectors is facing increasing pressure to become more cost-effective. Time-based competition and work-in-progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue. Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC-process development approach. The framework is used to analyse hip replacement patient episodes in Päijät-Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year. The work-in-progress concept is applicable to healthcare--notably that the DMAIC-process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient-in-process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency. Presents a framework that combines patient-in-process and DMAIC-process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.

  19. Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part two: the statistical analysis of probability and risk factors.

    Science.gov (United States)

    Price, M O; Jordan, C S; Moore, G; Price, F W

    2009-03-01

    To investigate risk factors and probability of initial immunological graft rejection episodes after Descemet stripping with endothelial keratoplasty (DSEK). Outcomes of 598 DSEK cases from a single tertiary referral centre were reviewed. Risk factors and probability of rejection were assessed by multivariate Cox proportional hazards modelling. Rejection episodes occurred in 54 eyes of 48 patients. Estimated probability of a rejection episode was 7.6% by 1 year and 12% by 2 years after grafting. Relative risk of rejection was five times higher for African-American patients compared with Caucasians (p = 0.0002). Eyes with pre-existing glaucoma (9%) or steroid-responsive ocular hypertension (27%) had twice the relative risk of rejection (p = 0.045) compared with eyes that did not have those problems. Patient age, sex and corneal diagnosis did not significantly influence rejection risk. Risk of rejection was not increased when fellow eyes were grafted within 1 year of the first eye (p = 0.62). Pre-existing glaucoma or steroid-responsive ocular hypertension and race were the two factors that independently influenced relative risk of rejection after DSEK. Rejection risk was not increased if the fellow eye was grafted within the prior year with DSEK.

  20. Analysis of clinical characteristics and antipsychotic medication prescribing practices of first-episode schizophrenia in Israel: a naturalistic prospective study.

    Science.gov (United States)

    Strous, Rael D; Bar, Faina; Keret, Noa; Lapidus, Raya; Kosov, Nikolai; Chelben, Joseph; Kotler, Moshe

    2006-01-01

    Investigation of the clinical presentation and treatment of first-episode psychosis is important in order to exclude effects of age, chronic illness, long-term treatment and institutionalization. The aim of this descriptive study was to investigate the management practices of first-episode schizophrenia in a cohort of patients in Israel and to document use of the various "typical" or "atypical" antipsychotic agents. Fifty-one consecutive patients (26 M, 25 F) with first-episode psychosis were recruited for study participation and were administered either typical or atypical antipsychotic medications in a naturalistic manner. While an approximately equal number of subjects received typical and atypical medications at illness onset, a prominent shift to atypical antipsychotic treatment occurred over the study course; 18 subjects had medication class shifts: 17 from typical to atypical, and one from atypical to typical. Negative symptoms did not affect length of hospitalization, but were associated with aggression. Higher depression rates were noted in patients with long hospitalizations who received typical antipsychotic medications. Immigrants were admitted at an age approximately four years older than native-born Israelis. The prominent shift from "typical" to "atypical" antipsychotic medications may indicate sensitivity of first-episode psychotic patients to side-effects of "typical" medications and prominence of use of atypical medications in this patient subpopulation be it due to improved efficacy over time or successful marketing. Unique cultural and population characteristics may contribute to the manifestation of first-episode psychosis and suggest the importance of more effective outreach to the immigrant population in order to manage an apparent treatment delay.

  1. A Role for the Left Angular Gyrus in Episodic Simulation and Memory.

    Science.gov (United States)

    Thakral, Preston P; Madore, Kevin P; Schacter, Daniel L

    2017-08-23

    Functional magnetic resonance imaging (fMRI) studies indicate that episodic simulation (i.e., imagining specific future experiences) and episodic memory (i.e., remembering specific past experiences) are associated with enhanced activity in a common set of neural regions referred to as the core network. This network comprises the hippocampus, medial prefrontal cortex, and left angular gyrus, among other regions. Because fMRI data are correlational, it is unknown whether activity increases in core network regions are critical for episodic simulation and episodic memory. In the current study, we used MRI-guided transcranial magnetic stimulation (TMS) to assess whether temporary disruption of the left angular gyrus would impair both episodic simulation and memory (16 participants, 10 females). Relative to TMS to a control site (vertex), disruption of the left angular gyrus significantly reduced the number of internal (i.e., episodic) details produced during the simulation and memory tasks, with a concomitant increase in external detail production (i.e., semantic, repetitive, or off-topic information), reflected by a significant detail by TMS site interaction. Difficulty in the simulation and memory tasks also increased after TMS to the left angular gyrus relative to the vertex. In contrast, performance in a nonepisodic control task did not differ statistically as a function of TMS site (i.e., number of free associates produced or difficulty in performing the free associate task). Together, these results are the first to demonstrate that the left angular gyrus is critical for both episodic simulation and episodic memory. SIGNIFICANCE STATEMENT Humans have the ability to imagine future episodes (i.e., episodic simulation) and remember episodes from the past (i.e., episodic memory). A wealth of neuroimaging studies have revealed that these abilities are associated with enhanced activity in a core network of neural regions, including the hippocampus, medial prefrontal

  2. How do episodic and semantic memory contribute to episodic foresight in young children?

    OpenAIRE

    Martin-Ordas, Gema; Atance, Cristina M.; Caza, Julian S.

    2014-01-01

    Humans are able to transcend the present and mentally travel to another time, place, or perspective. Mentally projecting ourselves backwards (i.e., episodic memory) or forwards (i.e., episodic foresight) in time are crucial characteristics of the human memory system. Indeed, over the past few years, episodic memory has been argued to be involved both in our capacity to retrieve our personal past experiences and in our ability to imagine and foresee future scenarios. However, recent theory and...

  3. The Composition of Episodic Memory.

    Science.gov (United States)

    Underwood, Benton J.; And Others

    This study examined the interrelationships among a number of episodic memory tasks and among various attributes of memory. A sample of 200 college students was tested for ten sessions; 28 different measures of episodic memory were obtained. In addition, five measures of semantic memory were available. Results indicated that episodic and semantic…

  4. Diagnostic yield of computed tomography of the brain in first episode psychosis

    International Nuclear Information System (INIS)

    Strahl, Britta; Cheung, York K.; Stuckey, Stephen L.

    2010-01-01

    Full text: Introduction: Brain computed tomography (CT) is inconsistently recommended worldwide in the investigative algorithm of patients presenting with first episode psychosis (FEP). The objective of this study is to investigate the clinical efficacy of brain CT in patients presenting with FEP without neurological signs in a major metropolitan teaching hospital. Methods: The CT brain scan reports of 237 consecutive patients, for which the imaging requests or reports provided a history of FEP but no focal neurological signs, were retrospectively identified within a 6-year period in a 7So-bed tertiary referral teaching hospital using the radiology information system text-search function (170 male, 67 female; mean age, 28.3 years). All reports were authored or approved by consultant radiologist. They were reviewed for the presence of any lesion that could cause psychosis and hence alter clinical management. Minor neuroradiological abnormalities were also noted. Hospital Ethics Committee registration and approval were obtained and patient informed consent was not required. Results: No focal brain lesion potentially responsible for the psychosis or focal lesion requiring surgical intervention was identified in any patient. Findings unable to be directly linked to the psychosis such as evidence of small vessel ischaemic disease, arachnoid cysts, cerebral atrophy, and normal variants were present in 17.6% of patients (4S of 237 studies), none of which led to an alteration of clinical management. Conclusion: The results of this study postulate that brain CT should not be universally performed in the initial assessment of patients with first episode psychosis without neurological signs.

  5. Long-term response in episodic acidification to declining SO42– deposition in two streams in Nova Scotia

    Directory of Open Access Journals (Sweden)

    H. Laudon

    2002-01-01

    Full Text Available Trends in anthropogenically driven episodic acidification associated with extended winter snow melt/rain episodes between 1983 and 1998 were investigated for two streams in Nova Scotia, Canada. The anthropogenic contribution to Acid Neutralization Capacity (ANC was analysed using the Boreal Dilution Model (Bishop et al., 2000 modified by applying a sea-salt correction to all input hydrochemistry. The anthropogenic contribution to episodic ANC decline was statistically significant and strongly correlated with the decline in acid deposition, which decreased by approximately 50% during the period of record. Sensitivity analysis demonstrated that the BDM can be applied to surface waters with sea-salt contributions although the correction increases model uncertainty. Results of this study demonstrate the effectiveness of reduced emissions in North America in the last decades in decreasing the severity of episodic acidification in the Atlantic region of Canada. Keywords: episodic acidification, acidification recovery, Nova Scotia, snowmelt, winter

  6. Analyzing quality of colorectal cancer care through registry statistics: a small community hospital example.

    Science.gov (United States)

    Hopewood, Ian

    2011-01-01

    As the quantity of elderly Americans requiring oncologic care grows, and as cancer treatment and medicine become more advanced, assessing quality of cancer care becomes a necessary and advantageous practice for any facility.' Such analysis is especially practical in small community hospitals, which may not have the resources of their larger academic counterparts to ensure that the care being provided is current and competitive in terms of both technique and outcome. This study is a comparison of the colorectal cancer care at one such center, Falmouth Community Hospital (FCH)--located in Falmouth, Massachusetts, about an hour and a half away from the nearest metropolitan center--to the care provided at a major nearby Boston Tertiary Center (BTC) and at teaching and research facilities across New England and the United States. The metrics used to measure performance encompass both outcome (survival rate data) as well as technique, including quality of surgery (number of lymph nodes removed) and the administration of adjuvant treatments, chemotherapy, and radiation therapy, as per national guidelines. All data for comparison between FCH and BTC were culled from those hospitals' tumor registries. Data for the comparison between FCH and national tertiary/referral centers were taken from the American College of Surgeons' Commission on Cancer, namely National Cancer Data Base (NCDB) statistics, Hospital Benchmark Reports and Practice Profile Reports. The results showed that, while patients at FCH were diagnosed at both a higher age and at a more advanced stage of colorectal cancer than their BTC counterparts, FCH stands up favorably to BTC and other large centers in terms of the metrics referenced above. Quality assessment such as the analysis conducted here can be used at other community facilities to spotlight, and ultimately eliminate, deficiencies in cancer programs.

  7. Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

    Science.gov (United States)

    Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

    2013-01-01

    Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (pstudy is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

  8. Automatic classification of transient ischaemic and transient non-ischaemic heart-rate related ST segment deviation episodes in ambulatory ECG records

    International Nuclear Information System (INIS)

    Faganeli, J; Jager, F

    2010-01-01

    In ambulatory ECG records, besides transient ischaemic ST segment deviation episodes, there are also transient non-ischaemic heart-rate related ST segment deviation episodes present, which appear only due to a change in heart rate and thus complicate automatic detection of true ischaemic episodes. The goal of this work was to automatically classify these two types of episodes. The tested features to classify the ST segment deviation episodes were changes of heart rate, changes of the Mahalanobis distance of the first five Karhunen–Loève transform (KLT) coefficients of the QRS complex, changes of time-domain morphologic parameters of the ST segment and changes of the Legendre orthonormal polynomial coefficients of the ST segment. We chose Legendre basis functions because they best fit typical shapes of the ST segment morphology, thus allowing direct insight into the ST segment morphology changes through the feature space. The classification was performed with the help of decision trees. We tested the classification method using all records of the Long-Term ST Database on all ischaemic and all non-ischaemic heart-rate related deviation episodes according to annotation protocol B. In order to predict the real-world performance of the classification we used second-order aggregate statistics, gross and average statistics, and the bootstrap method. We obtained the best performance when we combined the heart-rate features, the Mahalanobis distance and the Legendre orthonormal polynomial coefficient features, with average sensitivity of 98.1% and average specificity of 85.2%

  9. Radiology imaging delays as independent predictors of length of hospital stay for emergency medical admissions.

    Science.gov (United States)

    Cournane, S; Conway, R; Creagh, D; Byrne, D G; Sheehy, N; Silke, B

    2016-09-01

    To investigate the extent to which the time to completion for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound could be shown to influence the length of stay and costs incurred while in hospital, while accounting for patient acuity. All emergency admissions, totalling 25,326 imaging investigations between 2010-2014 were evaluated. The 50(th), 75(th), and 90(th) centiles of completion times for each imaging type was entered into a multivariable truncated Poisson regression model predicting the length of hospital stay. Estimates of risk (odds or incidence rate ratios [IRRs]) of the regressors were adjusted for acute illness severity, Charlson comorbidity index, chronic disabling disease score, and sepsis status. Quantile regression analysis was used to examine the impact of imaging on total hospital costs. For all imaging examinations, longer hospital lengths of stay were shown to be related to delays in imaging time. Increased delays in CT and MRI were shown to be associated with increased hospital episode costs, while ultrasound did not independently predict increased hospital costs. The magnitude of the effect of imaging delays on episode costs were equivalent to some measures of illness severity. CT, MRI, and ultrasound are undertaken in patients with differing clinical complexity; however, even with adjustment for complexity, the time delay in a more expeditious radiological service could potentially shorten the hospital episode and reduce costs. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. Apathy in first episode psychosis patients

    DEFF Research Database (Denmark)

    Evensen, Julie; Røssberg, Jan Ivar; Barder, Helene

    2012-01-01

    Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored.......Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored....

  11. Risk of Pancreatic Cancer After a Primary Episode of Acute Pancreatitis.

    Science.gov (United States)

    Rijkers, Anton P; Bakker, Olaf J; Ahmed Ali, Usama; Hagenaars, Julia C J P; van Santvoort, Hjalmar C; Besselink, Marc G; Bollen, Thomas L; van Eijck, Casper H

    2017-09-01

    Acute pancreatitis may be the first manifestation of pancreatic cancer. The aim of this study was to assess the risk of pancreatic cancer after a first episode of acute pancreatitis. Between March 2004 and March 2007, all consecutive patients with a first episode of acute pancreatitis were prospectively registered. Follow-up was based on hospital records audit, radiological imaging, and patient questionnaires. Outcome was stratified based on the development of chronic pancreatitis. We included 731 patients. The median follow-up time was 55 months. Progression to chronic pancreatitis was diagnosed in 51 patients (7.0%). In this group, the incidence rate per 1000 person-years for developing pancreatic cancer was 9.0 (95% confidence interval, 2.3-35.7). In the group of 680 patients who did not develop chronic pancreatitis, the incidence rate per 1000 person-years for developing pancreatic cancer in this group was 1.1 (95% confidence interval, 0.3-3.3). Hence, the rate ratio of pancreatic cancer was almost 9 times higher in patients who developed chronic pancreatitis compared with those who did not (P = 0.049). Although a first episode of acute pancreatitis may be related to pancreatic cancer, this risk is mainly present in patients who progress to chronic pancreatitis.

  12. Hospital Casemix Protocol - Medibank Private Perspective.

    Science.gov (United States)

    Szakiel, John

    2010-06-01

    Hospital Casemix Protocol data provide a brief summary outlining morbidity data and costs associated with an episode of care. Federal government legislation requires that hospitals report this information to private health insurers who, in turn, merge these data with benefit outlays and report their findings to the Department of Health and Ageing (DoHA). This article gives a brief outline of the collection, cleansing and processing of these data and subsequent reporting to DoHA by Medibank Private, which accounts for approximately 30% of collected data.

  13. The neuropsychology of emerging psychosis and the role of working memory in episodic memory encoding

    Directory of Open Access Journals (Sweden)

    Pflueger MO

    2018-05-01

    Full Text Available Marlon O Pflueger,1 Pasquale Calabrese,2 Erich Studerus,3 Ronan Zimmermann,4 Ute Gschwandtner,4 Stefan Borgwardt,5 Jacqueline Aston,3 Rolf-Dieter Stieglitz,6 Anita Riecher-Rössler3 1Department of Forensic Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland; 2Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland; 3Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland; 4Department of Neurology and Neurosurgery, Hospital of the University of Basel, Basel, Switzerland; 5Department of Psychiatry (UPK, University of Basel, Basel, Switzerland; 6Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland Background: Episodic memory encoding and working memory (WM deficits are among the first cognitive signs and symptoms in the course of schizophrenia spectrum disorders. However, it is not clear whether the deficit pattern is generalized or specific in nature. We hypothesized that encoding deficits at an early stage of the disease might be due to the more fundamental WM deficits. Methods: We examined episodic memory encoding and WM by administering the California Verbal Learning Test, a 2-back task, and the Wisconsin Card Sorting Test in 90 first-episode psychosis (FE patients and 116 individuals with an at-risk mental state for psychosis (ARMS compared to 57 healthy subjects. Results: Learning progress, but not span of apprehension, was diminished to a similar extent in both the ARMS and the FE. We showed that this was due to WM impairment by applying a structural equation approach. Conclusion: Thus, we conclude that verbal memory encoding deficits are secondary to primary WM impairment in emerging psychosis. Keywords: at-risk mental state, first-episode psychosis, cognition, serial position effect, recency, semantic cluster ratio, 2-back task, rate of learning

  14. Adverse events in surgical inpatients: A comparative analysis of public hospitals in Victoria

    OpenAIRE

    Katharina Hauck; Xueyan Zhao; Terri Jackson

    2010-01-01

    We compare adverse event rates for surgical inpatients across 36 public hospitals in the state of Victoria, Australia, conditioning on differences in patient complexity across hospitals. We estimate separate models for elective and emergency patients which stay at least one night in hospitals, using fixed effects complementary log-log models to estimate AEs as a function of patient and episode characteristics, and hospital effects. We use 4 years of patient level administrative hospital data ...

  15. Approaches to ascertaining comorbidity information: validation of routine hospital episode data with clinician-based case note review.

    Science.gov (United States)

    Soo, Martin; Robertson, Lynn M; Ali, Tariq; Clark, Laura E; Fluck, Nicholas; Johnston, Marjorie; Marks, Angharad; Prescott, Gordon J; Smith, William Cairns S; Black, Corri

    2014-04-21

    In clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease. A validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed. Median age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions. This study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was

  16. Relationship between menarche and psychosis onset in women with first episode of psychosis.

    Science.gov (United States)

    Rubio-Abadal, Elena; Usall, Judith; Barajas, Anna; Carlson, Janina; Iniesta, Raquel; Huerta-Ramos, Elena; Baños, Iris; Dolz, Montserrat; Sánchez, Bernardo; Ochoa, Susana

    2016-10-01

    The aim of this study was to explore the relationship between age at menarche and age at first episode of psychosis, as well as clinical severity and outcome, in a population of women with first-episode psychosis. Clinical and socio-demographical data, age at menarche and at first-episode psychosis, parental history of psychosis and cannabis-use habits were obtained from 42 subjects with a first episode of psychosis. Positive and Negative Syndrome Scale, Clinical Global Impression, Global Assessment Function, Disability Assessment Schedule, Wechsler Adult Intelligence Scale and Wechsler Intelligence Scale for Children, European Quality of Life, and Lewis and Murray Obstetric Complication Scales were administered. Statistical analysis was performed by means of zero-order correlations and Mann-Whitney U and Kruskal-Wallis tests using SPSS version 17.0. We found no significant correlation between age at menarche and age at first-episode psychosis, or with the clinical scores performed. We observed that subjects with earlier age at menarche had more parental history of psychosis. Our negative results do not support the theory of a possible protective role of oestrogen, which seems to be more complex than previously thought. We would suggest that further research is needed to investigate developmental influences of sex steroids on the onset of psychosis and potentially therapeutic benefits based upon oestrogen. © 2014 Wiley Publishing Asia Pty Ltd.

  17. Statistical study of autopsy cases in Hiroshima Atomic Bomb Hospital 1956-1975

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, T; Ishida, S [H.ma Atomic Bomb Hospital (Japan); Matsushita, Hiroshi

    1976-03-01

    In order to study the differences in the incidence of a variety of disease (excluding tumors), between the cases exposed to the atomic bomb and those who were unexposed, main lesions were studied statistically by autopsy. The subjects were 1230 cases autopsied at the Hiroshima Atomic Bomb Hospital or the Hiroshima Red-Cross Hospital. They were divided into 318 cases exposed at a short distance from the bombed area (within 2 km), and 420 cases exposed at a long distance from that area (more than 2 km), including those who had come to Hiroshima later. Four hundred twenty nine unexposed cases were selected as controls. The incidence of tumor, disturbance of circulation, disturbance of the blood vessels in the brain, blood disease, and respiratory disease was higher in the exposed cases than in the unexposed cases. The incidence of cirrhosis of the liver was higher in females than in males, and was lower in cases farther from the bombed area. Cardiac infarction, valvular disease, and endocarditis were more often seen in the cases exposed near the bombed area. The incidence of the blood vessels in the brain was highest in the exposed cases near the bombed area. The incidence of disturbance of circulation, and disturbance of the blood vessels in the brain had a tendency to be higher in the exposed cases than in the unexposed cases. This is considered to be due to the advanced age in the exposed cases.

  18. The Relationship between Place of Residence and Hospitalization Rate in the Biggest Referral Hospital of the Northwest according to Hospitalization Wards

    Directory of Open Access Journals (Sweden)

    Amin Talebpour

    2016-06-01

    Full Text Available ​ Background and objectives: In accordance with the global pattern, the urban population in Iran is higher than the rural population. But, are the statistics of using hospitalization services in public hospitals in these two categories similar to this pattern? This study seeks to determine the effect of place of residence on hospitalization rate by examining annual hospitalization statistics of the country’s biggest referral hospital in the northwest. Material and Methods: The method used in this study is cross-sectional and all cases of hospitalization in Imam Reza Hospital as the northwest’s biggest referral hospital were picked by available sampling method. The cases of 30260 hospitalized patients were examined through direct observation and items extracted from their files were recorded in the checklist. In order to determine the relations between the variables, K2 test was applied and the P-value was considered less than 0.05 The obtained data were analyzed by SPSS.16 software. Results: Results indicated that the frequency distribution of patients in terms of their urban or rural residence did not yield any significant difference (P>0/05. Results also showed that the highest hospitalization rate for urban patients was 16.1% (3305 individuals in surgery ward while it was 14.2% (1384 individuals for rural patients in orthopedic ward. The least significant statistical difference between urban and rural hospitalization rates was observed in renal ward with 72.9% (1162 individual urban patients and 27.1% (432 individuals rural patients of total patients hospitalized in this ward. The most significant statistical difference between urban and rural hospitalization rates was observed in ICU with 44.9% (297 individuals urban patients and 55.1% (365 individuals rural patients of the total patients hospitalized in this ward. Conclusion: A relative comparison among illnesses in urban and rural populations, aside from illnesses caused by trauma

  19. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

    Science.gov (United States)

    Sivasubramaniam, Vinothan; Patel, Hitesh C; Ozdemir, Baris A; Papadopoulos, Marios C

    2015-01-01

    Objectives Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Design Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends. Outcome measures Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100 000, respectively, (pdisease, and highlight the need for services capable of dealing with the increased comorbidity burden associated with an ageing patient group. PMID:26671956

  20. An analysis of high fine aerosol loading episodes in north-central Spain in the summer 2013 - Impact of Canadian biomass burning episode and local emissions

    Science.gov (United States)

    Burgos, M. A.; Mateos, D.; Cachorro, V. E.; Toledano, C.; de Frutos, A. M.; Calle, A.; Herguedas, A.; Marcos, J. L.

    2018-07-01

    This work presents an evaluation of a surprising and unusual high turbidity summer period in 2013 recorded in the north-central Iberian Peninsula (IP). The study is made up of three main pollution episodes characterized by very high aerosol optical depth (AOD) values with the presence of fine aerosol particles: the strongest long-range transport Canadian Biomass Burning (BB) event recorded, one of the longest-lasting European Anthropogenic (A) episodes and an extremely strong regional BB. The Canadian BB episode was unusually strong with maximum values of AOD(440 nm) ∼ 0.8, giving rise to the highest value recorded by photometer data in the IP with a clearly established Canadian origin. The anthropogenic pollution episode originated in Europe is mainly a consequence of the strong impact of Canadian BB events over north-central Europe. As regards the local episode, a forest fire in the nature reserve near the Duero River (north-central IP) impacted on the population over 200 km away from its source. These three episodes exhibited fingerprints in different aerosol columnar properties retrieved by sun-photometers of the AErosol RObotic NETwork (AERONET) as well as in particle mass surface concentrations, PMx, measured by the European Monitoring and Evaluation Programme (EMEP). Main statistics, time series and scatterplots relate aerosol loads (aerosol optical depth, AOD and particulate matter, PM) with aerosol size quantities (Ångström Exponent and PM ratio). More detailed microphysical/optical properties retrieved by AERONET inversion products are analysed in depth to describe these events: contribution of fine and coarse particles to AOD and its ratio (the fine mode fraction), volume particle size distribution, fine volume fraction, effective radius, sphericity fraction, single scattering albedo and absorption optical depth. Due to its relevance in climate studies, the aerosol radiative effect has been quantified for the top and bottom of the atmosphere

  1. Episodic Memory and Episodic Foresight in 3- and 5-Year-Old Children

    Science.gov (United States)

    Hayne, Harlene; Gross, Julien; McNamee, Stephanie; Fitzgibbon, Olivia; Tustin, Karen

    2011-01-01

    In the present study, we examined the development of episodic memory and episodic foresight. Three- and 5-year-olds were interviewed individually using a personalised timeline that included photographs of them at different points in their life. After constructing the timeline with the experimenter, each child was asked to discuss a number of…

  2. Course of insight in manic episode

    Directory of Open Access Journals (Sweden)

    A Kumar

    2013-01-01

    Full Text Available Background: Insight is an important factor associated with non compliance and poor outcome. Poor level of insight has been described as a characteristic in patients with acute bipolar disorder with more unawareness in social consequences with increasing severity in manic episode. Aim: Main aim of study was to see the baseline and longitudinal relationship between dimensions of insight with improvement in psychopathology. Setting and Design: Forty four patients diagnosed with mania, were selected from an inpatient setting at Institute of Mental Health and Hospital, Agra with mean age of 31.07(±9.00 years. They were assessed at base line and were followed up weekly or psychopathology and insight. Materials and Methods: The Young′s mania rating scale for psychopathology and insight was assessed on three dimensions of SUMD. Results: Twenty five patients eventually completed the study. There was a positive correlation with global insight and with psychopathology consistent in longitudinal follow-up (P<0.05, but not correlating for awareness for achieved effect of medication and social consequences. Linear regression showed a positive relationship at the first and second week of assessment of SUMD and YMRS scores (P=0.001; 0.019. Conclusion: Improvement in insight is graded in a manic episode as compared to psychopathology. There is slower improvement in awareness of social consequences of mental disorder. It means that improvement in psychopathology may not necessarily indicate remission and need further supervision to improve insight and hence monitoring.

  3. Key features of human episodic recollection in the cross-episode retrieval of rat hippocampus representations of space.

    Directory of Open Access Journals (Sweden)

    Eduard Kelemen

    2013-07-01

    Full Text Available Neurophysiological studies focus on memory retrieval as a reproduction of what was experienced and have established that neural discharge is replayed to express memory. However, cognitive psychology has established that recollection is not a verbatim replay of stored information. Recollection is constructive, the product of memory retrieval cues, the information stored in memory, and the subject's state of mind. We discovered key features of constructive recollection embedded in the rat CA1 ensemble discharge during an active avoidance task. Rats learned two task variants, one with the arena stable, the other with it rotating; each variant defined a distinct behavioral episode. During the rotating episode, the ensemble discharge of CA1 principal neurons was dynamically organized to concurrently represent space in two distinct codes. The code for spatial reference frame switched rapidly between representing the rat's current location in either the stationary spatial frame of the room or the rotating frame of the arena. The code for task variant switched less frequently between a representation of the current rotating episode and the stable episode from the rat's past. The characteristics and interplay of these two hippocampal codes revealed three key properties of constructive recollection. (1 Although the ensemble representations of the stable and rotating episodes were distinct, ensemble discharge during rotation occasionally resembled the stable condition, demonstrating cross-episode retrieval of the representation of the remote, stable episode. (2 This cross-episode retrieval at the level of the code for task variant was more likely when the rotating arena was about to match its orientation in the stable episode. (3 The likelihood of cross-episode retrieval was influenced by preretrieval information that was signaled at the level of the code for spatial reference frame. Thus key features of episodic recollection manifest in rat hippocampal

  4. Association between allergic rhinitis and hospital resource use among asthmatic children in Norway

    DEFF Research Database (Denmark)

    Sazonov Kocevar, V; Thomas, J; Jonsson, L

    2005-01-01

    of hospital admissions during a 2-year period, 1998-1999. Multivariate linear regression, adjusting for risk factors including age, gender, year of admission, urban/rural residence and severity of asthma episode, estimated the association between allergic rhinitis and total hospital days. A multivariate Cox...

  5. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe.

    Directory of Open Access Journals (Sweden)

    Marlieke E A de Kraker

    2011-10-01

    Full Text Available The relative importance of human diseases is conventionally assessed by cause-specific mortality, morbidity, and economic impact. Current estimates for infections caused by antibiotic-resistant bacteria are not sufficiently supported by quantitative empirical data. This study determined the excess number of deaths, bed-days, and hospital costs associated with blood stream infections (BSIs caused by methicillin-resistant Staphylococcus aureus (MRSA and third-generation cephalosporin-resistant Escherichia coli (G3CREC in 31 countries that participated in the European Antimicrobial Resistance Surveillance System (EARSS.The number of BSIs caused by MRSA and G3CREC was extrapolated from EARSS prevalence data and national health care statistics. Prospective cohort studies, carried out in hospitals participating in EARSS in 2007, provided the parameters for estimating the excess 30-d mortality and hospital stay associated with BSIs caused by either MRSA or G3CREC. Hospital expenditure was derived from a publicly available cost model. Trends established by EARSS were used to determine the trajectories for MRSA and G3CREC prevalence until 2015. In 2007, 27,711 episodes of MRSA BSIs were associated with 5,503 excess deaths and 255,683 excess hospital days in the participating countries, whereas 15,183 episodes of G3CREC BSIs were associated with 2,712 excess deaths and 120,065 extra hospital days. The total costs attributable to excess hospital stays for MRSA and G3CREC BSIs were 44.0 and 18.1 million Euros (63.1 and 29.7 million international dollars, respectively. Based on prevailing trends, the number of BSIs caused by G3CREC is likely to rapidly increase, outnumbering the number of MRSA BSIs in the near future.Excess mortality associated with BSIs caused by MRSA and G3CREC is significant, and the prolongation of hospital stay imposes a considerable burden on health care systems. A foreseeable shift in the burden of antibiotic resistance from Gram

  6. Investigating a high ozone episode in a rural mountain site

    International Nuclear Information System (INIS)

    Monteiro, A.; Strunk, A.; Carvalho, A.; Tchepel, O.; Miranda, A.I.; Borrego, C.; Saavedra, S.; Rodríguez, A.; Souto, J.; Casares, J.; Friese, E.; Elbern, H.

    2012-01-01

    A very high ozone episode with observed hourly values above 350 μg m −3 occurred in July 2005 at the Lamas d’Olo air quality monitoring station, located in a mountainous area in the north of Portugal. Aiming to identify the origin and formation of this ozone-rich episode, a statistical analysis and a modelling approach were applied. A cross-spectrum analysis in the frequency domain and a synoptic analysis of the meteorological and air quality time series were performed. In order to go further in this analysis, a numerical modelling approach was applied. The results indicate that the transport of ozone and its precursors is the main responsible for the high ozone concentrations. Together with the local mountain breeze and subsidence conditions, the sea-breeze circulation transporting pollutants from the coastal urban and industrialized areas that reach the site during late afternoon turn out to be the driving forces for the ozone peaks. - Highlights: ► A very high ozone episode occurred in a rural mountain site of Portugal in 2004. ► Data cross-spectrum analysis in the frequency domain was performed. ► A numerical modelling approach was also applied. ► The sea-breeze circulation transported pollutants from the urban and industrialized coast. ► The mountain breeze and subsidence conditions were also driving forces for ozone peaks. - The sea-breeze transporting pollutants from the coast, the mountain breeze and subsidence conditions, were the driving forces for the ozone episode occurred in a rural mountain site.

  7. Pre-hospital treatment of acute poisonings in Oslo

    Science.gov (United States)

    Heyerdahl, Fridtjof; Hovda, Knut E; Bjornaas, Mari A; Nore, Anne K; Figueiredo, Jose CP; Ekeberg, Oivind; Jacobsen, Dag

    2008-01-01

    Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40%) were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84%) were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%), were frequently comatose (35%), had respiratory depression (37%), and many received naloxone (49%). The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%), fewer were comatose (10%), and they rarely had respiratory depression (4%). Among the hospitalized, pharmaceutical poisonings were most common (58%), 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and

  8. Pre-hospital treatment of acute poisonings in Oslo

    Directory of Open Access Journals (Sweden)

    Nore Anne K

    2008-11-01

    Full Text Available Abstract Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40% were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84% were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%, were frequently comatose (35%, had respiratory depression (37%, and many received naloxone (49%. The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%, fewer were comatose (10%, and they rarely had respiratory depression (4%. Among the hospitalized, pharmaceutical poisonings were most common (58%, 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often

  9. Episodic memory in nonhuman animals.

    Science.gov (United States)

    Templer, Victoria L; Hampton, Robert R

    2013-09-09

    Episodic memories differ from other types of memory because they represent aspects of the past not present in other memories, such as the time, place, or social context in which the memories were formed. Focus on phenomenal experience in human memory, such as the sense of 'having been there', has resulted in conceptualizations of episodic memory that are difficult or impossible to apply to nonhuman species. It is therefore a significant challenge for investigators to agree on objective behavioral criteria that can be applied in nonhuman animals and still capture features of memory thought to be critical in humans. Some investigators have attempted to use neurobiological parallels to bridge this gap; however, defining memory types on the basis of the brain structures involved rather than on identified cognitive mechanisms risks missing crucial functional aspects of episodic memory, which are ultimately behavioral. The most productive way forward is likely a combination of neurobiology and sophisticated cognitive testing that identifies the mental representations present in episodic memory. Investigators that have refined their approach from asking the naïve question "do nonhuman animals have episodic memory" to instead asking "what aspects of episodic memory are shared by humans and nonhumans" are making progress. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Treating Dehydration at Home Avoids Healthcare Costs Associated With Emergency Department Visits and Hospital Readmissions for Adult Patients Receiving Home Parenteral Support.

    Science.gov (United States)

    Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F

    2017-06-01

    Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.

  11. Spatio-temporal dependencies between hospital beds, physicians and health expenditure using visual variables and data classification in statistical table

    Science.gov (United States)

    Medyńska-Gulij, Beata; Cybulski, Paweł

    2016-06-01

    This paper analyses the use of table visual variables of statistical data of hospital beds as an important tool for revealing spatio-temporal dependencies. It is argued that some of conclusions from the data about public health and public expenditure on health have a spatio-temporal reference. Different from previous studies, this article adopts combination of cartographic pragmatics and spatial visualization with previous conclusions made in public health literature. While the significant conclusions about health care and economic factors has been highlighted in research papers, this article is the first to apply visual analysis to statistical table together with maps which is called previsualisation.

  12. Spatio-temporal dependencies between hospital beds, physicians and health expenditure using visual variables and data classification in statistical table

    Directory of Open Access Journals (Sweden)

    Medyńska-Gulij Beata

    2016-06-01

    Full Text Available This paper analyses the use of table visual variables of statistical data of hospital beds as an important tool for revealing spatio-temporal dependencies. It is argued that some of conclusions from the data about public health and public expenditure on health have a spatio-temporal reference. Different from previous studies, this article adopts combination of cartographic pragmatics and spatial visualization with previous conclusions made in public health literature. While the significant conclusions about health care and economic factors has been highlighted in research papers, this article is the first to apply visual analysis to statistical table together with maps which is called previsualisation.

  13. [Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors].

    Science.gov (United States)

    Beauchêne, C; Martins-Héricher, J; Denis, D; Martin, L; Maillard, H

    2018-05-04

    Episodes of acquired bradykinin-mediated angioedema due to angiotensin-converting enzyme (ACE) inhibitors may result in fatal outcomes. There is no consensus regarding emergency pharmacological management of these episodes. Treatment options include icatibant and C1INH concentrate. Tranexamic acid is administered for moderate episodes. Its efficacy in the treatment of ACE inhibitor-induced episodes of angioedema is not established. The aim of this retrospective study is to assess the benefits of emergency tranexamic acid administration in the management of ACE inhibitor-induced episodes of angioedema. Retrospective analysis of the medical files of patients who consulted between 2010 and 2016 in two French tertiary care hospitals for a bradykinic angioedema attributed to an ACE treatment. All of them had received tranexamic acid as a first line treatment. Thirty three patients who had experienced severe episode of angioedema were included. Twenty seven patients showed significant improvement when treated with tranexamic acid alone. The six remaining patients were treated with icatibant (5/33) or C1INH concentrate (1/33), due to partial improvement after tranexamic acid therapy. None of the patients were intubated, no fatalities were recorded and no side effects were reported. Tranexamic acid is an easily accessible and affordable therapy that may provide effective treatment for ACE inhibitor-induced episodes of angioedema. It may help while waiting for a more specific treatment (icatibant and C1INH concentrate) that is at times unavailable in emergency departments. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  14. Following up patients with depression after hospital discharge: a mixed methods approach

    OpenAIRE

    Desplenter, Franciska A; Laekeman, Gert J; Simoens, Steven R

    2011-01-01

    Abstract Background A medication information intervention was delivered to patients with a major depressive episode prior to psychiatric hospital discharge. Methods The objective of this study was to explore how patients evolved after hospital discharge and to identify factors influencing this evolution. Using a quasi-experimental longitudinal design, the quantitative analysis measured clinical (using the Hospital Anxiety and Depression Scale, the somatic dimension of the Symptom Checklist 90...

  15. Mental images in episodic memory

    OpenAIRE

    Han, KyungHun

    2009-01-01

    Episodic memory, i.e. memorization of information within a spatiotemporal environment, is affected by Alzheimer's disease (AD) but its loss may also occur in the normal aging process. The purpose of this study is to analyze and evaluate episodic memory in patients with AD by examining their cognitive skills in episodic memory through the introspection technique. A new method was used, wherein we assessed mental images of the subject's own past recalled in the mind like projected pictures and ...

  16. The construction of semantic memory: grammar based representations learned from relational episodic information

    Directory of Open Access Journals (Sweden)

    Francesco P Battaglia

    2011-08-01

    Full Text Available After acquisition, memories underlie a process of consolidation, making them more resistant to interference and brain injury. Memory consolidation involves systems-level interactions, most importantly between the hippocampus and associated structures, which takes part in the initial encoding of memory, and the neocortex, which supports long-term storage. This dichotomy parallels the contrast between episodic memory (tied to the hippocampal formation, collecting an autobiographical stream of experiences, and semantic memory, a repertoire of facts and statistical regularities about the world, involving the neocortex at large. Experimental evidence points to a gradual transformation of memories, following encoding, from an episodic to a semantic character. This may require an exchange of information between different memory modules during inactive periods. We propose a theory for such interactions and for the formation of semantic memory, in which episodic memory is encoded as relational data. Semantic memory is modeled as a modified stochastic grammar, which learns to parse episodic configurations expressed as an association matrix. The grammar produces tree-like representations of episodes, describing the relationships between its main constituents at multiple levels of categorization, based on its current knowledge of world regularities. These regularities are learned by the grammar from episodic memory information, through an expectation-maximization procedure, analogous to the inside-outside algorithm for stochastic context-free grammars. We propose that a Monte-Carlo sampling version of this algorithm can be mapped on the dynamics of ``sleep replay'' of previously acquired information in the hippocampus and neocortex. We propose that the model can reproduce several properties of semantic memory such as decontextualization, top-down processing, and creation of schemata.

  17. The Construction of Semantic Memory: Grammar-Based Representations Learned from Relational Episodic Information

    Science.gov (United States)

    Battaglia, Francesco P.; Pennartz, Cyriel M. A.

    2011-01-01

    After acquisition, memories underlie a process of consolidation, making them more resistant to interference and brain injury. Memory consolidation involves systems-level interactions, most importantly between the hippocampus and associated structures, which takes part in the initial encoding of memory, and the neocortex, which supports long-term storage. This dichotomy parallels the contrast between episodic memory (tied to the hippocampal formation), collecting an autobiographical stream of experiences, and semantic memory, a repertoire of facts and statistical regularities about the world, involving the neocortex at large. Experimental evidence points to a gradual transformation of memories, following encoding, from an episodic to a semantic character. This may require an exchange of information between different memory modules during inactive periods. We propose a theory for such interactions and for the formation of semantic memory, in which episodic memory is encoded as relational data. Semantic memory is modeled as a modified stochastic grammar, which learns to parse episodic configurations expressed as an association matrix. The grammar produces tree-like representations of episodes, describing the relationships between its main constituents at multiple levels of categorization, based on its current knowledge of world regularities. These regularities are learned by the grammar from episodic memory information, through an expectation-maximization procedure, analogous to the inside–outside algorithm for stochastic context-free grammars. We propose that a Monte-Carlo sampling version of this algorithm can be mapped on the dynamics of “sleep replay” of previously acquired information in the hippocampus and neocortex. We propose that the model can reproduce several properties of semantic memory such as decontextualization, top-down processing, and creation of schemata. PMID:21887143

  18. Divergent thinking and constructing episodic simulations.

    Science.gov (United States)

    Addis, Donna Rose; Pan, Ling; Musicaro, Regina; Schacter, Daniel L

    2016-01-01

    Divergent thinking likely plays an important role in simulating autobiographical events. We investigated whether divergent thinking is differentially associated with the ability to construct detailed imagined future and imagined past events as opposed to recalling past events. We also examined whether age differences in divergent thinking might underlie the reduced episodic detail generated by older adults. The richness of episodic detail comprising autobiographical events in young and older adults was assessed using the Autobiographical Interview. Divergent thinking abilities were measured using the Alternative Uses Task. Divergent thinking was significantly associated with the amount of episodic detail for imagined future events. Moreover, while age was significantly associated with imagined episodic detail, this effect was strongly related to age-related changes in episodic retrieval rather than divergent thinking.

  19. An evaluation of hospital hand hygiene practice and glove use in Hong Kong.

    Science.gov (United States)

    Chau, Janita P-C; Thompson, David R; Twinn, Sheila; Lee, Diana T F; Pang, Sharon W M

    2011-05-01

    To identify omissions in hand hygiene practice and glove use among hospital workers in Hong Kong. Hospital-acquired infection is the commonest complication affecting hospitalised patients. Even though research evidence suggests that hand hygiene and proper glove use are the most important ways to prevent the spread of disease and infection, compliance with both are reported to be unacceptably low. An observational study of hospital workers in one acute and two convalescence and rehabilitation hospitals in Hong Kong was conducted. The participating clinical areas included the medical and surgical wards, accident and emergency department and intensive care unit. Hand hygiene practice and glove use amongst 206 hospital health and support workers, stratified according to years of working experience, were observed. The number of observed episodes for hand hygiene was 1037 and for glove use 304. Compliance with hand hygiene was 74.7% and with glove use 72.4%. In approximately two-third of episodes, participants washed their hands after each patient contact; though, 78.5% failed to rub their hands together vigorously for at least 15 seconds. The major break in compliance with glove use was failure to change gloves between procedures on the same patient. In 28.6% of observed glove use episodes, participants did not wear gloves during procedures that exposed them to blood, body fluids, excretion, non-intact skin or mucous membranes. Significant differences in performance scores on antiseptic hand rub were found between the two types of hospital and on glove use between the three groups of work experience: ≤ 5, 6-10, >10 years. Education and reinforcement of proper hand hygiene practice and glove use among hospital health and support workers is needed. © 2011 Blackwell Publishing Ltd.

  20. Obstetric complications as a risk factor for first psychotic episodes in childhood and adolescence

    OpenAIRE

    2009-01-01

    Abstract There are reports of significant association between obstetric complications (OC) and childhood psychosis. Authors conducted a case-control study of 102 children and adolescents with a first episode psychosis (FEP) and 94 healthy controls (HC), using the obstetric complications scale (OCS) and their medical records, to examine the risk of FPE. Patients were recruited from child and adolescent psychiatry units at six university hospitals and controls from publicly-funded sc...

  1. Do age-related increases in tip-of-the-tongue experiences signify episodic memory impairments?

    Science.gov (United States)

    Salthouse, Timothy A; Mandell, Arielle R

    2013-12-01

    Tip-of-the-tongue experiences (TOTs), in which a name is known but cannot be immediately retrieved from memory, can be a cause of concern if these experiences are viewed as a sign of memory decline. The current study was conducted to investigate the relation between age and TOT frequency, and the influence of episodic memory, which is the type of memory most often assessed to detect memory problems, on that relation. In a sample of adults, increased age was found to be associated with more TOTs across different types of materials, and additional analyses suggested that these relations between age and TOT frequency were not attributable to the use of different response criteria or to different amounts of knowledge. Because statistical control of a measure of episodic memory had little effect on the relation between age and TOT frequency, age-related increases in TOTs and age-related decreases in episodic memory appear to be at least partially independent phenomena.

  2. Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

    Directory of Open Access Journals (Sweden)

    Derek Bell

    Full Text Available Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR, including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent for a minimum of 4 hours per day (65% of study group had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03 and had a lower 7 day re-admission rate (p<0.02. This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

  3. Hospitalization resource use and costs before and after TIA and stroke: results from a population-based cohort study (OXVASC).

    Science.gov (United States)

    Luengo-Fernandez, Ramon; Silver, Louise E; Gutnikov, Sergei A; Gray, Alastair M; Rothwell, Peter M

    2013-01-01

    High hospitalization rates, prolonged length of stay, and increased risks of subsequent events mean a steep increase in health care usage after stroke. No study, however, has examined to what extent increased costs after transient ischemic attack (TIA) or stroke are due to hospitalizations for the initial event, recurrent events, and/or nonvascular hospitalizations, and how costs compare with the year prior to the event. We studied patients in a population-based cohort study (Oxford Vascular Study) in the United Kingdom from 2003 to 2007. Hospitalization and cost details were obtained from patients' individualized Hospital Episode Statistics records. A total of 295 incident TIA and 439 incident stroke patients were included. For patients with stroke, average costs increased from £1437 in the year pre-event to £6629 in the year post-event (PTIA, costs increased from £876 1 year before the event to £2410 in the year post-event (PTIA incurred nonsignificantly higher costs due to hospitalizations linked to subsequent vascular events (£774) than for hospitalizations linked to the index TIA (£720). Hospital costs increased after TIA or stroke, primarily because of increased initial cerebrovascular hospitalizations. The finding that costs due to nonvascular diagnoses also increased after TIA or stroke appears, in part, to be explained by the miscoding of TIA/stroke-related hospitalizations in electronic information systems. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. Mass Psychogenic Illness: Demography and Symptom Profile of an Episode

    Directory of Open Access Journals (Sweden)

    Binoy Krishna Tarafder

    2016-01-01

    Full Text Available Background. Mass psychogenic illness has been a recurrent phenomenon in Bangladesh over recent times. Objectives. This study was aimed at investigating the demographic characteristics and symptom profile of an outbreak of mass psychogenic illness occurring in a girls’ high school. Methods and Materials. In 14 April 2013, a total of 93 students of a girls’ high school suddenly developed various symptoms following intake of tiffin cake which resulted in panic and hospital admission. A descriptive, cross-sectional observational survey was done to define various characteristics of the outbreak. Results. No organic explanation for the reported illnesses was found. 93 female students were included who were hospitalized during the incident. Trigger factor was found in 98% of students. Most of the students were 13 years old. Average interval between exposure to the trigger and onset of symptoms was 151.5 minutes. Commonest symptoms were abdominal pain (83%, headache (73%, chest pain (69%, body ache (63%, nausea (69%, and generalized weakness and fatigue (61%. Hospital stay following the incident was about 12 hours on average. Conclusion. To avoid unnecessary panic in the community a prompt, coordinated response is important in resolving widespread community anxiety surrounding these episodes.

  5. Mass Psychogenic Illness: Demography and Symptom Profile of an Episode

    Science.gov (United States)

    Tarafder, Binoy Krishna; Khan, Mohammad Ashik Imran; Islam, Md. Tanvir; Mahmud, Sheikh Abdullah Al; Sarker, Md. Humayun Kabir; Faruq, Imtiaz; Miah, Md. Titu; Arafat, S. M. Yasir

    2016-01-01

    Background. Mass psychogenic illness has been a recurrent phenomenon in Bangladesh over recent times. Objectives. This study was aimed at investigating the demographic characteristics and symptom profile of an outbreak of mass psychogenic illness occurring in a girls' high school. Methods and Materials. In 14 April 2013, a total of 93 students of a girls' high school suddenly developed various symptoms following intake of tiffin cake which resulted in panic and hospital admission. A descriptive, cross-sectional observational survey was done to define various characteristics of the outbreak. Results. No organic explanation for the reported illnesses was found. 93 female students were included who were hospitalized during the incident. Trigger factor was found in 98% of students. Most of the students were 13 years old. Average interval between exposure to the trigger and onset of symptoms was 151.5 minutes. Commonest symptoms were abdominal pain (83%), headache (73%), chest pain (69%), body ache (63%), nausea (69%), and generalized weakness and fatigue (61%). Hospital stay following the incident was about 12 hours on average. Conclusion. To avoid unnecessary panic in the community a prompt, coordinated response is important in resolving widespread community anxiety surrounding these episodes. PMID:27294104

  6. Exploring pharmacist-customer communication: the established blood pressure measurement episode.

    Science.gov (United States)

    Cavaco, Afonso Neves; Romano, João P

    2010-10-01

    To characterize the communication ritual in the pharmacist-customer dyad during a blood pressure measurement and counselling episode. A Portuguese urban community pharmacy. An exploratory, cross-sectional design was used. Participants were purposively selected and data collected via audio recording, as well as demographics and clinical information via questionnaire. Encounters' verbal content was transcribed verbatim, utterances identified, time stamped, and classified according to a coding scheme of fifteen categories. All data was statistically analyzed using SPSSv17. Four dialogue structures: speaker turn, interactivity, turn density and turn duration measurements. From a total of 51 participants, 72.5% were female with a median age of 66 years. The average systolic blood pressure was 140 mmHg, while the diastolic was 78 mmHg. The blood pressure measurement episode lasted for 5:35 min, with an average of 81 utterances. From all utterances registered, 55.3% were produced by the customer. Visits averaged 38 speaker turns, with an interactivity rate of approximately 7 turns per episode minute. For pharmacists, turn duration averaged 7.0 s and turn density 2.1 utterances. The customers' turns comprised a mean of 8.0 s, with 2.4 utterances. Longer episodes were related to more speaker turns and greater customer turn density and duration, but lower dialogue interactivity. The interactivity rate was also lower when the customers' utterances increased. Pharmacists asked more questions (essentially closed ones), while the customers gave more information. No significant associations were observed between elderly/non-elderly and gender in relation to all communication variables. However, an increased number of speaker turns and closed-questions were associated to a higher systolic pressure. It seems that pharmacists tend to control the content of the dialogue, while customers have more influence on the visit duration and interactivity. Specific hypertensive episodes induce

  7. Duration of Untreated Psychosis Is Associated with More Negative Schizophrenia Symptoms after Acute Treatment for First-Episode Psychosis

    Science.gov (United States)

    Grano, Niklas; Lindsberg, Jenni; Karjalainen, Marjaana; Gronroos, Peter; Blomberg, Ari-Pekka

    2010-01-01

    Evidence of association between duration of untreated psychosis (DUP) and negative symptoms of schizophrenia in first-episode psychosis (FEP) patients is inconsistent in the recent literature. In the present study, DUP, schizophrenia symptoms, duration of medication, and diagnosis were obtained from hospital archives in a sample of FEP patients.…

  8. Application of Variable Life Adjusted Displays (VLAD on Victorian Admitted Episodes Dataset (VAED

    Directory of Open Access Journals (Sweden)

    Andrianopoulos Nick

    2012-08-01

    Full Text Available Abstract Background The need to improve patient safety has been identified as a major priority for health reform in developed countries, including Australia. We investigated the implementation and appropriateness of Variable Life Adjusted Displays as a quality control procedure to monitor “in-control” versus “out-of-control” processes in Victorian public hospitals. Methods Victorian Admitted Episode Data from Department of Human Services, Victoria for 2004–7 were used. The VLAD is a plot of a cumulative sum of the difference in expected outcome (range 0–1 and observed outcome (0 or 1 for sequential separations. Three outcomes were assessed: in-hospital mortality for acute myocardial infarction, stroke and heart failure. Logistic regression was used to obtain a realistic measure of expected mortality over the period 2004–5, adjusting for covariates and comorbidities, to estimate expected mortality risk for the separations between 2005–7. VLAD were plotted for the years 2005–7, by the 11 hospitals with the highest frequency of separations. Signalling limits for 30%, 50% and 75% risk decrease and risk increase were determined and plotted for each VLAD utilizing risk-adjusted cumulative sum techniques. This is a likelihood-ratio test statistic for signalling. If the VLAD signalled by intersecting with a limit, the limit was reset. Results The three logit models displayed reasonable fit to the observed data. There were n = 2999 separations in the AMI model, n = 3598 in the HF model and n = 1922 in the stroke model. The number of separations plotted by VLAD ranged from n = 126 to n = 648. No signals were observed in 64%, 55% and 18% of VLAD for AMI, HF and stroke respectively. For AMI and HF 9% of hospitals signalled at least once for each of 30%, 50% and 75% risk increase, whereas this was 45% for stroke. Hospitals signalling at least once for risk decrease ranged from 18% to 36% across the levels of risk and

  9. Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions

    NARCIS (Netherlands)

    Dijkema, Marieke B A; van Strien, Robert T; van der Zee, Saskia C; Mallant, Sanne F; Fischer, Paul; Hoek, Gerard; Brunekreef, Bert; Gehring, Ulrike

    2016-01-01

    BACKGROUND: Air pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with

  10. Episodic Memories in Anxiety Disorders: Clinical Implications

    Science.gov (United States)

    Zlomuzica, Armin; Dere, Dorothea; Machulska, Alla; Adolph, Dirk; Dere, Ekrem; Margraf, Jürgen

    2014-01-01

    The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD). The available literature on explicit, autobiographical, and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret, and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms. PMID:24795583

  11. Episodic memories in anxiety disorders: Clinical implications

    Directory of Open Access Journals (Sweden)

    Armin eZlomuzica

    2014-04-01

    Full Text Available The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD. The available literature on explicit-, autobiographical- and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms.

  12. A statistical study of autopsy cases in Hiroshima Atomic Bomb Hospital 1956-1975

    International Nuclear Information System (INIS)

    Hamada, Tadao; Ishida, Sadamu; Matsushita, Hiroshi.

    1976-01-01

    In order to study the differences in the incidence of a variety of disease (excluding tumors), between the cases exposed to the atomic bomb and those who were unexposed, main lesions were studied statistically by autopsy. The subjects were 1230 cases autopsied at the Hiroshima Atomic Bomb Hospital or the Hiroshima Red-Cross Hospital. They were divided into 318 cases exposed at a short distance from the bombed area (within 2 km), and 420 cases exposed at a long distance from that area (more than 2 km), including those who had come to Hiroshima later. Four hundred twenty nine unexposed cases were selected as controls. The incidence of tumor, disturbance of circulation, disturbance of the blood vessels in the brain, blood disease, and respiratory disease was higher in the exposed cases than in the unexposed cases. The incidence of cirrhosis of the liver was higher in females than in males, and was lower in cases farther from the bombed area. Cardiac infarction, valvular disease, and endocarditis were more often seen in the cases exposed near the bombed area. The incidence of the blood vessels in the brain was highest in the exposed cases near the bombed area. The incidence of disturbance of circulation, and disturbance of the blood vessels in the brain had a tendency to be higher in the exposed cases than in the unexposed cases. This is considered to be due to the advanced age in the exposed cases. (Serizawa, K.)

  13. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis.

    Science.gov (United States)

    Ahmed Ali, Usama; Issa, Yama; Hagenaars, Julia C; Bakker, Olaf J; van Goor, Harry; Nieuwenhuijs, Vincent B; Bollen, Thomas L; van Ramshorst, Bert; Witteman, Ben J; Brink, Menno A; Schaapherder, Alexander F; Dejong, Cornelis H; Spanier, B W Marcel; Heisterkamp, Joos; van der Harst, Erwin; van Eijck, Casper H; Besselink, Marc G; Gooszen, Hein G; van Santvoort, Hjalmar C; Boermeester, Marja A

    2016-05-01

    Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events. We performed a cross-sectional study of 669 patients with a first episode of acute pancreatitis admitted to 15 Dutch hospitals from December 2003 through March 2007. We collected information on disease course, outpatient visits, and hospital readmissions, as well as results from imaging, laboratory, and histology studies. Standardized follow-up questionnaires were sent to all available patients to collect information on hospitalizations and interventions for pancreatic disease, abdominal pain, steatorrhea, diabetes mellitus, medications, and alcohol and tobacco use. Patients were followed up for a median time period of 57 months. Primary end points were recurrent pancreatitis and CP. Risk factors were evaluated using regression analysis. The cumulative risk was assessed using Kaplan-Meier analysis. Recurrent pancreatitis developed in 117 patients (17%), and CP occurred in 51 patients (7.6%). Recurrent pancreatitis developed in 12% of patients with biliary disease, 24% of patients with alcoholic etiology, and 25% of patients with disease of idiopathic or other etiologies; CP occurred in 3%, 16%, and 10% of these patients, respectively. Etiology, smoking, and necrotizing pancreatitis were independent risk factors for recurrent pancreatitis and CP. Acute Physiology and Chronic Health Evaluation II scores at admission also were associated independently with recurrent pancreatitis. The cumulative risk for recurrent pancreatitis over 5 years was highest among smokers at 40% (compared with 13% for nonsmokers). For alcohol abusers and current smokers, the cumulative risks for CP were similar-approximately 18%. In contrast, the cumulative risk of CP increased to 30% in patients who smoked and abused alcohol. Based on a retrospective analysis of patients admitted to Dutch hospitals, a first

  14. Risk Factors for a Second Episode of Hemoptysis

    Directory of Open Access Journals (Sweden)

    Nobuhiko Seki

    2009-01-01

    Full Text Available Objectives Hemoptysis is an alarming symptom of underlying lung disease. Clinicians are often unsure how to deal with and follow up patients who have had a single episode of hemoptysis, especially if the cause remains unknown despite thorough examination, because a second, more severe episode of hemoptysis might occur despite an apparently stable condition. Investigations were done, using multivariate analyses, to see whether several clinical factors present during an initial episode of hemoptysis could be used to predict a second episode. Subjects and Methods Eighty patients with an initial episode of hemoptysis who underwent both computed tomographic and bronchoscopic examinations from 2003 through 2005 were reviewed. Results The isolation of bacteria from bronchial lavage fluid (odds ratio 13.5, P = 0.001 and the failure to determine the cause of the initial episode of hemoptysis (odds ratio 7.0, P = 0.014 were significant independent predictors of a second episode of hemoptysis. Subset analysis showed that isolation of either Pseudomonas aeruginosa or Haemophilus influenzae increased the likelihood of a second episode of hemoptysis (P = 0.077, even if colonization, representing host-bacterial equilibrium, had occurred. Furthermore, the failure to determine the etiology of an initial episode of hemoptysis was associated with an increased risk of a massive second episode (P = 0.042, regardless of the volume of the initial episode. Conclusions In patients with bacterial colonization of the respiratory tract or an initial episode of hemoptysis of unknown etiology, there is an increased possibility of a second episode of hemoptysis.

  15. Episodic memory function is associated with multiple measures of white matter integrity in cognitive aging

    Directory of Open Access Journals (Sweden)

    Samuel Neal Lockhart

    2012-03-01

    Full Text Available Previous neuroimaging research indicates that white matter injury and integrity, measured respectively by white matter hyperintensities (WMH and fractional anisotropy (FA obtained from diffusion tensor imaging, differ with aging and cerebrovascular disease and are associated with episodic memory deficits in cognitively normal older adults. However, knowledge about tract-specific relationships between WMH, FA, and episodic memory in aging remains limited. We hypothesized that white matter connections between frontal cortex and subcortical structures as well as connections between frontal and temporo-parietal cortex would be most affected. In the current study, we examined relationships between WMH, FA and episodic memory in 15 young adults, 13 elders with minimal WMH and 15 elders with extensive WMH, using an episodic recognition memory test for object-color associations. Voxel-based statistics were used to identify voxel clusters where white matter measures were specifically associated with variations in episodic memory performance, and white matter tracts intersecting these clusters were analyzed to examine white matter-memory relationships. White matter injury and integrity measures were significantly associated with episodic memory in extensive regions of white matter, located predominantly in frontal, parietal, and subcortical regions. Template based tractography indicated that white matter injury, as measured by WMH, in the uncinate and inferior longitudinal fasciculi were significantly negatively associated with episodic memory performance. Other tracts such as thalamo-frontal projections, superior longitudinal fasciculus, and dorsal cingulum bundle demonstrated strong negative associations as well. The results suggest that white matter injury to multiple pathways, including connections of frontal and temporal cortex and frontal-subcortical white matter tracts, plays a critical role in memory differences seen in older individuals.

  16. Editor's Choice - High Annual Hospital Volume is Associated with Decreased in Hospital Mortality and Complication Rates Following Treatment of Abdominal Aortic Aneurysms: Secondary Data Analysis of the Nationwide German DRG Statistics from 2005 to 2013.

    Science.gov (United States)

    Trenner, Matthias; Kuehnl, Andreas; Salvermoser, Michael; Reutersberg, Benedikt; Geisbuesch, Sarah; Schmid, Volker; Eckstein, Hans-Henning

    2018-02-01

    The aim of this study was to analyse the association between annual hospital procedural volume and post-operative outcomes following repair of abdominal aortic aneurysms (AAA) in Germany. Data were extracted from nationwide Diagnosis Related Group (DRG) statistics provided by the German Federal Statistical Office. Cases with a diagnosis of AAA (ICD-10 GM I71.3, I71.4) and procedure codes for endovascular aortic repair (EVAR; OPS 5-38a.1*) or open aortic repair (OAR; OPS 5-38.45, 5-38.47) treated between 2005 and 2013 were included. Hospitals were empirically grouped to quartiles depending on the overall annual volume of AAA procedures. A multilevel multivariable regression model was applied to adjust for sex, medical risk, type of procedure, and type of admission. Primary outcome was in hospital mortality. Secondary outcomes were complications, use of blood products, and length of stay (LOS). The association between AAA volume and in hospital mortality was also estimated as a function of continuous volume. A total of 96,426 cases, of which 11,795 (12.6%) presented as ruptured (r)AAA, were treated in >700 hospitals (annual median: 501). The crude in hospital mortality was 3.3% after intact (i)AAA repair (OAR 5.3%; EVAR 1.7%). Volume was inversely associated with mortality after OAR and EVAR. Complication rates, LOS, and use of blood products were lower in high volume hospitals. After rAAA repair, crude mortality was 40.4% (OAR 43.2%; EVAR 27.4%). An inverse association between mortality and volume was shown for rAAA repair; the same accounts for the use of blood products. When considering volume as a continuous variate, an annual caseload of 75-100 elective cases was associated with the lowest mortality risk. In hospital mortality and complication rates following AAA repair are inversely associated with annual hospital volume. The use of blood products and the LOS are lower in high volume hospitals. A minimum annual case threshold for AAA procedures might improve

  17. The impact of non-IPA HMOs on the number of hospitals and hospital capacity.

    Science.gov (United States)

    Chernew, M

    1995-01-01

    Concentration in the hospital market could limit the success of health care reform strategies that rely on managed care to constrain costs. Hospital market capacity also is important because capacity affects both costs and the degree of price competition. Because managed care plans, particularly non-individual practice association (non-IPA) model HMOs, practice a less hospital-intensive style of care, consolidation and downsizing in the hospital market potentially will accompany managed care growth, influencing the long-run effectiveness of managed care cost-containment strategies. Using Standard Metropolitan Statistical Area (SMSA) data from 1982 and 1987, a 10-percentage point increase in non-IPA HMO market share is estimated to reduce the number of hospitals by about 4%, causing an approximate 5% reduction in the number of hospital beds. No statistically significant relationship is found between non-IPA HMO penetration rates and hospital occupancy rates.

  18. Radiology imaging delays as independent predictors of length of hospital stay for emergency medical admissions

    International Nuclear Information System (INIS)

    Cournane, S.; Conway, R.; Creagh, D.; Byrne, D.G.; Sheehy, N.; Silke, B.

    2016-01-01

    Aim: To investigate the extent to which the time to completion for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound could be shown to influence the length of stay and costs incurred while in hospital, while accounting for patient acuity. Materials and methods: All emergency admissions, totalling 25,326 imaging investigations between 2010–2014 were evaluated. The 50"t"h, 75"t"h, and 90"t"h centiles of completion times for each imaging type was entered into a multivariable truncated Poisson regression model predicting the length of hospital stay. Estimates of risk (odds or incidence rate ratios [IRRs]) of the regressors were adjusted for acute illness severity, Charlson comorbidity index, chronic disabling disease score, and sepsis status. Quantile regression analysis was used to examine the impact of imaging on total hospital costs. Results: For all imaging examinations, longer hospital lengths of stay were shown to be related to delays in imaging time. Increased delays in CT and MRI were shown to be associated with increased hospital episode costs, while ultrasound did not independently predict increased hospital costs. The magnitude of the effect of imaging delays on episode costs were equivalent to some measures of illness severity. Conclusion: CT, MRI, and ultrasound are undertaken in patients with differing clinical complexity; however, even with adjustment for complexity, the time delay in a more expeditious radiological service could potentially shorten the hospital episode and reduce costs. - Highlights: • There are differing clinical complexities for patients depending on the modality. • A predictive risk model, incorporating advanced imaging, was devised. • Inpatients delays in radiology imaging associated with longer LOS. • Inpatients who underwent radiology imaging associated with increased hospital costs.

  19. Profound Autonomic Instability Complicated by Multiple Episodes of Cardiac Asystole and Refractory Bradycardia in a Patient with Anti-NMDA Encephalitis

    Directory of Open Access Journals (Sweden)

    Stephanie R. Mehr

    2016-01-01

    Full Text Available Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE is autoimmune encephalitis primarily affecting young adults and children. First described about a decade ago, it frequently manifests as a syndrome that includes progressive behavioral changes, psychosis, central hypoventilation, seizures, and autonomic instability. Although cardiac arrhythmias often accompany anti-NMDARE, the need for long-term electrophysiological support is rare. We describe the case of NMDARE whose ICU course was complicated by progressively worsening episodes of tachyarrhythmia-bradyarrhythmia and episodes of asystole from which she was successfully resuscitated. Her life-threatening episodes of autonomic instability were successfully controlled only after the placement of a permanent pacemaker during her ICU stay. She made a clinical recovery and was discharged to a skilled nursing facility after a protracted hospital course.

  20. Attentional episodes in visual perception

    NARCIS (Netherlands)

    Wyble, Brad; Potter, Mary C.; Bowman, Howard; Nieuwenstein, Mark

    Is one's temporal perception of the world truly as seamless as it appears? This article presents a computationally motivated theory suggesting that visual attention samples information from temporal episodes (episodic simultaneous type/serial token model; Wyble, Bowman, & Nieuwenstein, 2009). Breaks

  1. Risk factors for recurrent hospital-acquired Clostridium difficile infection in a Japanese university hospital

    Directory of Open Access Journals (Sweden)

    Hikone M

    2015-07-01

    Full Text Available Mayu Hikone,1 Yusuke Ainoda,1,2 Sayaka Tago,2 Takahiro Fujita,2 Yuji Hirai,2 Kaori Takeuchi,2 Kyoichi Totsuka31Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, 2Department of Infectious Diseases, Tokyo Women's Medical University, 3Department of Internal Medicine, Kitatama Hospital, Tokyo, JapanBackground: Clostridium difficile infection (CDI is a highly prevalent hospital-associated infection. Although most patients respond well to discontinuation of antibiotics, 20%–30% of patients relapse. To initiate early therapeutic measures, the risk factors for recurrent CDI must be identified, although very few Japanese studies have used standard surveillance definitions to identify these risk factors.Methods: We retrospectively reviewed the medical records of patients with health care facility-onset CDI between August 2011 and September 2013. Patients with diarrhea who were positive for Clostridium difficile (via an enzyme immunoassay were defined as having CDI. Clinical data (eg, demographics, comorbidities, medication, laboratory results, and clinical outcomes were evaluated, and multivariate analysis was used to identify risk factors that were associated with recurrent CDI.Results: Seventy-six health care facility-onset CDI cases were identified, with an incidence rate of 0.8 cases per 10,000 patient-days. Fourteen cases (18.4% were recurrent, with 13 patients having experienced a single recurrent episode and one patient having experienced three recurrent episodes. The 30-day and 90-day mortality rates were 7.9% and 14.5%, respectively. Multivariate analysis revealed that recurrent patients were more likely to have underlying malignant disease (odds ratio: 7.98; 95% confidence interval: 1.22–52.2; P=0.03 and a history of intensive care unit hospitalization (odds ratio: 49.9; 95% confidence interval: 1.01–2,470; P=0.049.Conclusion: Intensive care unit hospitalization and malignancy are risk factors for recurrent

  2. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

    Science.gov (United States)

    Levine, David M; Ouchi, Kei; Blanchfield, Bonnie; Diamond, Keren; Licurse, Adam; Pu, Charles T; Schnipper, Jeffrey L

    2018-05-01

    Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking. Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience. Randomized controlled trial. Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma. Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing. Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience. Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p = 0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p Home patients were more physically active (median minutes, 209 vs. 78; p home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups. The use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. No significant differences in quality, safety, and patient experience were noted, with more definitive results awaiting a larger trial. Trial Registration NCT02864420.

  3. Symptoms of delirium occurring before and after episodes of delirium in older long-term care residents.

    Science.gov (United States)

    Cole, Martin G; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Dyachenko, Alina; Belzile, Eric

    2012-12-01

    To describe Confusion Assessment Method (CAM) core symptoms of delirium occurring before and after incident episodes of delirium in older long-term care (LTC) residents. A secondary objective was to describe the mean number of symptoms before and after episodes by dementia status. Secondary analysis of data collected for a prospective cohort study of delirium, with repeated weekly assessments for up to 6 months. Seven LTC facilities in Montreal and Quebec City, Canada. Forty-one older LTC residents who had at least one CAM-defined incident episode of delirium. The Mini-Mental State Examination (MMSE), CAM, Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. The frequency, mean number, type, and duration of CAM core symptoms of delirium occurring before and after incident episodes were examined using descriptive statistics, frequency analysis, and survival analysis. CAM core symptoms of delirium preceded 38 (92.7%) episodes of delirium for many weeks; core symptoms followed 37 (90.2%) episodes for many weeks. Symptoms of inattention and disorganized thinking occurred most commonly. The mean number of symptoms was higher in residents with dementia but not significantly so. CAM core symptoms of delirium were frequent and protracted before and after most incident episodes of delirium in LTC residents with and without dementia. If replicated, these findings have potentially important implications for clinical practice and research in LTC settings. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  4. Statistical report on lung cancer irradiated in three hospital in Gunma Prefecture

    International Nuclear Information System (INIS)

    Yamanaka, Mikio; Saito, Yoshihiro; Ikeda, Hajime

    1982-01-01

    The data on 158 cases of lung cancer treated with radiotherapy at three hospitals (Hospital of School of Med., Gunma Univ., National Takasaki Hospital and Gunma Cancer Center Hospital) were analized. 1. Seventy one cases (44.9%) of all patients were more than 70 years old. As the histological type, epidermoid carcinoma was recognized in 44% of male patients, and adenocarcinoma in 51.5% of female. The number of patients with epidermoid carcinoma tended to increase with age. 2. Gunma Cancer Center was different from other hospitals in that half of the female patients (6/12) were stage I, adenocarcinoma. 3. The dwelling area of patients in Gunma Cancer Center Hospital distributed over towns and counties at the east district in Gunma prefecture, whereas in other hospitals concentrated in Maebashi and Takasaki cities. (author)

  5. High diversity of beta-lactamases in the General Hospital Vienna verified by whole genome sequencing and statistical analysis.

    Science.gov (United States)

    Barišić, Ivan; Mitteregger, Dieter; Hirschl, Alexander M; Noehammer, Christa; Wiesinger-Mayr, Herbert

    2014-10-01

    The detailed analysis of antibiotic resistance mechanisms is essential for understanding the underlying evolutionary processes, the implementation of appropriate intervention strategies and to guarantee efficient treatment options. In the present study, 110 β-lactam-resistant, clinical isolates of Enterobacteriaceae sampled in 2011 in one of Europe's largest hospitals, the General Hospital Vienna, were screened for the presence of 31 β-lactamase genes. Twenty of those isolates were selected for whole genome sequencing (WGS). In addition, the number of β-lactamase genes was estimated using biostatistical models. The carbapenemase genes blaKPC-2, blaKPC-3, and blaVIM-4 were identified in carbapenem-resistant and intermediate susceptible isolates, blaOXA-72 in an extended-spectrum β-lactamase (ESBL)-positive one. Furthermore, the observed high prevalence of the acquired blaDHA-1 and blaCMY AmpC β-lactamase genes (70%) in phenotypically AmpC-positive isolates is alarming due to their capability to become carbapenem-resistant upon changes in membrane permeability. The statistical analyses revealed that approximately 55% of all β-lactamase genes present in the General Hospital Vienna were detected by this study. In summary, this work gives a very detailed picture on the disseminated β-lactamases and other resistance genes in one of Europe's largest hospitals. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Implementation of directly observed patient hand hygiene for hospitalized patients by hand hygiene ambassadors in Hong Kong.

    Science.gov (United States)

    Cheng, Vincent C C; Tai, Josepha W M; Li, W S; Chau, P H; So, Simon Y C; Wong, Lisa M W; Ching, Radley H C; Ng, Modissa M L; Ho, Sara K Y; Lee, Doris W Y; Lee, W M; Wong, Sally C Y; Yuen, K Y

    2016-06-01

    The importance of compliance with hand hygiene by patients is increasingly recognized to prevent health care-associated infections. This descriptive study observed the effects of an education campaign, targeted to increase patients' self-initiated hand hygiene, and a hand hygiene ambassador-initiated directly observed hand hygiene program on patients' hand hygiene compliance in a university-affiliated hospital. The overall audited compliance of patients' self-initiated hand hygiene was only 37.5%, with a rate of 26.9% (112/416 episodes) before meals and medications, 27.5% (19/69 episodes) after using a urinal or bedpan, and 89.7% (87/97 episodes) after attending toilet facilities. Patients referred from a residential care home for older adults had significantly lower hand hygiene compliance (P = .007). Comparatively, the overall audited compliance of ambassador-initiated directly observed hand hygiene was 97.3% (428/440 episodes), which was significantly higher than patients' self-initiated hand hygiene via a patient education program (37.5%, 218/582 episodes, P hand hygiene can play an important role in improving compliance with hand hygiene by hospitalized patients. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  7. Episodic memory, semantic memory, and amnesia.

    Science.gov (United States)

    Squire, L R; Zola, S M

    1998-01-01

    Episodic memory and semantic memory are two types of declarative memory. There have been two principal views about how this distinction might be reflected in the organization of memory functions in the brain. One view, that episodic memory and semantic memory are both dependent on the integrity of medial temporal lobe and midline diencephalic structures, predicts that amnesic patients with medial temporal lobe/diencephalic damage should be proportionately impaired in both episodic and semantic memory. An alternative view is that the capacity for semantic memory is spared, or partially spared, in amnesia relative to episodic memory ability. This article reviews two kinds of relevant data: 1) case studies where amnesia has occurred early in childhood, before much of an individual's semantic knowledge has been acquired, and 2) experimental studies with amnesic patients of fact and event learning, remembering and knowing, and remote memory. The data provide no compelling support for the view that episodic and semantic memory are affected differently in medial temporal lobe/diencephalic amnesia. However, episodic and semantic memory may be dissociable in those amnesic patients who additionally have severe frontal lobe damage.

  8. The effects of organizational flexibility on nurse utilization and vacancy statistics in Ontario hospitals.

    Science.gov (United States)

    Fisher, Anita; Baumann, Andrea; Blythe, Jennifer

    2007-01-01

    Social and economic changes in industrial societies during the past quarter-century encouraged organizations to develop greater flexibility in their employment systems in order to adapt to organizational restructuring and labour market shifts (Kallenberg 2003). During the 1990s this trend became evident in healthcare organizations. Before healthcare restructuring, employment in the acute hospital sector was more stable, with higher levels of full-time staff. However, in the downsizing era, employers favoured more flexible, contingent workforces (Zeytinoglu 1999). As healthcare systems evolved, staffing patterns became more chaotic and predicting staffing requirements more complex. Increased use of casual and part-time staff, overtime and agency nurses, as well as alterations in skills mix, masked vacancy counts and thus rendered this measurement of nursing demand increasingly difficult. This study explores flexible nurse staffing practices and demonstrates how data such as nurse vacancy statistics, considered in isolation from nurse utilization information, are inaccurate indicators of nursing demand and nurse shortage. It develops an algorithm that provides a standard methodology for improved monitoring and management of nurse utilization data and better quantification of vacancy statistics. Use of standard methodology promotes more accurate measurement of nurse utilization and shortage. Furthermore, it provides a solid base for improved nursing workforce planning, production and management.

  9. Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia

    DEFF Research Database (Denmark)

    Rosenberg, J; Oturai, P; Erichsen, C J

    1994-01-01

    STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... surgery and 16 patients undergoing middle ear surgery, both with comparable general anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with continuous pulse oximetry on one preoperative night and the second postoperative night. Significant episodic or constant hypoxemia did not occur...... on the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the development...

  10. Caregiver psychoeducation for first-episode psychosis.

    LENUS (Irish Health Repository)

    McWilliams, Stephen

    2010-01-01

    International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a six-week caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes.

  11. Impact of pre-hospital antibiotic use on community-acquired pneumonia.

    Science.gov (United States)

    Simonetti, A F; Viasus, D; Garcia-Vidal, C; Grillo, S; Molero, L; Dorca, J; Carratalà, J

    2014-09-01

    Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  12. Menstrual-Cycle and Menstruation Disorders in Episodic vs Chronic Migraine: An Exploratory Study.

    Science.gov (United States)

    Spierings, Egilius L H; Padamsee, Aliya

    2015-07-01

    Migraine is a chronic condition of recurring moderate-to-severe headaches that affects an estimated 6% of men and 18% of women. The highest prevalence is in those 18-49 years of age, generally when women menstruate. It is divided into episodic and chronic migraine depending on the total number of headache days per month being 14 or less or 15 or more, respectively. Migraine has been associated with menorrhagia, dysmenorrhea, and endometriosis, the latter particularly in chronic migraine. We conducted a questionnaire survey of 96 women with migraine, 18-45 years old, to determine the occurrence of the menstrual-cycle disorders, oligomenorrhea, polymenorrhea, and irregular cycle, and the menstruation disorders, dysmenorrhea and menorrhagia, in episodic vs chronic migraine. The prevalence of menstrual-cycle disorders in general (41.2 vs 22.2%) and dysmenorrhea (51.0 vs 28.9%) was statistically significantly higher in the women with chronic migraine than in those with episodic migraine (P ≤ 0.05) (not corrected for multiple comparisons). Whether the migraine was menstruation sensitive, that is, the headaches consistently occurred or worsened with menstruation, did not impact the prevalence of menstrual disorders. We conclude that chronic migraine is possibly more often than episodic migraine associated with menstrual-cycle disorders in general and dysmenorrhea, without impact on menstruation sensitivity of the headaches. Wiley Periodicals, Inc.

  13. Prognostic Impact of In-Hospital and Postdischarge Heart Failure in Patients With Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Sulo, Gerhard; Igland, Jannicke; Nygård, Ottar

    2017-01-01

    Background: Heart failure (HF) is a serious complication of acute myocardial infarction (AMI). We explored the excess mortality associated with HF as an early or late complication of AMI and describe changes over time in such excess mortality. Methods and Results: All patients hospitalized with a...... or late complication of AMI—has a negative impact on patients' survival. Changes in the excess mortality associated with HF are driven by modest improvements in survival among AMI patients with HF as compared to those without HF.......Background: Heart failure (HF) is a serious complication of acute myocardial infarction (AMI). We explored the excess mortality associated with HF as an early or late complication of AMI and describe changes over time in such excess mortality. Methods and Results: All patients hospitalized...... with an incident AMI and without history of prior HF hospitalization were followed up to 1 year after AMI discharge for episodes of HF. New HF episodes were classified as in‐hospital HF if diagnosed during the AMI hospitalization or postdischarge HF if diagnosed within 1 year after discharge from the incident AMI...

  14. Medical facility statistics in Japan.

    Science.gov (United States)

    Hamajima, Nobuyuki; Sugimoto, Takuya; Hasebe, Ryo; Myat Cho, Su; Khaing, Moe; Kariya, Tetsuyoshi; Mon Saw, Yu; Yamamoto, Eiko

    2017-11-01

    Medical facility statistics provide essential information to policymakers, administrators, academics, and practitioners in the field of health services. In Japan, the Health Statistics Office of the Director-General for Statistics and Information Policy at the Ministry of Health, Labour and Welfare is generating these statistics. Although the statistics are widely available in both Japanese and English, the methodology described in the technical reports are primarily in Japanese, and are not fully described in English. This article aimed to describe these processes for readers in the English-speaking world. The Health Statistics Office routinely conduct two surveys called the Hospital Report and the Survey of Medical Institutions. The subjects of the former are all the hospitals and clinics with long-term care beds in Japan. It comprises a Patient Questionnaire focusing on the numbers of inpatients, admissions, discharges, and outpatients in one month, and an Employee Questionnaire, which asks about the number of employees as of October 1. The Survey of Medical Institutions consists of the Dynamic Survey, which focuses on the opening and closing of facilities every month, and the Static Survey, which focuses on staff, facilities, and services as of October 1, as well as the number of inpatients as of September 30 and the total number of outpatients during September. All hospitals, clinics, and dental clinics are requested to submit the Static Survey questionnaire every three years. These surveys are useful tools for collecting essential information, as well as providing occasions to implicitly inform facilities of the movements of government policy.

  15. Modeling Data with Excess Zeros and Measurement Error: Application to Evaluating Relationships between Episodically Consumed Foods and Health Outcomes

    KAUST Repository

    Kipnis, Victor; Midthune, Douglas; Buckman, Dennis W.; Dodd, Kevin W.; Guenther, Patricia M.; Krebs-Smith, Susan M.; Subar, Amy F.; Tooze, Janet A.; Carroll, Raymond J.; Freedman, Laurence S.

    2009-01-01

    Dietary assessment of episodically consumed foods gives rise to nonnegative data that have excess zeros and measurement error. Tooze et al. (2006, Journal of the American Dietetic Association 106, 1575-1587) describe a general statistical approach

  16. Costs of day hospital and community residential chemical dependency treatment.

    Science.gov (United States)

    Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya; Witbrodt, Jane

    2008-03-01

    Patient placement criteria developed by the American Society of Addiction Medicine (ASAM) have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher levels of severity. A recent clinical trial found similar outcomes at social model residential treatment and clinically-oriented day hospital programs, but did not report on costs. This paper addresses whether the similar outcomes in the recent trial were delivered with comparable costs, overall and within gender and ethnicity stratum. This paper reports on clients not at environmental risk who participated in a randomized trial conducted in three metropolitan areas served by a large pre-paid health plan. Cost data were collected using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Costs per episode were calculated by multiplying DATCAP-derived program-specific costs by each client's length of stay. Differences in length of stay, and in per-episode costs, were compared between residential and day hospital subjects. Lengths of stay at residential treatment were significantly longer than at day hospital, in the sample overall and in disaggregated analyses. This difference was especially marked among non-Whites. The average cost per week was USD 575 per week at day hospital, versus USD 370 per week at the residential programs. However, because of the longer stays in residential, per-episode costs were significantly higher in the sample overall and among non-Whites (and marginally higher for men). These cost results must be considered in light of the null findings comparing outcomes between subjects randomized to residential versus day hospital programs. The longer stays in the sample overall and for non-White clients at residential programs came at higher costs but did not lead to better rates of abstinence. The short stays in day hospital among non-Whites call into question the attractiveness of day hospital for minority clients. Outcomes and costs

  17. Factitious psychogenic nonepileptic paroxysmal episodes

    Directory of Open Access Journals (Sweden)

    Alissa Romano

    2014-01-01

    Full Text Available Mistaking psychogenic nonepileptic paroxysmal episodes (PNEPEs for epileptic seizures (ES is potentially dangerous, and certain features should alert physicians to a possible PNEPE diagnosis. Psychogenic nonepileptic paroxysmal episodes due to factitious seizures carry particularly high risks of morbidity or mortality from nonindicated emergency treatment and, often, high costs in wasted medical treatment expenditures. We report a case of a 28-year-old man with PNEPEs that were misdiagnosed as ES. The patient had been on four antiseizure medications (ASMs with therapeutic serum levels and had had multiple intubations in the past for uncontrolled episodes. He had no episodes for two days of continuous video-EEG monitoring. He then disconnected his EEG cables and had an episode of generalized stiffening and cyanosis, followed by jerking and profuse bleeding from the mouth. The manifestations were unusually similar to those of ES, except that he was clearly startled by spraying water on his face, while he was stiff in all extremities and unresponsive. There were indications that he had sucked blood from his central venous catheter to expel through his mouth during his PNEPEs while consciously holding his breath. Normal video-EEG monitoring; the patient's volitional and deceptive acts to fabricate the appearance of illness, despite pain and personal endangerment; and the absence of reward other than remaining in a sick role were all consistent with a diagnosis of factitious disorder.

  18. Cost of managing an episode of relapse in multiple sclerosis in the United States

    Directory of Open Access Journals (Sweden)

    Ward Alexandra J

    2003-09-01

    Full Text Available Abstract Background The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. Methods Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. Results Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female. Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was $1,847 and mild episode $243. Conclusions Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.

  19. Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer.

    Science.gov (United States)

    Zafar, Waleed; Ghafoor, Irum; Jamshed, Arif; Gul, Sabika; Hafeez, Haroon

    2017-04-01

    To review all episodes where an emergency code was called in a cancer-specialized hospital in Pakistan and to assess survival to discharge among patients who received a cardiopulmonary resuscitation (CPR). We reviewed demographic and clinical data related to all "code blue" calls over 3 years. Multivariate logistic regression analyses were used to test the association of clinical characteristics with the primary outcome of survival to discharge. A total of 646 code blue calls were included in the analysis. The CPR was performed in 388 (60%) of these calls. For every 20 episodes of CPR among patients with cancer of all ages, only 1 resulted in a patient's survival to discharge, even though in 52.2% episodes there was a return of spontaneous circulation. No association was found between the type of rhythm at initiation of CPR and likelihood of survival to discharge. The proportion of patients with advanced cancer surviving to discharge after in-hospital CPR in a low-income country was in line with the reported international experience. Most patients with cancer who received in-hospital CPR did not survive to discharge and did not appear to benefit from resuscitation. Advance directives by patients with cancer limiting aggressive interventions at end of life and proper documentation of these directives will help in provision of care that is humane and consonant with patients' wishes for a dignified death. Patients' early appreciation of the limited benefits of CPR in advanced cancer is likely to help them formulate such advance directives.

  20. Statistics in the pharmacy literature.

    Science.gov (United States)

    Lee, Charlene M; Soin, Herpreet K; Einarson, Thomas R

    2004-09-01

    Research in statistical methods is essential for maintenance of high quality of the published literature. To update previous reports of the types and frequencies of statistical terms and procedures in research studies of selected professional pharmacy journals. We obtained all research articles published in 2001 in 6 journals: American Journal of Health-System Pharmacy, The Annals of Pharmacotherapy, Canadian Journal of Hospital Pharmacy, Formulary, Hospital Pharmacy, and Journal of the American Pharmaceutical Association. Two independent reviewers identified and recorded descriptive and inferential statistical terms/procedures found in the methods, results, and discussion sections of each article. Results were determined by tallying the total number of times, as well as the percentage, that each statistical term or procedure appeared in the articles. One hundred forty-four articles were included. Ninety-eight percent employed descriptive statistics; of these, 28% used only descriptive statistics. The most common descriptive statistical terms were percentage (90%), mean (74%), standard deviation (58%), and range (46%). Sixty-nine percent of the articles used inferential statistics, the most frequent being chi(2) (33%), Student's t-test (26%), Pearson's correlation coefficient r (18%), ANOVA (14%), and logistic regression (11%). Statistical terms and procedures were found in nearly all of the research articles published in pharmacy journals. Thus, pharmacy education should aim to provide current and future pharmacists with an understanding of the common statistical terms and procedures identified to facilitate the appropriate appraisal and consequential utilization of the information available in research articles.

  1. A statewide review of postnatal care in private hospitals in Victoria, Australia

    Directory of Open Access Journals (Sweden)

    Forster Della A

    2010-05-01

    Full Text Available Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19 and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11. Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and

  2. Early detection of first-episode psychosis

    DEFF Research Database (Denmark)

    Larsen, Tor K; Melle, Ingrid; Auestad, Bjørn

    2006-01-01

    Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven.......Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven....

  3. Is there an optimal factor structure of the Positive and Negative Syndrome Scale in patients with first-episode psychosis?

    DEFF Research Database (Denmark)

    Langeveld, Johannes; Andreassen, OA; Auestad, B

    2013-01-01

    -defined first-episode psychosis sample. The aim of this paper is to examine the statistical fit of five different PANSS models in a first-episode, non-affective psychosis sample. Confirmatory factor analyses were performed on PANSS data (n = 588). A main criterion for best fit was defined as the Expected Cross...... Validation Index (ECVI). No tested model revealed an optimally satisfactory model fit index. The Wallwork/Fortgang five-factor model demonstrated the most optimal psychometric properties. The corresponding subscales of all evaluated five-factor models were strongly intercorrelated. The Wallwork/Fortgang five...

  4. Episodic Memory: A Comparative Approach

    Science.gov (United States)

    Martin-Ordas, Gema; Call, Josep

    2013-01-01

    Historically, episodic memory has been described as autonoetic, personally relevant, complex, context-rich, and allowing mental time travel. In contrast, semantic memory, which is theorized to be free of context and personal relevance, is noetic and consists of general knowledge of facts about the world. The field of comparative psychology has adopted this distinction in order to study episodic memory in non-human animals. Our aim in this article is not only to reflect on the concept of episodic memory and the experimental approaches used in comparative psychology to study this phenomenon, but also to provide a critical analysis of these paradigms. We conclude the article by providing new avenues for future research. PMID:23781179

  5. The relationship between the numbers of reflux episodes with anatomic changes of the esophagus in children under one year with gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    HamidrezaTalari

    2016-07-01

    Full Text Available Gastroesophageal reflux is the most common gastrointestinal disorder in the neonatal period, and the main reason for it is the lack of development in the first months of an infant's digestive system and it gets improved with the aging of baby and development of the digestive system. Some studies have shown that there is a relationship between characteristics of anatomic and esophageal reflux. This study aimed to determine the relationship between the characteristics and frequency of reflux in infants under one year old with gastroesophageal reflux disease. This study is a cross-sectional study that was conducted in 2015 in the hospital of martyr Beheshti. In this study, a group of 120 children with reflux in three age groups less than one month, 1-6 months and 6-12 months were choses and the relationship between reflux episodes with esophagus anatomic characteristics, including distal esophagus distention, Hiss angle, internal angle and length of esophagus were examined. The data were analyzed using the SPSS software and the relationship between the characteristics was compared with the number of reflux in three groups. According to the results, the frequency of reflux and extent of distention of the distal esophageal, Hiss angle, Internal Gastro esophageal angle and length of the esophagus, there was a statistically significant correlation (P <0.001. The correlation between reflux episodes and four parameters, are respectively, 0/95, 0/97, 0/71 and -0/79/. Also there was a direct relation between the frequency of reflux and extent of distention of the distal esophageal, Hiss angle, Internal Gastro esophageal angle and an inverse relation with length of the esophagus. The correlation between the frequency of reflux and esophageal characteristics in separation between all three age groups showed a statistically significant relationship exists between anatomical esophageal characteristics and reflux frequency. Based on the results of this study it

  6. Superficial Priming in Episodic Recognition

    Science.gov (United States)

    Dopkins, Stephen; Sargent, Jesse; Ngo, Catherine T.

    2010-01-01

    We explored the effect of superficial priming in episodic recognition and found it to be different from the effect of semantic priming in episodic recognition. Participants made recognition judgments to pairs of items, with each pair consisting of a prime item and a test item. Correct positive responses to the test item were impeded if the prime…

  7. Identifying Radiology's Place in the Expanding Landscape of Episode Payment Models.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Hirsch, Joshua A; Allen, Bibb; Harvey, H Benjamin; Nicola, Gregory N

    2017-07-01

    The current fee-for-service system for health care reimbursement in the United Stated is argued to encourage fragmented care delivery and a lack of accountability that predisposes to insufficient focus on quality as well as unnecessary or duplicative resource utilization. Episode payment models (EPMs) seek to improve coordination by linking payments for all services related to a patient's condition or procedure, thereby improving quality and efficiency of care. The CMS Innovation Center has implemented a broadening array of EPMs. Early models with relevance to radiologists include Bundled Payment for Care Improvement (involving 48 possible clinical conditions), Comprehensive Care for Joint Replacement (involving knee and hip replacement), and the Oncology Care Model (involving chemotherapy). In July 2016, CMS expanded the range of EPMs through three new models with mandatory hospital participation addressing inpatient and 90-day postdischarge care for acute myocardial infarction, coronary artery bypass graft, and surgical hip and femur fracture treatment. Moreover, some of the EPMs include tracks that allow participating entities to qualify as an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act (MACRA), reaping the associated reporting and payment benefits. Even though none of the available EPMs are radiology specific, the models will nevertheless likely influence reimbursements for some radiologists. Thus, radiologists should partner with hospitals and other specialties in care coordination through these episode-based initiatives, thereby having opportunities to apply their imaging expertise to help lower spending while improving quality and overall levels of health. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  8. Epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge in Japan: An exploratory descriptive study using a nationwide claims database.

    Science.gov (United States)

    Okumura, Yasuyuki; Sakata, Nobuo; Takahashi, Kunihiko; Nishi, Daisuke; Tachimori, Hisateru

    2017-08-01

    Little is known about the nationwide epidemiology of the annual rate, causative substance, and clinical course of overdose-related admission. We aimed to describe the epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge to home. We assessed all cases of admission due to overdose (21,663 episodes) in Japan from October 2012 through September 2013 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. The annual rate of overdose admission was 17.0 per 100,000 population. Women exhibited two peaks in admission rates at 19-34 years (40.9 per 100,000) and ≥75 years (27.8 per 100,000). Men exhibited one peak in the admission rate at ≥75 years (23.7 per 100,000). Within 90 days prior to overdose, ≥60% and ≥9% of patients aged 19-49 years received a prescription for benzodiazepines and barbiturates, respectively. In addition, 59% of patients aged ≥75 years received a prescription for benzodiazepines prior to overdose, 47% had a history of congestive heart failure, and 24% had a diagnosis of poisoning by cardiovascular drugs. The proportion of patients with recent psychiatric treatments decreased with age (65.1% in those aged 35-49 years and 13.9% in those aged ≥75 years). The findings emphasize the need for overdose prevention programs that focus on psychiatric patients aged 19-49 years who are prescribed benzodiazepines or barbiturates and on non-psychiatric patients aged ≥75 years who are prescribed benzodiazepines or digitalis. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  9. [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 III: Treatment of Resistant Depression and Psychotic Depression, Occupational Therapy and Day Hospital Treatment].

    Science.gov (United States)

    Gómez-Restrepo, Carlos; Peñaranda, Adriana Patricia Bohórquez; Valencia, Jenny García; Guarín, Maritza Rodríguez; Ángel, Juliana Rodríguez; Jaramillo, Luis Eduardo; Acosta, Carlos Alberto Palacio; Pedraza, Ricardo Sánchez; Díaz, Sergio Mario Castro; de la Hoz Bradford, Ana María

    2012-12-01

    This article presents recommendations based on the evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder. Emphasis was given to general treatment issues of resistant depression and psychotic depression, occupational therapy and day hospital treatment so as to grant diagnosed adult patients the health care parameters based on the best and more updated evidence available and achieve minimum quality standards. 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 23-25 corresponding to the management of depression are presented. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  10. Episodic-like memory in the rat.

    Science.gov (United States)

    Babb, Stephanie J; Crystal, Jonathon D

    2006-07-11

    A fundamental question in comparative cognition is whether animals remember unique, personal past experiences. It has long been argued that memories for specific events (referred to as episodic memory) are unique to humans. Recently, considerable evidence has accumulated to show that food-storing birds possess critical behavioral elements of episodic memory, referred to as episodic-like memory in acknowledgment of the fact that behavioral criteria do not assess subjective experiences. Here we show that rats have a detailed representation of remembered events and meet behavioral criteria for episodic-like memory. We provided rats with access to locations baited with distinctive (e.g., grape and raspberry) or nondistinctive (regular chow) flavors. Locations with a distinctive flavor replenished after a long but not a short delay, and locations with the nondistinctive flavor never replenished. One distinctive flavor was devalued after encoding its location by prefeeding that flavor (satiation) or by pairing it with lithium chloride (acquired taste aversion), while the other distinctive flavor was not devalued. The rats selectively decreased revisits to the devalued distinctive flavor but not to the nondevalued distinctive flavor. The present studies demonstrate that rats selectively encode the content of episodic-like memories.

  11. Neocortical connectivity during episodic memory formation.

    Science.gov (United States)

    Summerfield, Christopher; Greene, Matthew; Wager, Tor; Egner, Tobias; Hirsch, Joy; Mangels, Jennifer

    2006-05-01

    During the formation of new episodic memories, a rich array of perceptual information is bound together for long-term storage. However, the brain mechanisms by which sensory representations (such as colors, objects, or individuals) are selected for episodic encoding are currently unknown. We describe a functional magnetic resonance imaging experiment in which participants encoded the association between two classes of visual stimuli that elicit selective responses in the extrastriate visual cortex (faces and houses). Using connectivity analyses, we show that correlation in the hemodynamic signal between face- and place-sensitive voxels and the left dorsolateral prefrontal cortex is a reliable predictor of successful face-house binding. These data support the view that during episodic encoding, "top-down" control signals originating in the prefrontal cortex help determine which perceptual information is fated to be bound into the new episodic memory trace.

  12. Neocortical connectivity during episodic memory formation.

    Directory of Open Access Journals (Sweden)

    Christopher Summerfield

    2006-05-01

    Full Text Available During the formation of new episodic memories, a rich array of perceptual information is bound together for long-term storage. However, the brain mechanisms by which sensory representations (such as colors, objects, or individuals are selected for episodic encoding are currently unknown. We describe a functional magnetic resonance imaging experiment in which participants encoded the association between two classes of visual stimuli that elicit selective responses in the extrastriate visual cortex (faces and houses. Using connectivity analyses, we show that correlation in the hemodynamic signal between face- and place-sensitive voxels and the left dorsolateral prefrontal cortex is a reliable predictor of successful face-house binding. These data support the view that during episodic encoding, "top-down" control signals originating in the prefrontal cortex help determine which perceptual information is fated to be bound into the new episodic memory trace.

  13. Factors precipitating the risk of aspiration in hospitalized patients: findings from a multicentre critical incident technique study.

    Science.gov (United States)

    Palese, Alvisa; Lesa, Lucia; Stroppolo, Giulia; Lupieri, Giulia; Tardivo, Stefano; Brusaferro, Silvio

    2017-04-01

    To elucidate factors, other than those clinical, precipitating the risk of aspiration in hospitalized patients. The Critical Incident Technique was adopted for this study in 2015. Three departments located in two academic hospitals in the northeast of Italy, equipped with 800 and 1500 beds, respectively. A purposeful sample of 12 registered nurses (RN), all of whom (i) had reported one or more episodes of aspiration during the longitudinal survey, (ii) had worked ≥3 years in the department, and (iii) were willing to participate, were included. Antecedent factors involved in episodes of aspiration as experienced by RNs were collected through an open-ended interview, and qualitatively analysed. In addition to clinical factors, other factors interacting with each other may precipitate the risk of aspiration episodes during hospitalization: at the nursing care level (misclassifying patients, transferring tasks to other healthcare professionals and standardizing processes to remove potential threats); at the family level (misclassifying patients, dealing with the cultural relevance of eating) and at the environmental level (positioning the patient, managing time pressures, distracting patient while eating, dealing with food consistency and irritating oral medication). At the hospital level, an adequate nursing workforce and models of care delivery, as well as time for initial and continuing patient and family assessment are required. At the unit level, patient-centred models of care aimed at reducing care standardization are also recommended; in addition, nursing, family and environmental factors should be recorded in the incident reports documenting episodes of aspiration. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  14. Rats Remember Items in Context Using Episodic Memory.

    Science.gov (United States)

    Panoz-Brown, Danielle; Corbin, Hannah E; Dalecki, Stefan J; Gentry, Meredith; Brotheridge, Sydney; Sluka, Christina M; Wu, Jie-En; Crystal, Jonathon D

    2016-10-24

    Vivid episodic memories in people have been characterized as the replay of unique events in sequential order [1-3]. Animal models of episodic memory have successfully documented episodic memory of a single event (e.g., [4-8]). However, a fundamental feature of episodic memory in people is that it involves multiple events, and notably, episodic memory impairments in human diseases are not limited to a single event. Critically, it is not known whether animals remember many unique events using episodic memory. Here, we show that rats remember many unique events and the contexts in which the events occurred using episodic memory. We used an olfactory memory assessment in which new (but not old) odors were rewarded using 32 items. Rats were presented with 16 odors in one context and the same odors in a second context. To attain high accuracy, the rats needed to remember item in context because each odor was rewarded as a new item in each context. The demands on item-in-context memory were varied by assessing memory with 2, 3, 5, or 15 unpredictable transitions between contexts, and item-in-context memory survived a 45 min retention interval challenge. When the memory of item in context was put in conflict with non-episodic familiarity cues, rats relied on item in context using episodic memory. Our findings suggest that rats remember multiple unique events and the contexts in which these events occurred using episodic memory and support the view that rats may be used to model fundamental aspects of human cognition. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Severity of depressive episodes according to ICD-10

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2004-01-01

    BACKGROUND: The ICD-10 categorisation of severity of depression into mild, moderate and severe depressive episodes has not been validated. AIMS: To validate the ICD-10 categorisation of severity of depression by estimating its predictive ability on the course of illness and suicidal outcome. METHOD......: All psychiatric in-patients in Denmark who had received a diagnosis of a single depressive episode at their first discharge between 1994 and 1999 were identified. The risk of relapse and the risk of suicide were compared for patients discharged with an ICD-10 diagnosis of a single mild, moderate...... or severe depressive episode. RESULTS: At their first discharge, 1103 patients had an ICD-10 diagnosis of mild depressive episode, 3182 had a diagnosis of moderate depressive episode and 2914 had a diagnosis of severe depressive episode. The risk of relapse and the risk of suicide were significantly...

  16. Características clínicas de los episodios de hipoglucemia en niños y adolescentes con diabetes tipo 1 atendidos en el Hospital Pediátrico "William Soler" Clinical features of hypoglycemic episodes in children and adolescents presenting with type 1 diabetes seen in "William Soler" Children Hospital

    Directory of Open Access Journals (Sweden)

    Pedro González Fernández

    2010-12-01

    more serious problem associated with the disease. OBJETIVE: to determine the frequencies and the clinical features of hypoglycemia in a group of diabetic children and adolescents diagnosed with type 1 diabetes mellitus seen in the Endocrinology of the "William Soler" Children Hospital from January, 1987 and January, 2000. Medical records, general data of patient, insulin therapy , results of glycosylated hemoglobin were registered, as well as the recounted hypoglycemia episodes which were classified as slight and severe. RESULTS: there was a high frequency of hypoglycemia episodes (56,25 %. The first severe hypoglycemia was registered as more frequent at the age group of 5 years. The first severe hypoglycemia episode occurred before the first year of diagnosis of diabetes mellitus. Patients under a intensive regime had a greater percentage of episodes of severe hypoglycemia than those under a conventional regime. The metabolic control not influenced in occurrence of severe hypoglycemia episodes. CONCLUSIONS: the above mentioned episodes had a high frequency with predominance of the severe ones during the dawn and with more involvement in the group aged under 5 being a neurodevelopmental affection of development in this age group.

  17. Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder?

    Science.gov (United States)

    Kessing, L V; Andersen, P K

    2004-12-01

    Several findings suggest that some patients with depressive or bipolar disorder may be at increased risk of developing dementia. The present study aimed to investigate whether the risk of developing dementia increases with the number of affective episodes in patients with depressive disorder and in patients with bipolar disorder. This was a case register study including all hospital admissions with primary affective disorder in Denmark during 1970-99. The effect of the number of prior episodes leading to admission on the rate of readmission with a diagnosis of dementia following the first discharge after 1985 was estimated. A total of 18,726 patients with depressive disorder and 4248 patients with bipolar disorder were included in the study. The rate of a diagnosis of dementia on readmission was significantly related to the number of prior affective episodes leading to admission. On average, the rate of dementia tended to increase 13% with every episode leading to admission for patients with depressive disorder and 6% with every episode leading to admission for patients with bipolar disorder, when adjusted for differences in age and sex. On average, the risk of dementia seems to increase with the number of episodes in depressive and bipolar affective disorders.

  18. Reduction in hospitalwide incidence of infection or colonization with methicillin-resistant Staphylococcus aureus with use of antimicrobial hand-hygiene gel and statistical process control charts.

    Science.gov (United States)

    Harrington, Glenys; Watson, Kerrie; Bailey, Michael; Land, Gillian; Borrell, Susan; Houston, Leanne; Kehoe, Rosaleen; Bass, Pauline; Cockroft, Emma; Marshall, Caroline; Mijch, Anne; Spelman, Denis

    2007-07-01

    To evaluate the impact of serial interventions on the incidence of methicillin-resistant Staphylococcus aureus (MRSA). Longitudinal observational study before and after interventions. The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU). A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures. Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period. The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P=.047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P<.001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively. A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.

  19. Statistical studies on heart disease of the pathological autopsy cases in the Atomic Bomb Hospital

    Energy Technology Data Exchange (ETDEWEB)

    Matushita, H [Hiroshima Red Cross Hospital (Japan); Hamada, T; Ishida, S

    1976-03-01

    Of 1230 autopsied cases in the Atomic Bomb Hospital and in the Red-Cross Hospital from 1956 to March, 1975, a statistical study was made on 118 cases in which primary or secondary heart disease had been found. The results are as follows. The incidence of myocardial infarction was 2.4 times higher in the group exposed to the atomic bomb within 2 km distance from the bombed area than that it was in the unexposed group. The incidence of acquired valvular disease was 4.1 times higher in the exposed group than in the unexposed group. From the standpoint of the incidence of myocardiosis, there was no difference between the groups. The incidence of pericarditis was 1.5 times higher in the exposed group than in the unexposed group. The incidence of cor pulmonale was 1.8 times higher in the exposed group than in the unexposed group. The incidence of other heart disease including congenital disease was, however, 1.6 times higher in the unexposed group than in the exposed group. The incidence of general heart disease was 1.7 times higher in the exposed group than in the unexposed group. The incidence of hypertrophy of the heart (more than 400 g) was 1.2 times higher in the exposed group than in the unexposed group.

  20. Statistical studies on heart disease of the pathological autopsy cases in the Atomic Bomb Hospital

    International Nuclear Information System (INIS)

    Matushita, Hiroshi; Hamada, Tadao; Ishida, Sadamu.

    1976-01-01

    Of 1230 autopsied cases in the Atomic Bomb Hospital and in the Red-Cross Hospital from 1956 to March, 1975, a statistical study was made on 118 cases in which primary or secondary heart disease had been found. The results are as follows. The incidence of myocardial infarction was 2.4 times higher in the group exposed to the atomic bomb within 2 km distance from the bombed area than that it was in the unexposed group. The incidence of acquired valvular disease was 4.1 times higher in the exposed group than in the unexposed group. From the standpoint of the incidence of myocardiosis, there was no difference between the groups. The incidence of pericarditis was 1.5 times higher in the exposed group than in the unexposed group. The incidence of cor pulmonale was 1.8 times higher in the exposed group than in the unexposed group. The incidence of other heart disease including congenital disease was, however, 1.6 times higher in the unexposed group than in the exposed group. The incidence of general heart disease was 1.7 times higher in the exposed group than in the unexposed group. The incidence of hypertrophy of the heart (more than 400 g) was 1.2 times higher in the exposed group than in the unexposed group. (Namekawa, K.)

  1. Trends in hospital admission rates for anorexia nervosa in Oxford (1968-2011) and England (1990-2011): database studies.

    Science.gov (United States)

    Holland, Josephine; Hall, Nick; Yeates, David G R; Goldacre, Michael

    2016-02-01

    To report on long-term trends in hospital admission rates for anorexia nervosa using two English datasets. We used data on hospital day-case and inpatient care across five decades in the Oxford Record Linkage Study (ORLS), and similar data for all England from 1990. We analysed rates of admission for anorexia nervosa in people aged 10-44 years, using hospital episodes (counting every admission) and first-recorded admissions (counting only the first record for each person). Former Oxford NHS Region; and England. None; anonymous statistical records were used. In the longstanding ORLS, the age-standardised first-recorded admission rate for women was 2.7 (95% confidence interval 1.6-3.8) per 100,000 female population aged 10-44 years in 1968-1971; 2.7 (2.1-3.3) in 1992-1996; and 6.3 (5.5-7.2) in 2007-2011. Male rates were zero in the 1960s; 0.07 (0.0-0.1) per 100,000 men in 1992-1996; and 0.4 (0.2-0.6) in 2007-2011. In England, female rates increased from 4.2 (4.0-4.4) in 1998-2001 to 6.9 (6.7-7.1) in 2007-2011; and the corresponding male rates were 0.2 (0.1-0.3) and 0.5 (0.4-0.6). Episode-based admission rates rose more than person-based rates. The highest rates by far were in girls and women aged 15-19 years. In recent years, anorexia nervosa has become a greater burden on secondary care: not only have admission rates increased but so too have multiple admissions per person with anorexia nervosa. The increase in admission rates might reflect an increase in prevalence rates of anorexia nervosa in the general population, but other explanations, including lower clinical thresholds for admission, are possible and are discussed. © The Royal Society of Medicine.

  2. Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia.

    Science.gov (United States)

    Katzenellenbogen, Judith M; Miller, Laura J; Somerford, Peter; McEvoy, Suzanne; Bessarab, Dawn

    2015-09-01

    The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006-11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital readmissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes.

  3. Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England.

    Science.gov (United States)

    Bouras, George; Burns, Elaine Marie; Howell, Ann-Marie; Bottle, Alex; Athanasiou, Thanos; Darzi, Ara

    2015-01-01

    Trends towards day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE) may increasingly arise after hospital discharge. However, hospital data alone are unable to capture adverse events that occur outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of primary care data to quantify hospital care-related VTE. Data in surgical patients using these resources is lacking. The aim of this study was to measure VTE risk and associated mortality in general surgery using linked primary care and hospital databases, to improve our understanding of harm from VTE that arises beyond hospital stay. This was a longitudinal cohort study using nationally linked primary care (Clinical Practice Research Datalink, CPRD), hospital administrative (Hospital Episodes Statistics, HES), population statistics (Office of National Statistics, ONS) and National Cancer Intelligence Network databases. Routinely collected information was used to quantify 90-day in-hospital VTE, 90-day post-discharge VTE and 90-day mortality in adults undergoing one of twelve general surgical procedures between 1st April 1997 and 31st March 2012. The earliest postoperative recording of deep vein thrombosis or pulmonary embolism in CPRD, HES and ONS was counted in each patient. Covariates from multiple datasets were combined to derive detailed prediction models for VTE and mortality. Limitation included the capture of VTE presenting to healthcare only and the lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records. There were 981 VTE events captured within 90 days of surgery in 168005 procedures (23.7/1000 patient-years). Overall, primary care data increased the detection of postoperative VTE by a factor of 1.38 (981/710) when compared with using HES and ONS only. Total VTE rates ranged between 3.2/1000 patient-years in haemorrhoidectomy to 118

  4. On the Development of Episodic Memory: Two Basic Questions

    DEFF Research Database (Denmark)

    Dahl, Jonna Jelsbak; Sonne, Trine; Kingo, Osman Skjold

    2013-01-01

    In this focused review we present and discuss two basic questions related to the early development of episodic memory in children: (1) “What is an episode?”, and (2) “How do preverbal children recall a specific episode of a recurring event?” First, a brief introduction to episodic memory...... is outlined. We argue in favor of employing a definition of episodic memory allowing us to investigate the development of episodic memory by purely behavioral measures. Second, research related to each of the two questions are presented and discussed, at first separately, and subsequently together. We argue...... and attempt to demonstrate, that pursuing answers to both questions is of crucial importance – both conceptually and methodologically - if we are ever to understand the early development of episodic memory. ...

  5. Effects of competition on hospital quality: an examination using hospital administrative data.

    Science.gov (United States)

    Palangkaraya, Alfons; Yong, Jongsay

    2013-06-01

    This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl-Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned.

  6. Comparison of dementia recorded in routinely collected hospital admission data in England with dementia recorded in primary care.

    Science.gov (United States)

    Brown, Anna; Kirichek, Oksana; Balkwill, Angela; Reeves, Gillian; Beral, Valerie; Sudlow, Cathie; Gallacher, John; Green, Jane

    2016-01-01

    Electronic linkage of UK cohorts to routinely collected National Health Service (NHS) records provides virtually complete follow-up for cause-specific hospital admissions and deaths. The reliability of dementia diagnoses recorded in NHS hospital data is not well documented. For a sample of Million Women Study participants in England we compared dementia recorded in routinely collected NHS hospital data (Hospital Episode Statistics: HES) with dementia recorded in two separate sources of primary care information: a primary care database [Clinical Practice Research Datalink (CPRD), n = 340] and a survey of study participants' General Practitioners (GPs, n = 244). Dementia recorded in HES fully agreed both with CPRD and with GP survey data for 85% of women; it did not agree for 1 and 4%, respectively. Agreement was uncertain for the remaining 14 and 11%, respectively; and among those classified as having uncertain agreement in CPRD, non-specific terms compatible with dementia, such as 'memory loss', were recorded in the CPRD database for 79% of the women. Agreement was significantly better (p primary care (CPRD) than in hospital (HES) data. Age-specific rates for dementia based on the hospital admission data were lower than the rates based on the primary care data, but were similar if the delay in recording in HES was taken into account. Dementia recorded in routinely collected NHS hospital admission data for women in England agrees well with primary care records of dementia assessed separately from two different sources, and is sufficiently reliable for epidemiological research.

  7. Impact of daily number of urgency urinary incontinence episodes on overactive bladder patient reported outcomes.

    Science.gov (United States)

    Angulo, J C; Brenes, F J; Lizarraga, I; Rejas, J; Trillo, S; Ochayta, D; Arumi, D

    2016-04-01

    To explore the impact of urgency urinary incontinence (UUI) on well-being in non-institutionalized patients with overactive bladder (OAB) in a community sample. A cross-sectional web-based study was conducted in the general population, including males and females, >18 years of age. Patients with probable OAB were identified using a validated algorithm together with a score ≥8 on the OAB-V8 scale. Presence of coping behavior was considered determinant for the clinical diagnosis of OAB. Individual well-being was determined through a battery of patient-reported outcomes (PRO) measurements including assessment of health-related quality of life (EQ-5D), sleep disturbances (MOS Sleep), and life satisfaction (LISAT-8). Patients were grouped according to the number of daily UUI episodes (UUI severity): 0 (dry OAB),1, 2-3, or ≥4. Multivariate analysis to evaluate factors independently affecting quality of life was undertaken. A total of 396 patients (52.5% women, mean age: 55.3 [11.1] years, OAB-V8 mean score: 14.5 [7.9]) out of 2035 subjects participating from the general population met the criteria for OAB: 203 (51.3%) with 0episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with ≥4 episodes. A statistically significant linear adjusted association was found between number of UUI episodes and PRO scores. Participants with more episodes had poorer health profiles and self-evaluated quality of life, worse life satisfaction, and more sleep disturbances and fewer hours of sleep per night. Number of incontinence episodes was independent factor to affect quality of life using both LISAT-8 and MOS questionnaires. Severity of UUI was significantly associated with poorer individual well-being in subjects with OAB in a community sample in Spain. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Psychosocial work factors and first depressive episode: retrospective results from the French national SIP survey.

    Science.gov (United States)

    Niedhammer, Isabelle; Chastang, Jean-François

    2015-10-01

    The objective was to explore the associations between psychosocial work factors and first depressive episode. Additional objectives included the study of the frequency and duration of exposure, and the evaluation of the induction period between exposures and outcome and of the reversibility of the effects. The study was based on a sample of 13,648 men and women from the 2006 national representative French SIP survey. Retrospective evaluation was performed for depressive episode for the whole life history, for psychological demands, skill discretion, social support, tension with the public, reward and work-life imbalance for each job, and within each job before and after each major change, and for time-varying covariates. The outcome was the first depressive episode. Statistical analysis was performed using weighted discrete time logistic regression model. High psychological demands and low social support were risk factors for first depressive episode for both genders. The risk increased with the frequency of exposure to these factors. Associations were found with the frequency of exposure to tension with the public among women and to work-life imbalance among men. The risk increased with the duration of exposure to psychological demands and low social support for both genders, however, these associations become non-significant when recent exposure was taken into account. Past exposure older than 2 years was not associated with the outcome. Associations between psychosocial work factors and first depressive episode were observed, including dose-response associations. However, after removal of the exposure, the risk may be reduced after 2 years.

  9. Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study.

    Science.gov (United States)

    Shah, D N; Aitken, S L; Barragan, L F; Bozorgui, S; Goddu, S; Navarro, M E; Xie, Y; DuPont, H L; Garey, K W

    2016-07-01

    Few studies have investigated the additional healthcare costs of recurrent C. difficile infection (CDI). To quantify inpatient treatment costs for CDI and length of stay among hospitalized patients with primary CDI only, compared with CDI patients who experienced recurrent CDI. This was a prospective, observational cohort study of hospitalized adult patients with primary CDI followed for three months to assess for recurrent CDI episodes. Total and CDI-attributable hospital length of stay (LOS) and hospitalization costs were compared among patients who did or did not experience at least one recurrent CDI episode. In all, 540 hospitalized patients aged 62±17 years (42% males) with primary CDI were enrolled, of whom 95 patients (18%) experienced 101 recurrent CDI episodes. CDI-attributable median (interquartile range) LOS and costs (in US$) increased from 7 (4-13) days and $13,168 (7,525-24,456) for patients with primary CDI only versus 15 (8-25) days and $28,218 (15,050-47,030) for patients with recurrent CDI (Pcosts increased from 11 (6-22) days and $20,693 (11,287-41,386) for patients with primary CDI only versus 24 (11-48) days and $45,148 (20,693-82,772) for patients with recurrent CDI (Pcost of pharmacological treatment while hospitalized was $60 (23-200) for patients with primary CDI only (N=445) and $140 (30-260) for patients with recurrent CDI (P=0.0013). This study demonstrated that patients with CDI experience a significant healthcare economic burden attributed to CDI. Economic costs and healthcare burden increased significantly for patients with recurrent CDI. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. Severity of depressive episodes during the course of depressive disorder

    DEFF Research Database (Denmark)

    Kessing, L.V.

    2008-01-01

    Background It is not clear whether the severity of depressive episodes changes during the course of depressive disorder. Aims To investigate whether the severity of depressive episodes increases during the course of illness. Method Using a Danish nationwide case register, all psychiatric inpatients...... and out-patients with a main ICD-10 diagnosis of a single mild, moderate or severe depressive episode at the end of first contact were identified. Patients included in the study were from the period 1994-2003. Results A total of 19 392 patients received a diagnosis of a single depressive episode at first...... contact. The prevalence of severe depressive episodes increased from 25.5% at the first episode to 50.0% at the 15th episode and the prevalence of psychotic episodes increased from 8.7% at the first episode to 25.0% at the 15th episode. The same pattern was found regardless of gender, age at first contact...

  11. Severity of depressive episodes during the course of depressive disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2008-01-01

    BACKGROUND: It is not clear whether the severity of depressive episodes changes during the course of depressive disorder. AIMS: To investigate whether the severity of depressive episodes increases during the course of illness. METHOD: Using a Danish nationwide case register, all psychiatric in......-patients and out-patients with a main ICD-10 diagnosis of a single mild, moderate or severe depressive episode at the end of first contact were identified. Patients included in the study were from the period 1994-2003. RESULTS: A total of 19 392 patients received a diagnosis of a single depressive episode at first...... contact. The prevalence of severe depressive episodes increased from 25.5% at the first episode to 50.0% at the 15th episode and the prevalence of psychotic episodes increased from 8.7% at the first episode to 25.0% at the 15th episode. The same pattern was found regardless of gender, age at first contact...

  12. The Interaction between Semantic Representation and Episodic Memory.

    Science.gov (United States)

    Fang, Jing; Rüther, Naima; Bellebaum, Christian; Wiskott, Laurenz; Cheng, Sen

    2018-02-01

    The experimental evidence on the interrelation between episodic memory and semantic memory is inconclusive. Are they independent systems, different aspects of a single system, or separate but strongly interacting systems? Here, we propose a computational role for the interaction between the semantic and episodic systems that might help resolve this debate. We hypothesize that episodic memories are represented as sequences of activation patterns. These patterns are the output of a semantic representational network that compresses the high-dimensional sensory input. We show quantitatively that the accuracy of episodic memory crucially depends on the quality of the semantic representation. We compare two types of semantic representations: appropriate representations, which means that the representation is used to store input sequences that are of the same type as those that it was trained on, and inappropriate representations, which means that stored inputs differ from the training data. Retrieval accuracy is higher for appropriate representations because the encoded sequences are less divergent than those encoded with inappropriate representations. Consistent with our model prediction, we found that human subjects remember some aspects of episodes significantly more accurately if they had previously been familiarized with the objects occurring in the episode, as compared to episodes involving unfamiliar objects. We thus conclude that the interaction with the semantic system plays an important role for episodic memory.

  13. Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care.

    Science.gov (United States)

    Feld, April; Madden-Baer, Rose; McCorkle, Ruth

    2016-01-01

    The Centers for Medicare and Medicaid Services Innovation Center's Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider's approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.

  14. Rates of first episode of psychosis in a defined catchment area in Greece.

    Science.gov (United States)

    Peritogiannis, Vaios; Mantas, Christos; Tatsioni, Athina; Mavreas, Venetsanos

    2013-01-01

    This is the first Greek study presenting epidemiologic data on first-episode psychosis (FEP) patients in a defined catchment area. Data for first episode psychotic patients during a two-year period (2008 and 2009) were obtained by all the mental health providers in the area, public or private. A total of 132 FEP patients were examined in the 2-year period in the catchment area. Most of the patients (61.4%) were diagnosed and treated by private practicing psychiatrists. Statistical analysis showed no differences between the two sectors in terms of patients' age, gender, family and social status, profession and duration of untreated psychosis (median duration 6 months). Patients who were abusing substances and had no family psychiatric history were less likely been treated in the public sector. Immigrants comprised only a small proportion of the patients, probably because they have difficulties in accessing the mental health system.

  15. Cognitive dissonance resolution is related to episodic memory.

    Science.gov (United States)

    Salti, Moti; El Karoui, Imen; Maillet, Mathurin; Naccache, Lionel

    2014-01-01

    The notion that our past choices affect our future behavior is certainly one of the most influential concepts of social psychology since its first experimental report in the 50 s, and its initial theorization by Festinger within the "cognitive dissonance" framework. Using the free choice paradigm (FCP), it was shown that choosing between two similarly rated items made subjects reevaluate the chosen items as more attractive and the rejected items as less attractive. However, in 2010 a major work by Chen and Risen revealed a severe statistical flaw casting doubt on most previous studies. Izuma and colleagues (2010) supplemented the traditional FCP with original control conditions and concluded that the effect observed could not be solely attributed to this methodological flaw. In the present work we aimed at establishing the existence of genuine choice-induced preference change and characterizing this effect. To do so, we replicated Izuma et al.' study and added a new important control condition which was absent from the original study. Moreover, we added a memory test in order to measure the possible relation between episodic memory of choices and observed behavioral effects. In two experiments we provide experimental evidence supporting genuine choice-induced preference change obtained with FCP. We also contribute to the understanding of the phenomenon by showing that choice-induced preference change effects are strongly correlated with episodic memory.

  16. Elements of episodic-like memory in animal models.

    Science.gov (United States)

    Crystal, Jonathon D

    2009-03-01

    Representations of unique events from one's past constitute the content of episodic memories. A number of studies with non-human animals have revealed that animals remember specific episodes from their past (referred to as episodic-like memory). The development of animal models of memory holds enormous potential for gaining insight into the biological bases of human memory. Specifically, given the extensive knowledge of the rodent brain, the development of rodent models of episodic memory would open new opportunities to explore the neuroanatomical, neurochemical, neurophysiological, and molecular mechanisms of memory. Development of such animal models holds enormous potential for studying functional changes in episodic memory in animal models of Alzheimer's disease, amnesia, and other human memory pathologies. This article reviews several approaches that have been used to assess episodic-like memory in animals. The approaches reviewed include the discrimination of what, where, and when in a radial arm maze, dissociation of recollection and familiarity, object recognition, binding, unexpected questions, and anticipation of a reproductive state. The diversity of approaches may promote the development of converging lines of evidence on the difficult problem of assessing episodic-like memory in animals.

  17. Facts about Hospital Worker Safety

    Science.gov (United States)

    ... statistics show that hospitals are still relatively hazardous workplaces, and they have much room to improve. OSHA has developed this factbook to help hospital safety managers and other stakeholders understand the challenges of worker ...

  18. Database of episode-integrated solar energetic proton fluences

    Science.gov (United States)

    Robinson, Zachary D.; Adams, James H.; Xapsos, Michael A.; Stauffer, Craig A.

    2018-04-01

    A new database of proton episode-integrated fluences is described. This database contains data from two different instruments on multiple satellites. The data are from instruments on the Interplanetary Monitoring Platform-8 (IMP8) and the Geostationary Operational Environmental Satellites (GOES) series. A method to normalize one set of data to one another is presented to create a seamless database spanning 1973 to 2016. A discussion of some of the characteristics that episodes exhibit is presented, including episode duration and number of peaks. As an example of what can be understood about episodes, the July 4, 2012 episode is examined in detail. The coronal mass ejections and solar flares that caused many of the fluctuations of the proton flux seen at Earth are associated with peaks in the proton flux during this episode. The reasoning for each choice is laid out to provide a reference for how CME and solar flares associations are made.

  19. Database of episode-integrated solar energetic proton fluences

    Directory of Open Access Journals (Sweden)

    Robinson Zachary D.

    2018-01-01

    Full Text Available A new database of proton episode-integrated fluences is described. This database contains data from two different instruments on multiple satellites. The data are from instruments on the Interplanetary Monitoring Platform-8 (IMP8 and the Geostationary Operational Environmental Satellites (GOES series. A method to normalize one set of data to one another is presented to create a seamless database spanning 1973 to 2016. A discussion of some of the characteristics that episodes exhibit is presented, including episode duration and number of peaks. As an example of what can be understood about episodes, the July 4, 2012 episode is examined in detail. The coronal mass ejections and solar flares that caused many of the fluctuations of the proton flux seen at Earth are associated with peaks in the proton flux during this episode. The reasoning for each choice is laid out to provide a reference for how CME and solar flares associations are made.

  20. First Episode Psychosis

    Science.gov (United States)

    ... About Psychosis Treatment Share Fact Sheet: First Episode Psychosis Download PDF Download ePub Order a free hardcopy En Español Facts About Psychosis The word psychosis is used to describe conditions ...

  1. Initial diagnosis and treatment in first-episode psychosis: can an operationalized diagnostic classification system enhance treating clinicians' diagnosis and the treatment chosen?

    LENUS (Irish Health Repository)

    Coentre, Ricardo

    2011-05-01

    Diagnosis during the initial stages of first-episode psychosis is particularly challenging but crucial in deciding on treatment. This is compounded by important differences in the two major classification systems, International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). We aimed to compare the concordance between an operationalized diagnosis using Operational Criteria Checklist (OPCRIT) and treating clinician-generated diagnosis in first episode psychosis diagnosis and its correlation with treatment prescribed.

  2. The most dangerous hospital or the most dangerous equation?

    Science.gov (United States)

    Tu, Yu-Kang; Gilthorpe, Mark S

    2007-11-15

    Hospital mortality rates are one of the most frequently selected indicators for measuring the performance of NHS Trusts. A recent article in a national newspaper named the hospital with the highest or lowest mortality in the 2005/6 financial year; a report by the organization Dr Foster Intelligence provided information with regard to the performance of all NHS Trusts in England. Basic statistical theory and computer simulations were used to explore the relationship between the variations in the performance of NHS Trusts and the sizes of the Trusts. Data of hospital standardised mortality ratio (HSMR) of 152 English NHS Trusts for 2005/6 were re-analysed. A close examination of the information reveals a pattern which is consistent with a statistical phenomenon, discovered by the French mathematician de Moivre nearly 300 years ago, described in every introductory statistics textbook: namely that variation in performance indicators is expected to be greater in small Trusts and smaller in large Trusts. From a statistical viewpoint, the number of deaths in a hospital is not in proportion to the size of the hospital, but is proportional to the square root of its size. Therefore, it is not surprising to note that small hospitals are more likely to occur at the top and the bottom of league tables, whilst mortality rates are independent of hospital sizes. This statistical phenomenon needs to be taken into account in the comparison of hospital Trusts performance, especially with regard to policy decisions.

  3. Functional connectivity pattern during rest within the episodic memory network in association with episodic memory performance in bipolar disorder.

    Science.gov (United States)

    Oertel-Knöchel, Viola; Reinke, Britta; Matura, Silke; Prvulovic, David; Linden, David E J; van de Ven, Vincent

    2015-02-28

    In this study, we sought to examine the intrinsic functional organization of the episodic memory network during rest in bipolar disorder (BD). The previous work suggests that deficits in intrinsic functional connectivity may account for impaired memory performance. We hypothesized that regions involved in episodic memory processing would reveal aberrant functional connectivity in patients with bipolar disorder. We examined 21 patients with BD and 21 healthy matched controls who underwent functional magnetic resonance imaging (fMRI) during a resting condition. We did a seed-based functional connectivity analysis (SBA), using the regions of the episodic memory network that showed a significantly different activation pattern during task-related fMRI as seeds. The functional connectivity scores (FC) were further correlated with episodic memory task performance. Our results revealed decreased FC scores within frontal areas and between frontal and temporal/hippocampal/limbic regions in BD patients in comparison with controls. We observed higher FC in BD patients compared with controls between frontal and limbic regions. The decrease in fronto-frontal functional connectivity in BD patients showed a significant positive association with episodic memory performance. The association between task-independent dysfunctional frontal-limbic FC and episodic memory performance may be relevant for current pathophysiological models of the disease. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Experience with Hirschsprung's Disease at a Tertiary Hospital in ...

    African Journals Online (AJOL)

    latter group had more readmission episodes, longer lengths of hospital stays, higher loss to follow up rates and an average time to completion of care of. 1000 days. One-stage pull-through may limit the effects of colostomy creation we have documented in this study. In any case, an argument for earlier closure for those who ...

  5. A Reduction in Delay Discounting by Using Episodic Future Imagination and the Association with Episodic Memory Capacity.

    Science.gov (United States)

    Hu, Xiaochen; Kleinschmidt, Helena; Martin, Jason A; Han, Ying; Thelen, Manuela; Meiberth, Dix; Jessen, Frank; Weber, Bernd

    2016-01-01

    Delay discounting (DD) refers to the phenomenon that individuals discount future consequences. Previous studies showed that future imagination reduces DD, which was mediated by functional connectivity between medial prefrontal valuation areas and a key region for episodic memory (hippocampus). Future imagination involves an initial period of construction and a later period of elaboration, with the more elaborative latter period recruiting more cortical regions. This study examined whether elaborative future imagination modulated DD, and if so, what are the underlying neural substrates. It was assumed that cortical areas contribute to the modulation effect during the later period of imagination. Since future imagination is supported by episodic memory capacity, we additionally hypothesize that the neural network underlying the modulation effect is related to individual episodic memory capacity. Twenty-two subjects received an extensive interview on personal future events, followed by an fMRI DD experiment with and without the need to perform elaborative future imagination simultaneously. Subjects' episodic memory capacity was also assessed. Behavioral results replicate previous findings of a reduced discount rate in the DD plus imagination condition compared to the DD only condition. The behavioral effect positively correlated with: (i) subjective value signal changes in midline brain structures during the initial imagination period; and (ii) signal changes in left prefrontoparietal areas during the later imagination period. Generalized psychophysiological interaction (gPPI) analyses reveal positive correlations between the behavioral effect and functional connectivity among the following areas: right anterior cingulate cortex (ACC) and left hippocampus; left inferior parietal cortex (IPC) and left hippocampus; and left IPC and bilateral occipital cortices. These changes in functional connectivity are also associated with episodic memory capacity. A hierarchical

  6. Atypical major depressive episode as initial presentation of intracranial germinoma in a male adolescent

    Directory of Open Access Journals (Sweden)

    Chen YT

    2016-12-01

    Full Text Available Yi-Ting Chen,1,3,4 Kuan-Pin Su,2–5 Jane Pei-Chen Chang2–5 1Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; 2Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan; 3School of Medicine, China Medical University, Taichung, Taiwan; 4Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; 5Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK Abstract: A 17-year-old adolescent boy presented with atypical major depressive episode (MDE without specific focal neurological signs for 6 months. He had a diagnosis of intra­cranial germinoma, and the atypical MDE symptoms subsided after the operation. However, he had a relapse of atypical MDE 7 months after the first surgery. His mood and binge eating symptoms subsided, but intractable body weight gain only partially improved after treatment. When encountering manifestations of depression with atypical features, especially with binge eating symptoms in male children and adolescents, with early onset age, no family history, and prolonged depressive episodes, clinicians should consider not only mood disorders including bipolar spectrum disorders but also organic brain lesions such as intracranial germinoma. Keywords: intracranial germinoma, atypical major depressive episode, binge eating behavior, body weight gain

  7. Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

    Directory of Open Access Journals (Sweden)

    Evan S. Cole

    2016-09-01

    Full Text Available Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%. Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0, lengths of stay (61 versus 38 days, costs (US$143,898 versus US$115,056, but fewer discharges to the community (28.4% versus 51.8%. Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that

  8. Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Leonardo Marques; Dutra, João Pedro Passos [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil); Mantovani, Augusto [UFCSPA - Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS (Brazil); Lima, Gustavo Glotz de [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil); UFCSPA - Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS (Brazil); Leiria, Tiago Luiz Luz, E-mail: drleiria@cardiol.br [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil)

    2013-12-15

    Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature.

  9. Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

    International Nuclear Information System (INIS)

    Fischer, Leonardo Marques; Dutra, João Pedro Passos; Mantovani, Augusto; Lima, Gustavo Glotz de; Leiria, Tiago Luiz Luz

    2013-01-01

    Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature

  10. Determinants of adherence to treatment in first-episode psychosis: a comprehensive review

    Directory of Open Access Journals (Sweden)

    Emilie Leclerc

    2015-06-01

    Full Text Available Objective:To conduct a comprehensive review of current evidence on factors for nonadherence to treatment in individuals with first-episode psychosis (FEP.Methods:MEDLINE, LILACS, PsycINFO, and SciELO databases were searched with the keywords first episode psychosis, factor, adherence, nonadherence, engagement, disengagement, compliance, and intervention. References of selected studies were consulted for relevant articles.Results:A total of 157 articles were screened, of which 33 articles were retained for full review. The factors related to nonadherence were: a patient-related (e.g., lower education level, persistent substance use, forensic history, unemployment, history of physical abuse; b environment-related (e.g., no family involved in treatment, social adjustment difficulties; c medication-related (e.g., rapid remission of negative symptoms when starting treatment, therapeutic alliance; and d illness-related (e.g., more positive symptoms, more relapses. Treatment factors that improve adherence include a good therapeutic alliance and a voluntary first admission when hospitalization occurs.Conclusion:The results of this review suggest that nonadherence to treatment in FEP is multifactorial. Many of these factors are modifiable and can be specifically targeted in early intervention programs. Very few studies have assessed strategies to raise adherence in FEP.

  11. Effect of reclassification of cannabis on hospital admissions for cannabis psychosis: a time series analysis.

    Science.gov (United States)

    Hamilton, Ian; Lloyd, Charlie; Hewitt, Catherine; Godfrey, Christine

    2014-01-01

    The UK Misuse of Drugs Act (1971) divided controlled drugs into three groups A, B and C, with descending criminal sanctions attached to each class. Cannabis was originally assigned by the Act to Group B but in 2004, it was transferred to the lowest risk group, Group C. Then in 2009, on the basis of increasing concerns about a link between high strength cannabis and schizophrenia, it was moved back to Group B. The aim of this study is to test the assumption that changes in classification lead to changes in levels of psychosis. In particular, it explores whether the two changes in 2004 and 2009 were associated with changes in the numbers of people admitted for cannabis psychosis. An interrupted time series was used to investigate the relationship between the two changes in cannabis classification and their impact on hospital admissions for cannabis psychosis. Reflecting the two policy changes, two interruptions to the time series were made. Hospital Episode Statistics admissions data was analysed covering the period 1999 through to 2010. There was a significantly increasing trend in cannabis psychosis admissions from 1999 to 2004. However, following the reclassification of cannabis from B to C in 2004, there was a significant change in the trend such that cannabis psychosis admissions declined to 2009. Following the second reclassification of cannabis back to class B in 2009, there was a significant change to increasing admissions. This study shows a statistical association between the reclassification of cannabis and hospital admissions for cannabis psychosis in the opposite direction to that predicted by the presumed relationship between the two. However, the reasons for this statistical association are unclear. It is unlikely to be due to changes in cannabis use over this period. Other possible explanations include changes in policing and systemic changes in mental health services unrelated to classification decisions. Copyright © 2013 Elsevier B.V. All rights

  12. Recall from Semantic and Episodic Memory.

    Science.gov (United States)

    Gillund, Gary; Perlmutter, Marion

    Although research in episodic recall memory, comparing younger and older adults, favors the younger adults, findings in semantic memory research are less consistent. To examine age differences in semantic and episodic memory recall, 72 young adults (mean age, 20.8) and 72 older adults (mean age 71) completed three memory tests under varied…

  13. Epidemiology of 411 140 cataract operations performed in public hospitals and private hospitals/clinics in Denmark between 2004 and 2012

    DEFF Research Database (Denmark)

    Solborg Bjerrum, Søren; Mikkelsen, Kim Lyngby; la Cour, Morten

    2015-01-01

    PURPOSE: To study the epidemiology and mortality in patients who had cataract surgery in public hospitals and private hospitals/clinics in Denmark between 2004 and 2012 and to assess the validity of the Danish cataract registries. METHODS: Register- and chart-based study. RESULTS: A total of 411...... 140 cataract operations were performed in 243 856 patients. Patients who had cataract surgery in public hospitals had an overall statistically significantly 62% higher mortality compared to patients who had cataract surgery in private hospitals/clinics. The decrease in mean age at first eye cataract...... surgery in private hospitals/clinics was statistically significantly greater compared to the decrease in mean age at first eye cataract surgery in public hospitals (p

  14. Catatonia Secondary to Sudden Clozapine Withdrawal: A Case with Three Repeated Episodes and a Literature Review

    Directory of Open Access Journals (Sweden)

    John Bilbily

    2017-01-01

    Full Text Available A literature search identified 9 previously published cases that were considered as possible cases of catatonia secondary to sudden clozapine withdrawal. Two of these 9 cases did not provide enough information to make a diagnosis of catatonia according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5. The Liverpool Adverse Drug Reaction (ADR Causality Scale was modified to assess ADRs secondary to drug withdrawal. From the 7 published cases which met DSM-5 catatonia criteria, using the modified scale, we established that 3 were definitive and 4 were probable cases of catatonia secondary to clozapine withdrawal. A new definitive case is described with three catatonic episodes which (1 occurred after sudden discontinuation of clozapine in the context of decades of follow-up, (2 had ≥3 of 12 DSM-5 catatonic symptoms and serum creatinine kinase elevation, and (3 required medical hospitalization and intravenous fluids. Clozapine may be a gamma-aminobutyric acid (GABA receptor agonist; sudden clozapine withdrawal may explain a sudden decrease in GABA activity that may contribute to the development of catatonic symptoms in vulnerable patients. Based on the limited information from these cases, the pharmacological treatment for catatonia secondary to sudden clozapine withdrawal can include benzodiazepines and/or restarting clozapine.

  15. The most dangerous hospital or the most dangerous equation?

    Directory of Open Access Journals (Sweden)

    Tu Yu-Kang

    2007-11-01

    Full Text Available Abstract Background Hospital mortality rates are one of the most frequently selected indicators for measuring the performance of NHS Trusts. A recent article in a national newspaper named the hospital with the highest or lowest mortality in the 2005/6 financial year; a report by the organization Dr Foster Intelligence provided information with regard to the performance of all NHS Trusts in England. Methods Basic statistical theory and computer simulations were used to explore the relationship between the variations in the performance of NHS Trusts and the sizes of the Trusts. Data of hospital standardised mortality ratio (HSMR of 152 English NHS Trusts for 2005/6 were re-analysed. Results A close examination of the information reveals a pattern which is consistent with a statistical phenomenon, discovered by the French mathematician de Moivre nearly 300 years ago, described in every introductory statistics textbook: namely that variation in performance indicators is expected to be greater in small Trusts and smaller in large Trusts. From a statistical viewpoint, the number of deaths in a hospital is not in proportion to the size of the hospital, but is proportional to the square root of its size. Therefore, it is not surprising to note that small hospitals are more likely to occur at the top and the bottom of league tables, whilst mortality rates are independent of hospital sizes. Conclusion This statistical phenomenon needs to be taken into account in the comparison of hospital Trusts performance, especially with regard to policy decisions.

  16. Family Intervention in First-Episode Psychosis

    Directory of Open Access Journals (Sweden)

    Anvar Sadath

    2015-11-01

    Full Text Available Family interventions have produced benefits on clinical and family outcomes in long standing psychosis. However, little is known about the efficacy of such interventions in the early stages of psychosis. This article reviews published research over the last two decades on family intervention in first-episode psychosis. Electronic databases, such as PubMed, PsycINFO, and ScienceDirect, have been systematically searched. In addition, an exhaustive Internet search was also carried out using Google and Google Scholar to identify the potential studies that evaluated family interventions in first-episode psychosis. We have identified seven reports of five randomized controlled trials (RCTs and five non-randomized and uncontrolled studies of family intervention. Our review on 12 reports of family intervention studies has shown mixed effects on outcomes in first-episode psychosis. Most of the reports showed no added benefits or very short-term benefits on primary clinical or family outcome variables. There is a dearth of family intervention studies in first-episode psychosis. More RCTs are needed to reach reliable conclusions.

  17. Episodic memory and episodic future thinking impairments in high-functioning autism spectrum disorder: an underlying difficulty with scene construction or self-projection?

    Science.gov (United States)

    Lind, Sophie E; Williams, David M; Bowler, Dermot M; Peel, Anna

    2014-01-01

    There appears to be a common network of brain regions that underlie the ability to recall past personal experiences (episodic memory) and the ability to imagine possible future personal experiences (episodic future thinking). At the cognitive level, these abilities are thought to rely on "scene construction" (the ability to bind together multimodal elements of a scene in mind--dependent on hippocampal functioning) and temporal "self-projection" (the ability to mentally project oneself through time--dependent on prefrontal cortex functioning). Although autism spectrum disorder (ASD) is characterized by diminished episodic memory, it is unclear whether episodic future thinking is correspondingly impaired. Moreover, the underlying basis of such impairments (difficulties with scene construction, self-projection, or both) is yet to be established. The current study therefore aimed to elucidate these issues. Twenty-seven intellectually high-functioning adults with ASD and 29 age- and IQ-matched neurotypical comparison adults were asked to describe (a) imagined atemporal, non-self-relevant fictitious scenes (assessing scene construction), (b) imagined plausible self-relevant future episodes (assessing episodic future thinking), and (c) recalled personally experienced past episodes (assessing episodic memory). Tests of narrative ability and theory of mind were also completed. Performances of participants with ASD were significantly and equally diminished in each condition and, crucially, this diminution was independent of general narrative ability. Given that participants with ASD were impaired in the fictitious scene condition, which does not involve self-projection, we suggest the underlying difficulty with episodic memory/future thinking is one of scene construction.

  18. Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients.

    Science.gov (United States)

    Lohman, Matthew C; Cotton, Brandi P; Zagaria, Alexandra B; Bao, Yuhua; Greenberg, Rebecca L; Fortuna, Karen L; Bruce, Martha L

    2017-12-01

    Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. Cross-sectional analysis using data from 132 home health agencies in the US. Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes

  19. Hospital marketing: characterization of marketing actions in private hospitals in the city of São Paulo - Brazil.

    Science.gov (United States)

    Leiderman, Eduardo Blay; Padovan, Jorge Luis; Zucchi, Paola

    2010-01-01

    Characterize the marketing actions in private hospitals in the city of São Paulo, the organizational structure of the marketing area, the target public of marketing actions and the media used. Exploratory cross-sectional study, carried out by a survey made with hospital administrators. The hospitals studied were clearly divided in two groups whose differentials are statistically significant: 1. good infrastructure and equipment, with a well-defined investment policy in marketing; 2. worse infrastructure and less equipment, with lower proportional investment in marketing. 1. The actions most used are the evaluation of patients/caregivers satisfaction, web site and dissemination of the hospital services. 2. The hospital administrators attribute a level of significant importance to the application of hospital marketing concepts. 3. There is a marketing structure in most of the hospitals studied. 4. The hospitals consider as extremely or very important publics: patients and relatives, doctors, collaborators, health plans and community. 5. The media most used are the most simple and of lower cost. 6. There is a statistically significant correlation between the higher investment in marketing and the best infrastructure. 7. The studied hospitals apply the concept of marketing in a restricted way.

  20. Coding accuracy for Parkinson's disease hospital admissions: implications for healthcare planning in the UK.

    Science.gov (United States)

    Muzerengi, S; Rick, C; Begaj, I; Ives, N; Evison, F; Woolley, R L; Clarke, C E

    2017-05-01

    Hospital Episode Statistics data are used for healthcare planning and hospital reimbursements. Reliability of these data is dependent on the accuracy of individual hospitals reporting Secondary Uses Service (SUS) which includes hospitalisation. The number and coding accuracy for Parkinson's disease hospital admissions at a tertiary centre in Birmingham was assessed. Retrospective, routine-data-based study. A retrospective electronic database search for all Parkinson's disease patients admitted to the tertiary hospital over a 4-year period (2009-2013) was performed on the SUS database using International Classification of Disease codes, and on the local inpatient electronic prescription database, Prescription and Information Communications System, using medication prescriptions. Capture-recapture methods were used to estimate the number of patients and admissions missed by both databases. From the two databases, between July 2009 and June 2013, 1068 patients with Parkinson's disease accounted for 1999 admissions. During these admissions, the Parkinson's disease was coded as a primary or secondary diagnosis. Ninety-one percent of these admissions were recorded on the SUS database. Capture-recapture methods estimated that the number of Parkinson's disease patients admitted during this period was 1127 patients (95% confidence interval: 1107-1146). A supplementary search of both SUS and Prescription and Information Communications System was undertaken using the hospital numbers of these 1068 patients. This identified another 479 admissions. SUS database under-estimated Parkinson's disease admissions by 27% during the study period. The accuracy of disease coding is critical for healthcare policy planning and must be improved. If the under-reporting of Parkinson's disease admissions on the SUS database is repeated nationally, expenditure on Parkinson's disease admissions in England is under-estimated by approximately £61 million per year. Copyright © 2016 The Royal

  1. Risk of maltreatment-related injury: a cross-sectional study of children under five years old admitted to hospital with a head or neck injury or fracture.

    Directory of Open Access Journals (Sweden)

    Joseph Jonathan Lee

    Full Text Available To determine the predictive value and sensitivity of demographic features and injuries (indicators for maltreatment-related codes in hospital discharge records of children admitted with a head or neck injury or fracture.Population-based, cross sectional study.NHS hospitals in England.Children under five years old admitted acutely to hospital with head or neck injury or fracture.Hospital Episodes Statistics, 1997 to 2009.Maltreatment-related injury admissions, defined by ICD10 codes, were used to calculate for each indicator (demographic feature and/or type of injury: i the predictive value (proportion of injury admissions that were maltreatment-related; ii sensitivity (proportion of all maltreatment-related injury admissions with the indicator.Of 260,294 childhood admissions for fracture or head or neck injury, 3.2% (8,337 were maltreatment-related. With increasing age of the child, the predictive value for maltreatment-related injury declined but sensitivity increased. Half of the maltreatment-related admissions occurred in children older than one year, and 63% occurred in children with head injuries without fractures or intracranial injury.Highly predictive injuries accounted for very few maltreatment-related admissions. Protocols that focus on high-risk injuries may miss the majority of maltreated children.

  2. Memantine improves attention and episodic memory in Parkinson's disease dementia and dementia with Lewy bodies.

    Science.gov (United States)

    Wesnes, Keith A; Aarsland, Dag; Ballard, Clive; Londos, Elisabet

    2015-01-01

    In both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), attentional dysfunction is a core clinical feature together with disrupted episodic memory. This study evaluated the cognitive effects of memantine in DLB and PDD using automated tests of attention and episodic memory. A randomised double-blind, placebo-controlled, 24-week three centre trial of memantine (20 mg/day) was conducted in which tests of attention (simple and choice reaction time) and word recognition (immediate and delayed) from the CDR System were administered prior to dosing and again at 12 and 24 weeks. Although other results from this study have been published, the data from the CDR System tests were not included and are presented here for the first time. Data were available for 51 patients (21 DLB and 30 PDD). In both populations, memantine produced statistically significant medium to large effect sized improvements to choice reaction time, immediate and delayed word recognition. These are the first substantial improvements on cognitive tests of attention and episodic recognition memory identified with memantine in either DLB or PDD. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Hemophilia Data and Statistics

    Science.gov (United States)

    ... View public health webinars on blood disorders Data & Statistics Language: English (US) Español (Spanish) Recommend on Facebook ... genetic testing is done to diagnose hemophilia before birth. For the one-third ... rates and hospitalization rates for bleeding complications from hemophilia ...

  4. [Relating costs to activities in hospitals. Use of internal cost accounting].

    Science.gov (United States)

    Stavem, K

    1995-01-10

    During the last few years hospital cost accounting has become widespread in many countries, in parallel with increasing cost pressure, greater competition and new financing schemes. Cost accounting has been used in the manufacturing industry for many years. Costs can be related to activities and production, e.g. by the costing of procedures, episodes of care and other internally defined cost objectives. Norwegian hospitals have lagged behind in the adoption of cost accounting. They ought to act quickly if they want to be prepared for possible changes in health care financing. The benefits can be considerable to a hospital operating in a rapidly changing health care environment.

  5. Episode-Centered Guidelines for Teacher Belief Change toward Technology Integration

    Science.gov (United States)

    Er, Erkan; Kim, ChanMin

    2017-01-01

    Teachers' episodic memories influence their beliefs. The investigation of episodic memories can help identify the teacher beliefs that limit technology-integration. We propose the Episode-Centered Belief Change (ECBC) model that utilizes teachers' episodic memories for changing beliefs impeding effective technology integration. We also propose…

  6. Aging-related episodic memory decline: are emotions the key?

    Science.gov (United States)

    Kinugawa, Kiyoka; Schumm, Sophie; Pollina, Monica; Depre, Marion; Jungbluth, Carolin; Doulazmi, Mohamed; Sebban, Claude; Zlomuzica, Armin; Pietrowsky, Reinhard; Pause, Bettina; Mariani, Jean; Dere, Ekrem

    2013-01-01

    Episodic memory refers to the recollection of personal experiences that contain information on what has happened and also where and when these events took place. Episodic memory function is extremely sensitive to cerebral aging and neurodegerative diseases. We examined episodic memory performance with a novel test in young (N = 17, age: 21–45), middle-aged (N = 16, age: 48–62) and aged but otherwise healthy participants (N = 8, age: 71–83) along with measurements of trait and state anxiety. As expected we found significantly impaired episodic memory performance in the aged group as compared to the young group. The aged group also showed impaired working memory performance as well as significantly decreased levels of trait anxiety. No significant correlation between the total episodic memory and trait or state anxiety scores was found. The present results show an age-dependent episodic memory decline along with lower trait anxiety in the aged group. Yet, it still remains to be determined whether this difference in anxiety is related to the impaired episodic memory performance in the aged group. PMID:23378831

  7. Concealed semantic and episodic autobiographical memory electrified.

    Science.gov (United States)

    Ganis, Giorgio; Schendan, Haline E

    2012-01-01

    Electrophysiology-based concealed information tests (CIT) try to determine whether somebody possesses concealed information about a crime-related item (probe) by comparing event-related potentials (ERPs) between this item and comparison items (irrelevants). Although the broader field is sometimes referred to as "memory detection," little attention has been paid to the precise type of underlying memory involved. This study begins addressing this issue by examining the key distinction between semantic and episodic memory in the autobiographical domain within a CIT paradigm. This study also addresses the issue of whether multiple repetitions of the items over the course of the session habituate the brain responses. Participants were tested in a 3-stimulus CIT with semantic autobiographical probes (their own date of birth) and episodic autobiographical probes (a secret date learned just before the study). Results dissociated these two memory conditions on several ERP components. Semantic probes elicited a smaller frontal N2 than episodic probes, consistent with the idea that the frontal N2 decreases with greater pre-existing knowledge about the item. Likewise, semantic probes elicited a smaller central N400 than episodic probes. Semantic probes also elicited a larger P3b than episodic probes because of their richer meaning. In contrast, episodic probes elicited a larger late positive complex (LPC) than semantic probes, because of the recent episodic memory associated with them. All these ERPs showed a difference between probes and irrelevants in both memory conditions, except for the N400, which showed a difference only in the semantic condition. Finally, although repetition affected the ERPs, it did not reduce the difference between probes and irrelevants. These findings show that the type of memory associated with a probe has both theoretical and practical importance for CIT research.

  8. Concealed semantic and episodic autobiographical memory electrified

    Directory of Open Access Journals (Sweden)

    Giorgio eGanis

    2013-01-01

    Full Text Available Electrophysiology-based concealed information tests (CIT try to determine whether somebody possesses concealed information about a probe item by comparing event-related potentials (ERPs between this item and comparison items (irrelevants. Although the broader field is sometimes referred to as memory detection, little attention has been paid to the precise type of underlying memory involved. This study begins addressing this issue by examining the key distinction between semantic and episodic memory in the autobiographical domain within a CIT paradigm. This study also addressed the issue of whether multiple repetitions of the items over the course of the session habituate the brain responses. Participants were tested in a 3-stimulus CIT with semantic autobiographical probes (their own date of birth and episodic autobiographical probes (a secret date learned just before the study. Results dissociated these two memory conditions on several ERP components. Semantic probes elicited a smaller frontal N2 than episodic probes, consistent with the idea that the frontal N2 decreases with greater pre-existing semantic knowledge about the item. Likewise, semantic probes elicited a smaller central N400 than episodic probes. Semantic probes also elicited a larger P3b than episodic probes because of their richer meaning. In contrast, episodic probes elicited a larger late positive component (LPC than semantic probes, because of the recent episodic memory associated with them. All these ERPs showed a difference between probes and irrelevants in both memory conditions, except for the N400, which showed a difference only in the semantic condition. Finally, although repetition affected the ERPs, it did not reduce the difference between probes and irrelevants. Thus, the type of memory associated with a probe has both theoretical and practical importance for CIT research.

  9. Episodic memory for natural and transformed food.

    Science.gov (United States)

    Aiello, Marilena; Vignando, Miriam; Foroni, Francesco; Pergola, Giulio; Rossi, Paola; Silveri, Maria Caterina; Rumiati, Raffaella I

    2018-05-10

    It has been proposed that the conceptual knowledge of food and its putative subdivision into natural (i.e., fruit/vegetables) and transformed (i.e., food that underwent thermic or non-thermic processing) may follow the living/non-living distinction. In the present study, we investigated whether the advantage for living things compared to non-living things observed in episodic memory (the so-called animacy effect) extends to natural foods and transformed foods respectively. We pursued this issue in two experiments. In Experiment 1, we measured episodic memory for natural and transformed foods in young participants. In Experiment 2, we enrolled dementia-free centenarians, patients with Alzheimer's disease (DAT), Progressive primary aphasia (PPA), and healthy controls whose episodic memory was also tested for living/non-living things. Results showed that young participants had better recognition memory for transformed foods compared to natural foods. This difference disappeared in centenarians and patients. However, centenarians and PPA exhibited enhanced levels of false alarms (FA) with natural food, and DAT patients with both natural and transformed food. As far as the living/non-living distinction is concerned, the episodic memory for the living category appears more resilient to the decline compared to the non-living category in patients, particularly those with PPA. In conclusion, our study shows that transformed food is better remembered than natural food, suggesting that it is more salient and possibly relevant from an evolutionary perspective. The natural/transformed distinction appears susceptible to erosion only in the presence of a high degree of episodic memory impairment. These results offer novel insight on episodic memory of food, and also extend the current knowledge on the animacy effect in episodic memory. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Concealed semantic and episodic autobiographical memory electrified

    Science.gov (United States)

    Ganis, Giorgio; Schendan, Haline E.

    2013-01-01

    Electrophysiology-based concealed information tests (CIT) try to determine whether somebody possesses concealed information about a crime-related item (probe) by comparing event-related potentials (ERPs) between this item and comparison items (irrelevants). Although the broader field is sometimes referred to as “memory detection,” little attention has been paid to the precise type of underlying memory involved. This study begins addressing this issue by examining the key distinction between semantic and episodic memory in the autobiographical domain within a CIT paradigm. This study also addresses the issue of whether multiple repetitions of the items over the course of the session habituate the brain responses. Participants were tested in a 3-stimulus CIT with semantic autobiographical probes (their own date of birth) and episodic autobiographical probes (a secret date learned just before the study). Results dissociated these two memory conditions on several ERP components. Semantic probes elicited a smaller frontal N2 than episodic probes, consistent with the idea that the frontal N2 decreases with greater pre-existing knowledge about the item. Likewise, semantic probes elicited a smaller central N400 than episodic probes. Semantic probes also elicited a larger P3b than episodic probes because of their richer meaning. In contrast, episodic probes elicited a larger late positive complex (LPC) than semantic probes, because of the recent episodic memory associated with them. All these ERPs showed a difference between probes and irrelevants in both memory conditions, except for the N400, which showed a difference only in the semantic condition. Finally, although repetition affected the ERPs, it did not reduce the difference between probes and irrelevants. These findings show that the type of memory associated with a probe has both theoretical and practical importance for CIT research. PMID:23355816

  11. [Assessing the economic impact of adverse events in Spanish hospitals by using administrative data].

    Science.gov (United States)

    Allué, Natalia; Chiarello, Pietro; Bernal Delgado, Enrique; Castells, Xavier; Giraldo, Priscila; Martínez, Natalia; Sarsanedas, Eugenia; Cots, Francesc

    2014-01-01

    To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010. A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project. This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure. Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  12. Metabolic Syndrome in First Episode Schizophrenia, Based on the National Mental Health Registry of Schizophrenia (NMHR) in a General Hospital in Malaysia: A 10-Year Retrospective Cohort Study.

    Science.gov (United States)

    Lee, Albert Muh Haur; Ng, Chong Guan; Koh, Ong Hui; Gill, Jesjeet Singh; Aziz, Salina Abdul

    2018-05-07

    Schizophrenia has been linked with various medical comorbidities, particularly metabolic syndrome. The number of studies on this aspect is lacking in Malaysia. (1) Objective: To investigate metabolic syndrome rates and its associated factors. (2) Method: This is the first 10-year retrospective-outcome study of patients with first episode schizophrenia in Malaysia. Out of 394 patients diagnosed with first episode schizophrenia and registered with the National Mental Health Registry of Schizophrenia (NMHR) in the General Hospital Kuala Lumpur (GHKL) in 2004⁻2005, 174 patients consented to participate in the study. They were interviewed using a Schizophrenia outcome questionnaire and the International Physical Activity Questionnaire (IPAQ). The diagnosis of metabolic syndrome was made using the National Cholesterol Education Program—Third Adult Treatment Panel (NCEP ATP III). (3) Results: All patients’ weight, body mass index, fasting blood sugar, and blood pressure are significantly increased. Sixty-three subjects (36.2%) developed metabolic syndrome while 36 (23.2%) were hypertensive, and 41 (28.1%) were diabetic. Use of fluphenthixol depot (CI = 1.05⁻5.09, OR: 0.84, p = 0.039), reduced physical activity (CI = 0.13⁻1.00, OR: −1.04, p = 0.049), and substance use disorder (CI = 1.40, 13.89, OR: 1.48, p = 0.012) were significantly associated with metabolic syndrome based on univariate analysis. In further multivariate analysis, comorbid substance abuse was the only significant factor associated with metabolic syndrome after adjusting for physical activity and intramuscular depot. (4) Conclusion: Patients with schizophrenia are at high risk of metabolic syndrome. It is important to address substance use problems as an important risk factor of this comorbidity.

  13. Intermittent inhaled corticosteroids in infants with episodic wheezing

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Hermansen, Mette Northman; Loland, Lotte

    2006-01-01

    BACKGROUND: We hypothesized that asthma is preceded by a stage of recurrent episodes of wheezing during the first years of life and that inhaled corticosteroid therapy during symptomatic episodes in this early phase may delay progression to persistent wheezing. METHODS: We assigned one-month-old ......BACKGROUND: We hypothesized that asthma is preceded by a stage of recurrent episodes of wheezing during the first years of life and that inhaled corticosteroid therapy during symptomatic episodes in this early phase may delay progression to persistent wheezing. METHODS: We assigned one......-month-old infants to treatment with two-week courses of inhaled budesonide (400 mug per day) or placebo, initiated after a three-day episode of wheezing, in this single-center, randomized, double-blind, prospective study of three years' duration. The primary outcome was the number of symptom-free days; key...... secondary outcomes were the time to discontinuation due to persistent wheezing and safety, as evaluated by height and bone mineral density at the end of the study. RESULTS: We enrolled 411 infants and randomly assigned 294 to receive budesonide at a first episode of wheezing. The proportion of symptom...

  14. Episodic-like memory in zebrafish.

    Science.gov (United States)

    Hamilton, Trevor J; Myggland, Allison; Duperreault, Erika; May, Zacnicte; Gallup, Joshua; Powell, Russell A; Schalomon, Melike; Digweed, Shannon M

    2016-11-01

    Episodic-like memory tests often aid in determining an animal's ability to recall the what, where, and which (context) of an event. To date, this type of memory has been demonstrated in humans, wild chacma baboons, corvids (Scrub jays), humming birds, mice, rats, Yucatan minipigs, and cuttlefish. The potential for this type of memory in zebrafish remains unexplored even though they are quickly becoming an essential model organism for the study of a variety of human cognitive and mental disorders. Here we explore the episodic-like capabilities of zebrafish (Danio rerio) in a previously established mammalian memory paradigm. We demonstrate that when zebrafish were presented with a familiar object in a familiar context but a novel location within that context, they spend more time in the novel quadrant. Thus, zebrafish display episodic-like memory as they remember what object they saw, where they saw it (quadrant location), and on which occasion (yellow or blue walls) it was presented.

  15. Do HMO penetration and hospital competition impact quality of hospital care?

    Science.gov (United States)

    Rivers, P A; Fottler, M D

    2004-11-01

    This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

  16. First episode schizophrenia

    African Journals Online (AJOL)

    with schizophrenia present clinically with psychotic, negative and cognitive ... changes in their emotions, cognition or behaviour which may indicate a ... contribute 80% to the risk of schizophrenia developing. A number of .... Positive symptoms ... Depression ... treatment of first episode schizophrenia is of critical importance.

  17. Comparative Cognition: Action Imitation Using Episodic Memory.

    Science.gov (United States)

    Crystal, Jonathon D

    2016-12-05

    Humans encounter a myriad of actions or events and later recall some of these events using episodic memory. New research suggests that dogs can imitate recently encountered actions using episodic memory. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. [The development of hospital medical supplies information management system].

    Science.gov (United States)

    Cao, Shaoping; Gu, Hongqing; Zhang, Peng; Wang, Qiang

    2010-05-01

    The information management of medical materials by using high-tech computer, in order to improve the efficiency of the consumption of medical supplies, hospital supplies and develop a new technology way to manage the hospital and material support. Using C # NET, JAVA techniques to develop procedures for the establishment of hospital material management information system, set the various management modules, production of various statistical reports, standard operating procedures. The system is convenient, functional and strong, fluent statistical functions. It can always fully grasp and understand the whole hospital supplies run dynamic information, as a modern and effective tool for hospital materials management.

  19. [Treatment of the first episode of spontaneous pneumothorax].

    Science.gov (United States)

    Moubachir, H; Zaghba, N; Benjelloun, H; Bakhatar, A; Yassine, N

    2016-11-01

    The management of a first episode of spontaneous pneumothorax is controversial and the best technique to be used as an initial intervention, aspiration or intercostal drainage, is still debated. We present a retrospective case series during two and a half consecutive years describing the immediate management of spontaneous pneumothoraces, comparing aspiration versus thoracic drainage. One hundred and thirty-three clinical files from patients with spontaneous pneumothoraces were analyzed (17 primary and 116 secondary). The pneumothoraces were of varying size and different etiologies. Patients were initially treated with simple aspiration in 68 cases, with an immediate success rate of 37.5%, intercostal drainage in 49 cases, and by rest alone in 16 cases. In case of secondary pneumothorax, aspiration appeared to offer advantages as an initial strategy over intercostal drainage in terms of hospital stay (11 versus 22 days), and with significant effectiveness (37.5%). Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  20. Suicide risk in placebo-controlled trials of treatment for acute manic episode and prevention of manic-depressive episode

    NARCIS (Netherlands)

    Storosum, Jitschak G.; Wohlfarth, Tamar; Gispen-de Wied, Christine C.; Linszen, Don H.; Gersons, Berthold P. R.; van Zwieten, Barbara J.; van den Brink, Wim

    2005-01-01

    Objective: The authors' goal was to investigate whether there is a greater suicide risk in the placebo arms of placebo-controlled studies of active medication for the treatment of acute manic episode and the prevention of manic/depressive episode. If so, this would be a strong ethical argument

  1. The prevalence and clinical characteristics associated with Diagnostic and Statistical Manual Version-5-defined anxious distress specifier in adults with major depressive disorder

    DEFF Research Database (Denmark)

    McIntyre, Roger S.; Woldeyohannes, Hanna O; Soczynska, Joanna K

    2016-01-01

    OBJECTIVES: The aim of the study was to evaluate the prevalence of and illness characteristics in adults with major depressive disorder (MDD) with anxious distress specifier (ADS) enrolled in the International Mood Disorders Collaborative Project, which is a collaborative research platform...... at the Mood Disorders Psychopharmacology Unit, University of Toronto, Canada and the Cleveland Clinic, Cleveland, Ohio, USA. METHODS: Data from participants who met criteria for a current major depressive episode as part of MDD (n = 830) were included in this post hoc analysis. Diagnostic and Statistical......, employment, marital status). Greater severity of illness was observed in adults with ADS as evidenced by a higher number of hospitalizations, higher rates of suicidal ideation, greater depressive symptom severity, greater workplace impairment, decreased quality of life, and greater self-reported cognitive...

  2. Hippocampal functional connectivity and episodic memory in early childhood.

    Science.gov (United States)

    Riggins, Tracy; Geng, Fengji; Blankenship, Sarah L; Redcay, Elizabeth

    2016-06-01

    Episodic memory relies on a distributed network of brain regions, with the hippocampus playing a critical and irreplaceable role. Few studies have examined how changes in this network contribute to episodic memory development early in life. The present addressed this gap by examining relations between hippocampal functional connectivity and episodic memory in 4- and 6-year-old children (n=40). Results revealed similar hippocampal functional connectivity between age groups, which included lateral temporal regions, precuneus, and multiple parietal and prefrontal regions, and functional specialization along the longitudinal axis. Despite these similarities, developmental differences were also observed. Specifically, 3 (of 4) regions within the hippocampal memory network were positively associated with episodic memory in 6-year-old children, but negatively associated with episodic memory in 4-year-old children. In contrast, all 3 regions outside the hippocampal memory network were negatively associated with episodic memory in older children, but positively associated with episodic memory in younger children. These interactions are interpreted within an interactive specialization framework and suggest the hippocampus becomes functionally integrated with cortical regions that are part of the hippocampal memory network in adults and functionally segregated from regions unrelated to memory in adults, both of which are associated with age-related improvements in episodic memory ability. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. A retrospective study of the impact of a telephone alert service (Healthy Outlook) on hospital admissions for patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Sarran, Christophe; Halpin, David; Levy, Mark L; Prigmore, Samantha; Sachon, Patrick

    2014-10-23

    Healthy Outlook is a service delivered by the UK Met Office directly to patients with chronic obstructive pulmonary disease (COPD) that has been in place since 2006. Its objective is to reduce the severity and length of COPD exacerbations, hence improving the quality of life and life expectancy. To assess the effect of the Healthy Outlook service on hospital admission rates of all general practitioners that have used the service. Control practices were selected for each of the 661 participating practices. The number of hospital admissions for each practice was extracted from the Hospital Episode Statistics database. The differences in admission rates per practice between the first year of use of the Healthy Outlook service and the previous year were compared by paired t-test analyses. For admissions with a primary diagnosis of COPD, the difference between participating and control practices was -0.8% (95% confidence interval (CI)=-1.8 to 0.2%; P=0.13). For admissions with a primary or co-morbid diagnosis of COPD, the difference was -2.3% (95% CI=-4.2 to -0.4%; P=0.02). Participation in the Healthy Outlook service reduces hospital admission rates for patients coded on discharge with COPD (including co-morbid).

  4. Treatment outcomes of acute bipolar depressive episode with psychosis.

    Science.gov (United States)

    Caldieraro, Marco Antonio; Dufour, Steven; Sylvia, Louisa G; Gao, Keming; Ketter, Terence A; Bobo, William V; Walsh, Samantha; Janos, Jessica; Tohen, Mauricio; Reilly-Harrington, Noreen A; McElroy, Susan L; Shelton, Richard C; Bowden, Charles L; Deckersbach, Thilo; Nierenberg, Andrew A

    2018-05-01

    The impact of psychosis on the treatment of bipolar depression is remarkably understudied. The primary aim of this study was to compare treatment outcomes of bipolar depressed individuals with and without psychosis. The secondary aim was to compare the effect of lithium and quetiapine, each with adjunctive personalized treatments (APTs), in the psychotic subgroup. We assessed participants with DSM-IV bipolar depression included in a comparative effectiveness study of lithium and quetiapine with APTs (the Bipolar CHOICE study). Severity was assessed by the Bipolar Inventory of Symptoms Scale (BISS) and by the Clinical Global Impression Scale-Severity-Bipolar Version (CGI-S-BP). Mixed models were used to assess the course of symptom change, and Cox regression survival analysis was used to assess the time to remission. Psychotic features were present in 10.6% (n = 32) of the depressed participants (n = 303). Those with psychotic features had higher scores on the BISS before (75.2 ± 17.6 vs. 54.9 ± 16.3; P Bipolar depressive episodes with psychotic features are more severe, and compared to nonpsychotic depressions, present a similar course of improvement. Given the small number of participants presenting psychosis, the lack of statistically significant difference between lithium- and quetiapine-based treatment of psychotic bipolar depressive episodes needs replication in a larger sample. © 2018 Wiley Periodicals, Inc.

  5. Reproductive encounters: Negev bedouin women’s lay encounters at childbirth in an Israeli hospital

    NARCIS (Netherlands)

    Kisch, S.

    2009-01-01

    Though hospital studies have often focused on the vertical relationships between patients and medical staff, the interactions between patients have received much less attention. Whereas interaction with staff members is episodic, patients often spend long hours sharing intimate space and daily

  6. Intrinsic motivation and amotivation in first episode and prolonged psychosis.

    Science.gov (United States)

    Luther, Lauren; Lysaker, Paul H; Firmin, Ruth L; Breier, Alan; Vohs, Jenifer L

    2015-12-01

    The deleterious functional implications of motivation deficits in psychosis have generated interest in examining dimensions of the construct. However, there remains a paucity of data regarding whether dimensions of motivation differ over the course of psychosis. Therefore, this study examined two motivation dimensions, trait-like intrinsic motivation, and the negative symptom of amotivation, and tested the impact of illness phase on the 1) levels of these dimensions and 2) relationship between these dimensions. Participants with first episode psychosis (FEP; n=40) and prolonged psychosis (n=66) completed clinician-rated measures of intrinsic motivation and amotivation. Analyses revealed that when controlling for group differences in gender and education, the FEP group had significantly more intrinsic motivation and lower amotivation than the prolonged psychosis group. Moreover, intrinsic motivation was negatively correlated with amotivation in both FEP and prolonged psychosis, but the magnitude of the relationship did not statistically differ between groups. These findings suggest that motivation deficits are more severe later in the course of psychosis and that low intrinsic motivation may be partially independent of amotivation in both first episode and prolonged psychosis. Clinically, these results highlight the importance of targeting motivation in early intervention services. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Statistical Observations of The Patients With Vertigo in The Oto-Rhino-Laryngological Department of The Ryukyu University Hospital in 1980

    OpenAIRE

    勢理客, 友子; 名嘉嶺, 苗子; 喜友名, 千佳子; 又吉, 重光; 野田, 寛; Serikyaku, Tomoko; Nakamine, Naeko; Kiyuna, Chikako; Matayoshi, Shigemitsu; Noda, Yutaka; 琉球大学医学部附属病院耳鼻咽喉科

    1982-01-01

    Statistical analyses were presented, regarding to the 69 patients with vertigo in the Oto-Rhino-Laryngological Department of the Ryukyus University Hospital, and the following features were observed : 1. We had monthly 7.7 patients with vertigo on an average, which were increased in comparison with average 4.9 patients a month in 1979. 2. Many of the patients were presented in the third to the fifth decade of age in both sex, and the female patients were 2.5 times more than the male. 3. The p...

  8. Psychosis: clinical insight and beliefs in immigrants in their first episode.

    Science.gov (United States)

    Berg, Akiah Ottesen; Barrett, Elizabeth Ann; Nerhus, Mari; Büchman, Camilla; Simonsen, Carmen; Faerden, Ann; Andreassen, Ole A; Melle, Ingrid

    2018-04-01

    Lack of insight into illness is frequent in psychotic disorders and seen as part of their primary pathology. The recognition of symptoms as psychotic, and beliefs about treatment alternatives, is also influenced by socio-cultural factors. Here we examined clinical insight into illness and beliefs about psychosis in immigrants in their first episode of psychosis compared with a reference group. A total of 277 first-episode psychosis participants were recruited to this cross-sectional study; 40 first- and 40 second-generation immigrants from Europe, Americas and Oceania (n = 37), Asia including Turkey (n = 28) or Africa (n = 15). The Birchwood Insight Scale was used to measure clinical insight and 'The Attitudes and Beliefs about Mental Health Problems' schizophrenia version to assess socio-cultural beliefs. Immigrants did not differ from the reference sample in clinical insight. After controlling for education level, first-generation immigrants were less likely to recognize psychotic symptoms (odds ratio (OR) 2.9; Wald = 8.977, degrees of freedom (d.f.) 1, P = 0.003) and viewed hospitalization (OR 5.2; Wald = 20.388, d.f. 1, P = 0.001) and treatment by a psychiatrist (OR 4.9; Wald = 6.609, d.f. 1, P = 0.01)) as less beneficial than the reference group. Immigrants from Asia held more alternative explanations (OR 0.3; Wald = 6.567, d.f. 1, P = 0.010). There were significantly stronger associations between clinical insight and socio-cultural beliefs in the reference group. Socio-cultural beliefs about psychosis in immigrants in first-episode psychosis call for more tailored information to this group, and emphasize the importance of treatment interventions involving both a cultural and personal perspective of insight. © 2015 Wiley Publishing Asia Pty Ltd.

  9. The contributions of handedness and working memory to episodic memory.

    Science.gov (United States)

    Sahu, Aparna; Christman, Stephen D; Propper, Ruth E

    2016-11-01

    Past studies have independently shown associations of working memory and degree of handedness with episodic memory retrieval. The current study takes a step ahead by examining whether handedness and working memory independently predict episodic memory. In agreement with past studies, there was an inconsistent-handed advantage for episodic memory; however, this advantage was absent for working memory tasks. Furthermore, regression analyses showed handedness, and complex working memory predicted episodic memory performance at different times. Results are discussed in light of theories of episodic memory and hemispheric interaction.

  10. The Generalized Quantum Episodic Memory Model.

    Science.gov (United States)

    Trueblood, Jennifer S; Hemmer, Pernille

    2017-11-01

    Recent evidence suggests that experienced events are often mapped to too many episodic states, including those that are logically or experimentally incompatible with one another. For example, episodic over-distribution patterns show that the probability of accepting an item under different mutually exclusive conditions violates the disjunction rule. A related example, called subadditivity, occurs when the probability of accepting an item under mutually exclusive and exhaustive instruction conditions sums to a number >1. Both the over-distribution effect and subadditivity have been widely observed in item and source-memory paradigms. These phenomena are difficult to explain using standard memory frameworks, such as signal-detection theory. A dual-trace model called the over-distribution (OD) model (Brainerd & Reyna, 2008) can explain the episodic over-distribution effect, but not subadditivity. Our goal is to develop a model that can explain both effects. In this paper, we propose the Generalized Quantum Episodic Memory (GQEM) model, which extends the Quantum Episodic Memory (QEM) model developed by Brainerd, Wang, and Reyna (2013). We test GQEM by comparing it to the OD model using data from a novel item-memory experiment and a previously published source-memory experiment (Kellen, Singmann, & Klauer, 2014) examining the over-distribution effect. Using the best-fit parameters from the over-distribution experiments, we conclude by showing that the GQEM model can also account for subadditivity. Overall these results add to a growing body of evidence suggesting that quantum probability theory is a valuable tool in modeling recognition memory. Copyright © 2016 Cognitive Science Society, Inc.

  11. Cannabis use and first manic episode.

    Science.gov (United States)

    Bally, Nathalie; Zullino, Daniele; Aubry, Jean-Michel

    2014-08-01

    Cannabis is the most commonly abused drug among patients with bipolar disorder. Available data has shown that the risk of psychotic disorders increases with the frequency and intensity of cannabis abuse. The present purpose was to review relevant studies to investigate whether cannabis use can be linked to the onset of mania in bipolar disorder. Articles published between 1972 and December 2013 were searched on Medline and PsychInfo using the following keywords: first manic episode, or onset mania, or bipolar disorder and cannabis. Relevant papers cited in the references of selected articles were further considered for inclusion into the review. Lifetime use of cannabis among bipolar patients appears to be around 70% and approximately 30% of patients with a bipolar disorder present a comorbidity of cannabis abuse or dependence. Cannabis use is associated with younger age at onset of first mania and with more frequent depressive or manic episodes, although the evidence is somewhat inconsistent. Likewise cannabis consumption is related to poorer outcome and an increased risk of rapid cycling or mixed episodes. In contrast, neuro-cognitive functioning seems to be positively affected in patients with psychiatric comorbidity. While cannabis use often precedes first manic episodes, the causal direction remains to be determined. Variations in definition of cannabis use/dependence. Lack of controlled studies limiting definite conclusions about a putative causal relationship between cannabis and onset of mania. Further investigations are needed to clarify the relationships between cannabis use and first manic episode. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data.

    Directory of Open Access Journals (Sweden)

    Manisha Nair

    Full Text Available As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1 the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI by reproducing an Australian indicator using routinely available hospital data, 2 the impact of modifications to the indicator to address potential data quality issues, 3 the reliability of the indicator.We used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES database of the Health and Social care Information centre (HSCIC. A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies.EMMOI included 26 morbid events (17 diagnosis and 9 procedures. Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out.While routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.

  13. Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010.

    Science.gov (United States)

    Bhuiyan, Mejbah U; Luby, Stephen P; Alamgir, Nadia I; Homaira, Nusrat; Mamun, Abdullah A; Khan, Jahangir A M; Abedin, Jaynal; Sturm-Ramirez, Katharine; Gurley, Emily S; Zaman, Rashid U; Alamgir, A S M; Rahman, Mahmudur; Widdowson, Marc-Alain; Azziz-Baumgartner, Eduardo

    2014-07-01

    Understanding the costs of influenza-associated illness in Bangladesh may help health authorities assess the cost-effectiveness of influenza prevention programs. We estimated the annual economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh. From May through October 2010, investigators identified both outpatients and inpatients at four tertiary hospitals with laboratory-confirmed influenza infection through rRT-PCR. Research assistants visited case-patients' homes within 30 days of hospital visit/discharge and administered a structured questionnaire to capture direct medical costs (physician consultation, hospital bed, medicines and diagnostic tests), direct non-medical costs (food, lodging and travel) and indirect costs (case-patients' and caregivers' lost income). We used WHO-Choice estimates for routine healthcare service costs. We added direct, indirect and healthcare service costs to calculate cost-per-episode. We used median cost-per-episode, published influenza-associated outpatient and hospitalization rates and Bangladesh census data to estimate the annual economic burden of influenza-associated illnesses in 2010. We interviewed 132 outpatients and 41 hospitalized patients. The median cost of an influenza-associated outpatient visit was US$4.80 (IQR = 2.93-8.11) and an influenza-associated hospitalization was US$82.20 (IQR = 59.96-121.56). We estimated that influenza-associated outpatient visits resulted in US$108 million (95% CI: 76-147) in direct costs and US$59 million (95% CI: 37-91) in indirect costs; influenza-associated hospitalizations resulted in US$1.4 million (95% CI: 0.4-2.6) in direct costs and US$0.4 million (95% CI: 0.1-0.8) in indirect costs in 2010. In Bangladesh, influenza-associated illnesses caused an estimated US$169 million in economic loss in 2010, largely driven by frequent but low-cost outpatient visits. © 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons

  14. Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010

    Science.gov (United States)

    Bhuiyan, Mejbah U; Luby, Stephen P; Alamgir, Nadia I; Homaira, Nusrat; Mamun, Abdullah A; Khan, Jahangir A M; Abedin, Jaynal; Sturm-Ramirez, Katharine; Gurley, Emily S; Zaman, Rashid U; Alamgir, ASM; Rahman, Mahmudur; Widdowson, Marc-Alain; Azziz-Baumgartner, Eduardo

    2014-01-01

    Objective Understanding the costs of influenza-associated illness in Bangladesh may help health authorities assess the cost-effectiveness of influenza prevention programs. We estimated the annual economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh. Design From May through October 2010, investigators identified both outpatients and inpatients at four tertiary hospitals with laboratory-confirmed influenza infection through rRT-PCR. Research assistants visited case-patients' homes within 30 days of hospital visit/discharge and administered a structured questionnaire to capture direct medical costs (physician consultation, hospital bed, medicines and diagnostic tests), direct non-medical costs (food, lodging and travel) and indirect costs (case-patients' and caregivers' lost income). We used WHO-Choice estimates for routine healthcare service costs. We added direct, indirect and healthcare service costs to calculate cost-per-episode. We used median cost-per-episode, published influenza-associated outpatient and hospitalization rates and Bangladesh census data to estimate the annual economic burden of influenza-associated illnesses in 2010. Results We interviewed 132 outpatients and 41 hospitalized patients. The median cost of an influenza-associated outpatient visit was US$4.80 (IQR = 2.93–8.11) and an influenza-associated hospitalization was US$82.20 (IQR = 59.96–121.56). We estimated that influenza-associated outpatient visits resulted in US$108 million (95% CI: 76–147) in direct costs and US$59 million (95% CI: 37–91) in indirect costs; influenza-associated hospitalizations resulted in US$1.4 million (95% CI: 0.4–2.6) in direct costs and US$0.4 million (95% CI: 0.1–0.8) in indirect costs in 2010. Conclusions In Bangladesh, influenza-associated illnesses caused an estimated US$169 million in economic loss in 2010, largely driven by frequent but low-cost outpatient visits. PMID:24750586

  15. Burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children.

    Directory of Open Access Journals (Sweden)

    Rajiv Sarkar

    2014-07-01

    Full Text Available Cryptosporidium spp. is a common, but under-reported cause of childhood diarrhea throughout the world, especially in developing countries. A comprehensive estimate of the burden of cryptosporidiosis in resource-poor settings is not available.We used published and unpublished studies to estimate the burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children. Our estimates suggest that annually, one in every 6-11 children <2 years of age will have an episode of cryptosporidial diarrhea, 1 in every 169-633 children will be hospitalized and 1 in every 2890-7247 children will die due to cryptosporidiosis. Since there are approximately 42 million children <2 years of age in India, it is estimated that Cryptosporidium results in 3.9-7.1 million diarrheal episodes, 66.4-249.0 thousand hospitalizations, and 5.8-14.6 thousand deaths each year.The findings of this study suggest a high burden of cryptosporidiosis among children <2 years of age in India and makes a compelling case for further research on transmission and prevention modalities of Cryptosporidium spp. in India and other developing countries.

  16. Elements of episodic-like memory in animals.

    Science.gov (United States)

    Clayton, N S; Griffiths, D P; Emery, N J; Dickinson, A

    2001-09-29

    A number of psychologists have suggested that episodic memory is a uniquely human phenomenon and, until recently, there was little evidence that animals could recall a unique past experience and respond appropriately. Experiments on food-caching memory in scrub jays question this assumption. On the basis of a single caching episode, scrub jays can remember when and where they cached a variety of foods that differ in the rate at which they degrade, in a way that is inexplicable by relative familiarity. They can update their memory of the contents of a cache depending on whether or not they have emptied the cache site, and can also remember where another bird has hidden caches, suggesting that they encode rich representations of the caching event. They make temporal generalizations about when perishable items should degrade and also remember the relative time since caching when the same food is cached in distinct sites at different times. These results show that jays form integrated memories for the location, content and time of caching. This memory capability fulfils Tulving's behavioural criteria for episodic memory and is thus termed 'episodic-like'. We suggest that several features of episodic memory may not be unique to humans.

  17. Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae.

    Science.gov (United States)

    Zahar, Jean-Ralph; Lesprit, Philippe; Ruckly, Stephane; Eden, Aurelia; Hikombo, Hitoto; Bernard, Louis; Harbarth, Stephan; Timsit, Jean-François; Brun-Buisson, Christian

    2017-01-01

    Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  18. Review of Application Development and the Patient Encounter Concept within the University of Iowa Hospital Information System

    Science.gov (United States)

    Wagner, James R.; Wood, David E.

    1982-01-01

    The logical structure of the patient data base supporting the University of Iowa Hospital Information System has produced significant management reporting capabilities. A technique is discussed for grouping information concerning the services provided by the hospital during each Patient Encounter that allows subsequent analysis by Medical Episode and Financial Account. The implementation of this data organization structure is discussed in the context of the 13 major health care applications implemented at the University of Iowa Hospitals and Clinics.

  19. Emotion episodes of Afrikaans-speaking employees in the workplace

    Directory of Open Access Journals (Sweden)

    Cara S. Jonker

    2013-07-01

    Research purpose: The objective of this study was to determine the positive and negative emotion episodes and frequencies of working Afrikaans-speaking adults. Motivation for the study: To date, no study has been conducted to determine emotion episodes amongst White Afrikaans-speaking working adults in South Africa. Gooty, Connelly, Griffith and Gupta also argue for research on emotions in the natural settings in which they occur – the workplace. Research design, approach and method: A survey design with an availability sample was used. The participants (N = 179 consisted of White Afrikaans-speaking working adults. The Episode Grid was administered to capture the emotion episodes. Main findings: The main emotion episodes reported on with positive content included goal achievement, receiving recognition and personal incidents. Emotion episodes with negative content included categories such as behaviour of work colleagues, acts of boss/superior/management and task requirements. Practical and/or managerial implications: The findings are useful for managers who want to enhance the emotional quality of the work-life of employees. Changes could be made, for example, to practices of giving recognition within work environments and the clarification of task requirements. The knowledge on emotion episodes could be very useful in planning interventions. Contribution and/or value-adding: The findings and results of this study provided insight into emotion episodes as events in the workplace can cause positive and negative workplace experiences. This information should be taken into consideration with regard to wellness and emotion measurement efforts.

  20. 77 FR 28597 - Agency Forms Undergoing Paperwork Reduction Act Review

    Science.gov (United States)

    2012-05-15

    ... order to increase the wealth of data on health care utilization in hospitals across episodes of care and... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention [30Day-12-12AL... Hospital Care Survey--New-- National Center for Health Statistics (NCHS), Centers for Disease Control and...

  1. Personality traits in the differentiation of major depressive disorder and bipolar disorder during a depressive episode.

    Science.gov (United States)

    Araujo, Jaciana Marlova Gonçalves; dos Passos, Miguel Bezerra; Molina, Mariane Lopez; da Silva, Ricardo Azevedo; Souza, Luciano Dias de Mattos

    2016-02-28

    The aim of this study was to determine the differences in personality traits between individuals with Major Depressive Disorder (MDD) and Bipolar Disorder (BD) during a depressive episode, when it can be hard to differentiate them. Data on personality traits (NEO-FFI), mental disorders (Mini International Neuropsychiatric Interview Plus) and socioeconomic variables were collected from 245 respondents who were in a depressive episode. Individuals with MDD (183) and BD (62) diagnosis were compared concerning personality traits, clinical aspects and socioeconomic variables through bivariate analyses (chi-square and ANOVA) and multivariate analysis (logistic regression). There were no differences in the prevalence of the disorders between socioeconomic and clinical variables. As for the personality traits, only the difference in Agreeableness was statistically significant. Considering the control of suicide risk, gender and anxiety comorbidity in the multivariate analysis, the only variable that remained associated was Agreeableness, with an increase in MDD cases. The brief version of the NEO inventories (NEO-FFI) does not allow for the analysis of personality facets. During a depressive episode, high levels of Agreeableness can indicate that MDD is a more likely diagnosis than BD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Transfusion practice in Helsinki University Central Hospital: an analysis of diagnosis-related groups (DRG).

    Science.gov (United States)

    Syrjälä, M T; Kytöniemi, I; Mikkolainen, K; Ranimo, J; Lauharanta, J

    2001-12-01

    Transfusion data combined with data automatically recorded in hospital databases provides an outstanding tool for blood utilization reporting. When the reporting is performed with an online analytical processing (OLAP) tool, real time reporting can be provided to blood subscribers. When this data is combined with a common patient classification system, Diagnosis-Related Groups (DRG), it is possible to produce statistical results, that are similar in different institutions and may provide a means for international transfusion bench-marking and cost comparison. We use a DRG classification to describe the transfusion practice in Helsinki University Central Hospital. The key indicators include the percentage of transfused patients, the number of transfused units and costs in different DRG groups, as well as transfusion rates per DRG weighted treatment episodes. Ninety-three per cent of all transfusions could be classified into different DRGs. The largest blood-using DRG group was acute adult leukaemia (DRG 473), which accounted for 10.4% of all transfusion costs. The 13 largest blood consuming DRGs accounted for half the total costs in 1998. Currently, there is a lack of an internationally accepted standardized way to report institutional or national transfusion practices. DRG-based transfusion reporting might serve as a means for transfusion benchmarking and thus aid studies of variations in transfusion practice.

  3. Lifespan trends of autobiographical remembering: episodicity and search for meaning.

    Science.gov (United States)

    Habermas, Tilmann; Diel, Verena; Welzer, Harald

    2013-09-01

    Autobiographical memories of older adults show fewer episodic and more non-episodic elements than those of younger adults. This semantization effect is attributed to a loss of episodic memory ability. However the alternative explanation by an increasing proclivity to search for meaning has not been ruled out to date. To test whether a decrease in episodicity and an increase in meaning-making in autobiographical narratives are related across the lifespan, we used different instructions, one focussing on specific episodes, the other on embedding events in life, in two lifespan samples. A continuous decrease of episodic quality of memory (memory specificity, narrative quality) was confirmed. An increase of search for meaning (interpretation, life story integration) was confirmed only up to middle adulthood. This non-inverse development of episodicity and searching for meaning in older age speaks for an autonomous semantization effect that is not merely due to an increase in interpretative preferences. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

    Science.gov (United States)

    2015-11-24

    This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

  5. General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis.

    Science.gov (United States)

    Tsiachristas, Apostolos; McDaid, David; Casey, Deborah; Brand, Fiona; Leal, Jose; Park, A-La; Geulayov, Galit; Hawton, Keith

    2017-10-01

    Self-harm is an extremely common reason for hospital presentation. However, few estimates have been made of the hospital costs of assessing and treating self-harm. Such information is essential for planning services and to help strengthen the case for investment in actions to reduce the frequency and effects of self-harm. In this study, we aimed to calculate the costs of hospital medical care associated with a self-harm episode and the costs of psychosocial assessment, together with identification of the key drivers of these costs. In a retrospective analysis, we estimated hospital resource use and care costs for all presentations for self-harm to the John Radcliffe Hospital (Oxford, UK), between April 1, 2013, and March 31, 2014. Episode-related data were provided by the Oxford Monitoring System for Self-harm and we linked these with financial hospital records to quantify costs. We assessed time and resources allocated to psychosocial assessments through discussion with clinical and managerial staff. We then used generalised linear models to investigate the associations between hospital costs and methods of self-harm. Between April 1, 2013, and March 31, 2014, 1647 self-harm presentations by 1153 patients were recorded. Of these, 1623 (99%) presentations by 1140 patients could be linked with hospital finance records. 179 (16%) patients were younger than 18 years. 1150 (70%) presentations were for self-poisoning alone, 367 (22%) for self-injury alone, and 130 (8%) for a combination of methods. Psychosocial assessments were made in 75% (1234) of all episodes. The overall mean hospital cost per episode of self-harm was £809. Costs differed significantly between different types of self-harm: self-injury alone £753 (SD 2061), self-poisoning alone £806 (SD 1568), self-poisoning and self-injury £987 (SD 1823; p<0·0001). Costs were mainly associated with the type of health-care service contact such as inpatient stay, intensive care, and psychosocial assessment. Mean

  6. Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain.

    Science.gov (United States)

    González-Ramallo, V J; Mirón-Rubio, M; Mujal, A; Estrada, O; Forné, C; Aragón, B; Rivera, A J

    2017-07-01

    The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189-7406]. The mean cost per OPAT episode was €1356 (95% CI €1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947-4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  7. Measuring case-mix complexity of tertiary care hospitals using DRGs.

    Science.gov (United States)

    Park, Hayoung; Shin, Youngsoo

    2004-02-01

    The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.

  8. Examining Duration of Binge Eating Episodes in Binge Eating Disorder

    Science.gov (United States)

    Schreiber-Gregory, Deanna N.; Lavender, Jason M.; Engel, Scott G.; Wonderlich, Steve A.; Crosby, Ross D.; Peterson, Carol B.; Simonich, Heather; Crow, Scott; Durkin, Nora; Mitchell, James E.

    2013-01-01

    Objective The primary goal of this paper is to examine and clarify characteristics of binge eating in individuals with binge eating disorder (BED), particularly the duration of binge eating episodes, as well as potential differences between individuals with shorter compared to longer binge eating episodes. Method Two studies exploring binge eating characteristics in BED were conducted. Study 1 examined differences in clinical variables among individuals (N = 139) with BED who reported a short (binge duration. Study 2 utilized an ecological momentary assessment (EMA) design to examine the duration and temporal pattern of binge eating episodes in the natural environment in a separate sample of nine women with BED. Results Participants in Study 1 who were classified as having long duration binge eating episodes displayed greater symptoms of depression and lower self-esteem, but did not differ on other measures of eating disorder symptoms, compared to those with short duration binge eating episodes. In Study 2, the average binge episode duration was approximately 42 minutes, and binge eating episodes were most common during the early afternoon and evening hours, as well as more common on weekdays versus weekends. Discussion Past research on binge episode characteristics, particularly duration, has been limited to studies of binge eating episodes in BN. This study contributes to the existing literature on characteristics of binge eating in BED. PMID:23881639

  9. Modeling HIV-1 drug resistance as episodic directional selection.

    Science.gov (United States)

    Murrell, Ben; de Oliveira, Tulio; Seebregts, Chris; Kosakovsky Pond, Sergei L; Scheffler, Konrad

    2012-01-01

    The evolution of substitutions conferring drug resistance to HIV-1 is both episodic, occurring when patients are on antiretroviral therapy, and strongly directional, with site-specific resistant residues increasing in frequency over time. While methods exist to detect episodic diversifying selection and continuous directional selection, no evolutionary model combining these two properties has been proposed. We present two models of episodic directional selection (MEDS and EDEPS) which allow the a priori specification of lineages expected to have undergone directional selection. The models infer the sites and target residues that were likely subject to directional selection, using either codon or protein sequences. Compared to its null model of episodic diversifying selection, MEDS provides a superior fit to most sites known to be involved in drug resistance, and neither one test for episodic diversifying selection nor another for constant directional selection are able to detect as many true positives as MEDS and EDEPS while maintaining acceptable levels of false positives. This suggests that episodic directional selection is a better description of the process driving the evolution of drug resistance.

  10. Modeling HIV-1 drug resistance as episodic directional selection.

    Directory of Open Access Journals (Sweden)

    Ben Murrell

    Full Text Available The evolution of substitutions conferring drug resistance to HIV-1 is both episodic, occurring when patients are on antiretroviral therapy, and strongly directional, with site-specific resistant residues increasing in frequency over time. While methods exist to detect episodic diversifying selection and continuous directional selection, no evolutionary model combining these two properties has been proposed. We present two models of episodic directional selection (MEDS and EDEPS which allow the a priori specification of lineages expected to have undergone directional selection. The models infer the sites and target residues that were likely subject to directional selection, using either codon or protein sequences. Compared to its null model of episodic diversifying selection, MEDS provides a superior fit to most sites known to be involved in drug resistance, and neither one test for episodic diversifying selection nor another for constant directional selection are able to detect as many true positives as MEDS and EDEPS while maintaining acceptable levels of false positives. This suggests that episodic directional selection is a better description of the process driving the evolution of drug resistance.

  11. Functional neuroimaging of semantic and episodic musical memory.

    Science.gov (United States)

    Platel, Hervé

    2005-12-01

    The distinction between episodic and semantic memory has become very popular since it was first proposed by Tulving in 1972. So far, very few neuropsychological, psychophysical, and imaging studies have related to the mnemonic aspects of music, notably on the long-term memory features, and practically nothing is known about the functional anatomy of long-term memory for music. Numerous functional imaging studies have shown that retrieval from semantic and episodic memory is subserved by distinct neural networks. For instance, the HERA model (hemispheric encoding/retrieval asymmetry) ascribes to the left prefrontal cortex a preferential role in the encoding process of episodic material and the recall of semantic information, while the right prefrontal cortex would preferentially operate in the recall of episodic information. However, these results were essentially obtained with verbal and visuo-spatial material. We have done a study to determine the neural substrates underlying the semantic and episodic components of music using familiar and nonfamiliar melodic tunes. Two distinct patterns of activations were found: bilateral activation of the middle and superior frontal areas and precuneus for episodic memory, and activation of the medial and orbital frontal cortex bilaterally, left angular gyrus, and the anterior part of the left middle and superior temporal gyri for semantic memory. We discuss these findings in light of the available neuropsychological data obtained in brain-damaged subjects and functional neuroimaging studies.

  12. A statistical-dynamical downscaling procedure for global climate simulations

    International Nuclear Information System (INIS)

    Frey-Buness, A.; Heimann, D.; Sausen, R.; Schumann, U.

    1994-01-01

    A statistical-dynamical downscaling procedure for global climate simulations is described. The procedure is based on the assumption that any regional climate is associated with a specific frequency distribution of classified large-scale weather situations. The frequency distributions are derived from multi-year episodes of low resolution global climate simulations. Highly resolved regional distributions of wind and temperature are calculated with a regional model for each class of large-scale weather situation. They are statistically evaluated by weighting them with the according climate-specific frequency. The procedure is exemplarily applied to the Alpine region for a global climate simulation of the present climate. (orig.)

  13. [Repeated poisoning episodes: Alarm sign of risk situations].

    Science.gov (United States)

    García González, Elsa; Trenchs Sainz de la Maza, Victoria; Martínez Sánchez, Lidia; Ferrer Bosch, Nuria; Luaces Cubells, Carles

    2017-11-01

    Prevention is an essential aspect in paediatric poisonings, especially when recurrent episodes are detected. The aims of this article are to detect the recurrence rate for suspected poisoning in emergency consultations, as well as to identify the cases in which specific preventive measures are indicated, and to determine whether the creation of a specific item for recurrent episodes in the computerised medical records system facilitates its detection. A retrospective study was conducted on patients less than 18 years of age treated in the emergency room due to suspected poisoning during 2013 and 2014. Patients were divided according to the presence or absence of previous episodes. From January 2014, a specific item is present in the computerised medical records of the poisoned patient, where the history of previous episodes is registered. The preventive measures used between both groups were compared. A total of 731 consultations were recorded for suspected poisoning. A history of previous episodes was detected in 9% of cases. Medical injury reports and follow-up in outpatient clinics were more often performed in patients with recurrent episodes than in patients without them (28.8% vs 18.0%, P=.034, and 65.2% vs. 18.8%, P<.001, respectively). In 2013, the recurrence rate was 5.9% vs 12% in 2014 (P=.004). The recurrence rate observed is significant. Although preventive measures are more frequently indicated in these patients, their application is low. The creation of a specific item for recurrent episodes in a computerised medical records system facilitates their detection. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Perceptions of clinicians treating young people with first-episode psychosis for post-traumatic stress disorder.

    Science.gov (United States)

    Gairns, Sarah; Alvarez-Jimenez, Mario; Hulbert, Carol; McGorry, Patrick; Bendall, Sarah

    2015-02-01

    Evidence shows that approximately half of young people with first-episode psychosis have post-traumatic stress disorder. Yet, post-traumatic stress disorder is often left untreated in the presence of psychosis. To support the development of a post-traumatic stress disorder intervention for young people with first-episode psychosis, clinicians' perceptions of trauma-focused interventions were sought. Two research questions were explored: What treatment barriers were associated with treating young people with first-episode psychosis? What supports would be useful to implement post-traumatic stress disorder intervention? A mixed-methods design incorporated quantitative and qualitative data from a questionnaire with qualitative data from two focus groups. Sixteen (of 20) case managers from an early psychosis intervention centre participated in the study (16 completed a questionnaire, eight participated in focus groups). Descriptive statistics were generated for quantitative data and qualitative material was examined using a grounded theory approach. The results showed that perceived barriers to delivering trauma-focused intervention were increased mental health risks for clients with psychosis, workload pressures and poor client engagement. Targeted training and formal professional guidance were thought to best scaffold an intervention. Post-traumatic stress disorder intervention for first-episode psychosis clients should address engagement, make safeguarded provisions for family involvement and be sufficiently paced and flexible. Trauma-focused intervention is perceived with a degree of caution, is often not prioritized, lacks institutional support and requires more targeted training. It is important to conduct further research regarding the safety of trauma interventions alongside psychosis in order to address widespread concerns. © 2013 Wiley Publishing Asia Pty Ltd.

  15. Primary pneumocystis infection in infants hospitalized with acute respiratory tract infection

    DEFF Research Database (Denmark)

    Larsen, Hans Henrik; von Linstow, Marie-Louise; Lundgren, Bettina

    2007-01-01

    with 431 episodes of acute respiratory tract infection (RTI) by using a real-time PCR assay. In 68 episodes in 67 infants, P. jirovecii was identified. The odds ratio (95% confidence interval) of a positive signal compared with the first quartile of age (7-49 days) was 47.4 (11.0-203), 8.7 (1......Acquisition of Pneumocystis jirovecii infection early in life has been confirmed by serologic studies. However, no evidence of clinical illness correlated with the primary infection has been found in immunocompetent children. We analyzed 458 nasopharyngeal aspirates from 422 patients hospitalized.......9-39.7), and 0.6 (0.1-6.7) for infants in the second (50-112 days), third (113-265 days), and fourth (268-4,430 days) age quartiles, respectively. Infants with an episode of upper RTI (URTI) were 2.0 (1.05-3.82) times more likely to harbor P. jirovecii than infants with a lower RTI. P. jirovecii may manifest...

  16. Impacto de la introducción de la vacuna contra el rotavirus en la hospitalización por gastroenteritis aguda grave en el Hospital del Niño de la Ciudad de Panamá Impact of rotavirus vaccine introduction on hospital admissions for severe acute gastroenteritis at the Children's Hospital in Panama City

    Directory of Open Access Journals (Sweden)

    Javier Nieto Guevara

    2008-09-01

    < 0.05. RESULTS: There was a total of 1 240 episodes of severe acute gastroenteritis in 1 222 children. No significant differences were found between the two study periods regarding the number of complications (P = 0.92 and deaths (P = 1.00. Although there were more episodes of severe acute gastroenteritis after initiating vaccination against human rotavirus than there were in the period prior, the difference was not statistically significant (RR = 1.12; 95%CI: 087-1.44; P = 0.39. There were no significant differences found in the length of hospital stay by age groups studied in each time period. The percent of cases treated with antibiotics was similar in both study periods (29.7% versus 25.2%; P = 0.08. CONCLUSIONS: The introduction of infant rotavirus vaccination was not found to lead to a significant reduction in hospital admission rates for gastroenteritis among children less than 5 years of age. Significant changes in morbidity and in antibiotics use were not found after the introduction of the vaccine.

  17. Tramadol use and the risk of hospitalization for hypoglycemia in patients with noncancer pain.

    Science.gov (United States)

    Fournier, Jean-Pascal; Azoulay, Laurent; Yin, Hui; Montastruc, Jean-Louis; Suissa, Samy

    2015-02-01

    Tramadol is a weak opioid analgesic whose use has increased rapidly, and it has been associated with adverse events of hypoglycemia. To assess whether tramadol use, when compared with codeine use, is associated with an increased risk of hospitalization for hypoglycemia. A nested case-control analysis was conducted within the United Kingdom Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database of all patients newly treated with tramadol or codeine for noncancer pain between 1998 and 2012. Cohort and case-crossover analyses were also conducted to assess consistency of the results. Cases of hospitalization for hypoglycemia were matched with up to 10 controls on age, sex, and duration of follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated comparing use of tramadol with codeine. A cohort analysis, with high-dimensional propensity score-adjusted hazard ratios (HRs) and 95% CIs, was performed comparing tramadol with codeine in the first 30 days after treatment initiation. Finally, a case-crossover analysis was also performed, in which exposure to tramadol in a 30-day risk period immediately before the hospitalization for hypoglycemia was compared with 11 consecutive 30-day control periods. Odds ratios and 95% CIs were estimated using conditional logistic regression analysis. The cohort included 334,034 patients, of whom 1105 were hospitalized for hypoglycemia during follow-up (incidence, 0.7 per 1000 per year) and matched to 11,019 controls. Compared with codeine, tramadol use was associated with an increased risk of hospitalization for hypoglycemia (OR, 1.52 [95% CI, 1.09-2.10]), particularly elevated in the first 30 days of use (OR, 2.61 [95% CI, 1.61-4.23]). This 30-day increased risk was confirmed in the cohort (HR, 3.60 [95% CI, 1.56-8.34]) and case-crossover analyses (OR, 3.80 [95% CI, 2.64-5.47]). The initiation of tramadol therapy is associated with an increased risk of hypoglycemia requiring

  18. Intrusions in Episodic Memory: Reconsolidation or Interference?

    Science.gov (United States)

    Klingmüller, Angela; Caplan, Jeremy B.; Sommer, Tobias

    2017-01-01

    It would be profoundly important if reconsolidation research in animals and other memory domains generalized to human episodic memory. A 3-d-list-discrimination procedure, based on free recall of objects, with a contextual reminder cue (the testing room), has been thought to demonstrate reconsolidation of human episodic memory (as noted in a…

  19. EEG Suppression Associated with Apneic Episodes in a Neonate

    Directory of Open Access Journals (Sweden)

    Evonne Low

    2012-01-01

    Full Text Available We describe the EEG findings from an ex-preterm neonate at term equivalent age who presented with intermittent but prolonged apneic episodes which were presumed to be seizures. A total of 8 apneic episodes were captured (duration 23–376 seconds during EEG monitoring. The baseline EEG activity was appropriate for corrected gestational age and no electrographic seizure activity was recorded. The average baseline heart rate was 168 beats per minute (bpm and the baseline oxygen saturation level was in the mid-nineties. Periods of complete EEG suppression lasting 68 and 179 seconds, respectively, were recorded during 2 of these 8 apneic episodes. Both episodes were accompanied by bradycardia less than 70 bpm and oxygen saturation levels of less than 20%. Short but severe episodes of apnea can cause complete EEG suppression in the neonate.

  20. A decentralised model of psychiatric care: Profile, length of stay and outcome of mental healthcare users admitted to a district-level public hospital in the Western Cape

    Directory of Open Access Journals (Sweden)

    Eileen Thomas

    2015-02-01

    Full Text Available Background. There is a lack of studies assessing the profile and outcome of psychiatric patients at entry-level public hospitals that are prescribed by the Mental Health Care Act to provide a decentralised model of psychiatric care. Objective. To assess the demographic and clinical profile as well as length of stay and outcomes of mental healthcare users admitted to a district-level public hospital in the Western Cape.  Method. Demographic data, clinical diagnosis, length of stay, referral profile and outcomes of patients (N=487 admitted to Helderberg Hospital during the period 1 January 2011 - 31 December 2011 were collected.  Results. Psychotic disorders were the most prevalent (n=287, 59% diagnoses, while 228 (47% of admission episodes had comorbid/secondary diagnoses. Substance use disorders were present in 184 (38% of admission episodes, 37 (57% of readmissions and 19 (61% of abscondments. Most admission episodes (n=372, 76% were discharged without referral to specialist/tertiary care.  Conclusion. Methamphetamine use places a significant burden on the provision of mental healthcare services at entry-level care. Recommendations for improving service delivery at this district-level public hospital are provided.

  1. White Matter Changes in First Episode Psychosis and their Relation to the Size of Sample Studied: A DTI Study

    Czech Academy of Sciences Publication Activity Database

    Melicher, T.; Horáček, J.; Hlinka, Jaroslav; Španiel, F.; Tintěra, J.; Ibrahim, I.; Mikoláš, P.; Novák, T.; Mohr, P.; Höschl, C.

    2015-01-01

    Roč. 162, 1-3 (2015), s. 22-28 ISSN 0920-9964 R&D Projects: GA ČR GA13-23940S Grant - others:GA UK(CZ) 1392213 Institutional support: RVO:67985807 Keywords : first episode psychosis * schizophrenia * diffusion tensor imaging * Tract-Based Spatial Statistics * fractional anisotropy Subject RIV: FL - Psychiatry, Sexuology Impact factor: 4.453, year: 2015

  2. Episodic memory impairment in Addison's disease: results from a telephonic cognitive assessment.

    Science.gov (United States)

    Henry, Michelle; Thomas, Kevin G F; Ross, Ian L

    2014-06-01

    Patients with Addison's disease frequently self-report memory and attention difficulties, even when on standard replacement therapy. However, few published studies examine, using objective measures and assessing across multiple domains, the cognitive functioning of Addison's disease patients relative to healthy controls. The primary aim of this study was to investigate whether the previously reported subjective cognitive deficits in Addison's disease are confirmed by objective measures. Conducting comprehensive neuropsychological assessments of patients with relatively rare clinical disorders, such as Addison's disease, is challenging because access to those patients is often limited, and because their medical condition might prevent extended testing sessions. Brief telephonic cognitive assessments are a useful tool in such circumstances. Hence, we administered the Brief Test of Adult Cognition by Telephone to 27 Addison's disease patients and 27 matched healthy controls. The instrument provides objective assessment of episodic memory, working memory, executive functioning, reasoning, and speed of processing. Statistical analyses confirmed that, as expected, patients performed significantly more poorly than controls on the episodic memory subtest. There were, however, no significant between-group differences on the attention, executive functioning, reasoning, and speed of processing subtests. Furthermore, patients with a longer duration of illness performed more poorly across all domains of cognition. We conclude that, for Addison's disease patients, previously reported subjective cognitive deficits are matched by objective impairment, but only in the domain of episodic memory. Future research might investigate (a) whether these memory deficits are material-specific (i.e., whether non-verbal memory is also affected), and (b) the neurobiological mechanisms underlying these deficits.

  3. Functional mapping of the neural basis for the encoding and retrieval of human episodic memory using H215O PET

    International Nuclear Information System (INIS)

    Lee, Jae Sung; Nam, Hyun Woo; Lee, Dong Soo; Lee, Sang Kun; Jang, Myoung Jin; Ahn, Ji Young; Park, Kwang Suk; Chung, June Key; Lee, Myung Chul

    2000-01-01

    Episodic memory is described as an 'autobiographical' memory responsible for storing a record of the events in our lives. We performed functional brain activation study using H 2 1 5O PET to reveal the neural basis of the encoding and the retrieval of episodic memory in human normal volunteers. Four repeated H 2 1 5O PET scans with two reference and two activation tasks were performed on 6 normal volunteers to activate brain areas engaged in encoding and retrieval with verbal materials. Images from the same subject were spatially registered and normalized using linear and nonlinear transformation. Using the means and variances for every condition which were adjusted with analysis of covariance, t-statistic analysis were performed voxel-wise. Encoding of episodic memory activated the opercular and triangular parts of left inferior frontal gyrus, right prefrontal cortex, medial frontal area, cingulate gyrus, posterior middle and inferior temporal gyri, and cerebellum, and both primary visual and visual association areas. Retrieval of episodic memory activated the triangular part of left inferior frontal gyrus and inferior temporal gyrus, right prefrontal cortex and medial temporal ares, and both cerebellum and primary visual and visual association areas. The activations in the opercular part of left inferior frontal gyrus and the right prefrontal cortex meant the essential role of these areas in the encoding and retrieval of episodic memeory. We could localize the neural basis of the encoding and retrieval of episodic memory using H 2 1 5O PET, which was partly consistent with the hypothesis of hemispheric encoding/retrieval asymmetry.=20

  4. Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?.

    Science.gov (United States)

    Noles, Marissa J; Reiter, Kristin L; Boortz-Marx, Jonathan; Pink, George

    2015-01-01

    The number of stand-alone rural hospitals has been shrinking as larger health systems target these hospitals for mergers and acquisitions (M and As). However, little research has focused specifically on rural hospital M and A transactions. Using data from Irving Levin Associates' Healthcare M and A Report and Medicare Cost Reports from 2005 to 2012, we examined two research questions: (1) What were the characteristics of rural hospitals that merged or were acquired, and (2) were there changes in rural hospital financial performance, staffing, or services after an M and A transaction? We used logistic regression to identify factors predictive of merger, and we used multiple regression to examine various hospital measures after an M or A. Study results showed that hospitals with weaker financial performance but lower staffing levels and staffing costs were more likely to merge or be acquired. Statistically weak evidence suggested that operating margins declined after the merger; stronger evidence suggested reductions in salary expense. There was no statistically significant evidence of changes to the number of full-time equivalent (FTE) employees, the service lines that were included in the study, capital expenditures, or the amount of debt financing among the hospitals that merged or were acquired. M and A may not result in a rapid influx of capital, a relief of debt burden, or an improvement in bottom-line profitability. However, M and A may be a viable option for maintaining the hospital and the access to care it provides.

  5. Episodes of care: is emergency medicine ready?

    Science.gov (United States)

    Wiler, Jennifer L; Beck, Dennis; Asplin, Brent R; Granovsky, Michael; Moorhead, John; Pilgrim, Randy; Schuur, Jeremiah D

    2012-05-01

    Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting. Copyright © 2011. Published by Mosby, Inc.

  6. HMO penetration: has it hurt public hospitals?

    Science.gov (United States)

    Clement, J P; Grazier, K L

    2001-01-01

    The purpose of this study is to determine the extent to which health maintenance organization (HMO) penetration within the public hospitals' market area affects the financial performance and viability of these institutions, relative to private hospitals. Hospital- and market-specific measures are examined in a fully interacted model of over 2,300 hospitals in 321 metropolitan statistical areas (MSAs) in 1995. Although hospitals located in markets with higher HMO penetration have lower financial performance as reflected in revenues, expenses and operating margin, public hospitals are not more disadvantaged than other hospitals by managed care.

  7. [Pain management nursing in hospitalized patients with non-oncological diseases].

    Science.gov (United States)

    Sepúlveda-Sánchez, Juana María; Canca-Sánchez, José Carlos; Rivas-Ruiz, Francisco; Martín-García, Mónica; Pérez-González, María Josefa; Timonet-Andreu, Eva María

    2016-01-01

    To assess pain management in patients hospitalized with a non-oncological disease and evaluate factors involved in pain assessment. A descriptive, cross-sectional study. We reviewed pain episodes documented in the medical records of 105 patients aged>18 years admitted to the medical units of a regional hospital between September and December 2014. Reports of pain episodes were evaluated by assessing 22 variables related to pain management quality criteria. A total of 184 reports were reviewed. Pain was measured using the visual analogue scale (VAS) in 70.1% of patients (n=129); pain was reassessed in 44.3% (n=54) of patients. Pain reassessment was significantly more frequent in patients agedPain was more frequently considered to be unrelated to the cause of admission in women as compared to men (50 vs. 25.7% p=0.027). Pain was identified in the patient care plan as a collaborative problem by the nurse for 21.1% of the patients. Some aspects of pain management should be improved, especially those regarding pain description and reassessment. The age and sex of patients significantly influence the approach of pain. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. [Psychopathology of anxiety-phobic disorders that led to hospitalization in a psychiatric hospital].

    Science.gov (United States)

    Chugunov, D A; Schmilovitch, A A

    To study the psychopathology of anxiety-phobic disorders and motives of hospitalization of patients in a psychiatric hospital. One hundred and thirty-two patients were examined, 72 patients of the main group were admitted to general psychiatric departments, 60 patients of the control group in the sanatorium psychiatric departments. Clinical-psychopathological, follow-up, psychometric and statistical methods were used. Patients with hospital anxiety-phobic disorders had agoraphobia with panic disorder, social phobias, hypochondriacal phobias, specific phobias and multiple phobias. The main reasons for hospitalization were: the intensity of anxiety-phobic disorders, contrast content of phobias, multiplicity of anxiety-phobic disorders, ambulance calls, personality accentuations and rental aims.

  9. Following up patients with depression after hospital discharge: a mixed methods approach

    Directory of Open Access Journals (Sweden)

    Desplenter Franciska A

    2011-11-01

    Full Text Available Abstract Background A medication information intervention was delivered to patients with a major depressive episode prior to psychiatric hospital discharge. Methods The objective of this study was to explore how patients evolved after hospital discharge and to identify factors influencing this evolution. Using a quasi-experimental longitudinal design, the quantitative analysis measured clinical (using the Hospital Anxiety and Depression Scale, the somatic dimension of the Symptom Checklist 90 and recording the number of readmissions and humanistic (using the Quality of Life Enjoyment and Satisfaction Questionnaire outcomes of patients via telephone contacts up to one year following discharge. The qualitative analysis was based on the researcher diary, consisting of reports on the telephone outcome assessment of patients with major depression (n = 99. All reports were analyzed using the thematic framework approach. Results The change in the participants' health status was as diverse as it was at hospital discharge. Participants reported on remissions; changes in mood; relapses; and re-admissions (one third of patients. Quantitative data on group level showed low anxiety, depression and somatic scores over time. Three groups of contributing factors were identified: process, individual and environmental factors. Process factors included self caring process, medical care after discharge, resumption of work and managing daily life. Individual factors were symptom control, medication and personality. Environmental factors were material and social environment. Each of them could ameliorate, deteriorate or be neutral to the patient's health state. A mix of factors was observed in individual patients. Conclusions After hospital discharge, participants with a major depressive episode evolved in many different ways. Process, individual and environmental factors may influence the participant's health status following hospital discharge. Each of the factors

  10. Analysis of macular and nerve fiber layer thickness in multiple sclerosis patients according to severity level and optic neuritis episodes.

    Science.gov (United States)

    Soler García, A; Padilla Parrado, F; Figueroa-Ortiz, L C; González Gómez, A; García-Ben, A; García-Ben, E; García-Campos, J M

    2016-01-01

    Quantitative assessment of macular and nerve fibre layer thickness in multiple sclerosis patients with regard to expanded disability status scale (EDSS) and presence or absence of previous optic neuritis episodes. We recruited 62 patients with multiple sclerosis (53 relapsing-remitting and 9 secondary progressive) and 12 disease-free controls. All patients underwent an ophthalmological examination, including quantitative analysis of the nerve fibre layer and macular thickness using optical coherence tomography. Patients were classified according to EDSS as A (lower than 1.5), B (between 1.5 and 3.5), and C (above 3.5). Mean nerve fibre layer thickness in control, A, B, and C groups was 103.35±12.62, 99.04±14.35, 93.59±15.41, and 87.36±18.75μm respectively, with statistically significant differences (P<.05). In patients with no history of optic neuritis, history of episodes in the last 3 to 6 months, or history longer than 6 months, mean nerve fibre layer thickness was 99.25±13.71, 93.92±13.30 and 80.07±15.91μm respectively; differences were significant (P<.05). Mean macular thickness in control, A, B, and C groups was 220.01±12.07, 217.78±20.02, 217.68±20.77, and 219.04±24.26μm respectively. Differences were not statistically significant. The mean retinal nerve fibre layer thickness in multiple sclerosis patients is related to the EDSS level. Patients with previous optic neuritis episodes have a thinner retinal nerve fibre layer than patients with no history of these episodes. Mean macular thickness is not correlated to EDSS level. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Outpatient admissions and hospital costs of Syrian refugees in a Turkish university hospital.

    Science.gov (United States)

    Tahirbegolli, Bernard; Çavdar, Sabanur; Çetinkaya Sümer, Esin; Akdeniz, Sıdıka I; Vehid, Suphi

    2016-07-01

    To examine the most frequent admitted polyclinics, diagnoses, and the costs of Syrian refugee patient in a Turkish university hospital in the metropolitan city of Istanbul, Western part of Turkey.  Research methodology consist of analyzing outpatient admissions to the Hospital Polyclinics of Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey from January-June 2014. We carried out diagnosis groups as classified in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, and analyzed the hospital cost of first admission through records based in the hospital information system.  Median age of 251 Syrian refugee patients is 19 years, inter quartile rate 7-34 years. Patients aged 65 and older compared with those until 18 years and 19 to 64 years aged groups have made statistically significant (p less than 0.001) less hospital admissions. The Most frequented clinic was the emergency clinic. On June there have been significantly (p less than 0.001) more admissions compared with other months. The most common diagnoses were diseases of the respiratory system. The costs of per admission was estimated nearly 48 US Dollar/per patient and the total amount of hospital admissions was 12,031.93 US Dollar.  On the specified dates, the clinics were mostly frequented from Syrian refugees until 18 years group. The most common presenting symptoms are respiratory diseases and most frequented clinic is emergency.

  12. Episodic memory and the witness trump card.

    Science.gov (United States)

    Henry, Jeremy; Craver, Carl

    2018-01-01

    We accept Mahr & Csibra's (M&C's) causal claim that episodic memory provides humans with the means for evaluating the veracity of reports about non-occurrent events. We reject their evolutionary argument that this is the proper function of episodic memory. We explore three intriguing implications of the causal claim, for cognitive neuropsychology, comparative psychology, and philosophy.

  13. Reduced context effects on retrieval in first-episode schizophrenia.

    Directory of Open Access Journals (Sweden)

    Lucia M Talamini

    Full Text Available BACKGROUND: A recent modeling study by the authors predicted that contextual information is poorly integrated into episodic representations in schizophrenia, and that this is a main cause of the retrieval deficits seen in schizophrenia. METHODOLOGY/PRINCIPAL FINDINGS: We have tested this prediction in patients with first-episode schizophrenia and matched controls. The benefit from contextual cues in retrieval was strongly reduced in patients. On the other hand, retrieval based on item cues was spared. CONCLUSIONS/SIGNIFICANCE: These results suggest that reduced integration of context information into episodic representations is a core deficit in schizophrenia and one of the main causes of episodic memory impairment.

  14. Dose Escalation and Healthcare Resource Use among Ulcerative Colitis Patients Treated with Adalimumab in English Hospitals: An Analysis of Real-World Data.

    Directory of Open Access Journals (Sweden)

    Christopher M Black

    Full Text Available To describe the real-world use of adalimumab for maintenance treatment of ulcerative colitis (UC and associated healthcare costs in English hospitals.Retrospective cohort study.Analysis of NHS Hospital Episode Statistics linked with pharmacy dispensing data in English hospitals.Adult UC patients receiving ≥240mg during adalimumab treatment induction, subsequently maintained on adalimumab.Frequency and pattern of adalimumab use and dose escalation during maintenance treatment and associated healthcare costs (prescriptions and hospital visits.191 UC patients completed adalimumab treatment induction. 83 (43.46% dose escalated during maintenance treatment by ≥100% (equivalent to weekly dosing (median time to dose escalation: 139 days. 56 patients (67.47% subsequently de-escalated by ≥50% (median time to dose de-escalation: 21 days. Mean all-cause healthcare costs for all patients ≤12 months of index were £13,892. Dose escalators incurred greater mean healthcare costs than non-escalators ≤12 months of index (£14,596 vs. £13,351. Prescriptions accounted for 96.49% of UC-related healthcare costs (£11,090 of £11,494 in all patients.Within the cohort, 43.46% of UC patients escalated their adalimumab dose by ≥100% and incurred greater costs than non-escalators. The apparent underestimation of adalimumab dose escalation in previous studies may have resulted in underestimated costs in healthcare systems.

  15. Temporal Clustering and Sequencing in Short-Term Memory and Episodic Memory

    Science.gov (United States)

    Farrell, Simon

    2012-01-01

    A model of short-term memory and episodic memory is presented, with the core assumptions that (a) people parse their continuous experience into episodic clusters and (b) items are clustered together in memory as episodes by binding information within an episode to a common temporal context. Along with the additional assumption that information…

  16. Statistics of the thyroid pathology operated in the ORL-CCC service of the Hospital Rafael Angel Calderon Guardia, between 2008-2012

    International Nuclear Information System (INIS)

    Ramos Castro, Paula

    2013-01-01

    The statistics of the Servicio de Otorrinolaringologia y Cirugia de Cabeza y Cuello de Hospital Rafael Angel Calderon Guardia were described, in terms of thyroid surgery; in the period from January 1, 2008 to December 31, 2012, compiling 200 cases of operated patients. Due to the increase in the diagnosis of these diseases in the Costa Rican hospital environment and the lack of an instrument to evaluate the therapeutic action, the need to perform an evaluation of the surgical management given to thyroid pathology is born. Through a table of data complications and the systematic review of the records of the population, the presentation of the results obtained was made using the inclusion criteria such as: patients older than 12 years, diagnosis of benign or malignant thyroid pathology with need of surgical resolution, presence of BAAF reported in medical record, case report of patient in interdisciplinary thyroid session, with surgery or surgeries performed in the period between January 2008 and December 2012, with a written report of surgery and biopsy defined with medical record. The exclusion criteria were: patients without reports of FNAB, operative sheet and/or defined biopsy with medical record, patients whose medical record will not be located in the hospital center to collect the information. (author) [es

  17. Comparing the executive function of patients with schizophrenia, acute/chronic type I disorder (manic episode, and healthy controls on Wisconsin Card Sorting Test and Continuous Performance Test

    Directory of Open Access Journals (Sweden)

    Hossein Zare

    2017-05-01

    Full Text Available Introduction: From among various cognitive deficits, deficits in executive processes have an effective role in limiting the patients’ ability to retain, acquire, and re-learn the skills necessary for real-life performance. Thus, the present study aimed to compare the executive function of patients with schizophrenia, acute/chronic type I disorder, and the healthy group. Methods: The present research was an analytical-comparative study. The statistical population consisted of all the outpatients and inpatients with acute/chronic schizophrenia and acute/chronic type I disorder (manic episode visiting Shafa Psychiatric Hospital, Rasht, Iran. Using convenience sampling, 60 male subjects aging 18-49 years old were selected in 2014-2015. They were matched for the variables of sex, age, and education level. The Wisconsin Card Sorting Test, Continuous Performance Test, and Raven’s Progressive Matrices were administered, and the data were analyzed using MANOVA and Tukey post-hoc test. Results: A significant difference was observed between the acute/chronic schizophrenia group, acute/chronic type I disorder (manic episode, and healthy group on the two tests. Patients with schizophrenia had a weaker executive function and attention deficit compared to those with type I disorder and the healthy group (P0.05. Conclusion: Both schizophrenia and type I disorder patients show deficits in executive function and attention. However, the former group manifests higher impairment in cognitive activities, concept formation, cognitive flexibility, and attention deficit.

  18. Triple whammy

    African Journals Online (AJOL)

    2014-01-14

    Jan 14, 2014 ... peri-operative hypotension would help reduce, if not eliminate such AKI - a call for more ... Key words: Angiotensin converting enzyme inhibitors, acute kidney injury, .... Research Database, and the Hospital Episodes Statistics.

  19. Statistical study on cancer patients of cancer research hospital

    International Nuclear Information System (INIS)

    Shim, Yoon Sang; Choi, Soo Yong; Won, Hyuk; Kim, Kee Hwa

    1991-01-01

    The total number of malignant neoplasms included on this study 7,787 cases(10.4%) among 74,928 cases for 2 years. On sex, females with 57.6% were much more than males with 42.4%. The highest proportion of cancer 50-59 age group. The most frequent primary site among males was found to be stomach with 36.2%, followed by liver(12.3%), lung(12.2%), esophagus(15.5%) and larynx(4.9%). In females, the first order was uterine cervix with 47.3%, followed most common type of morphology of malignant neoplasms was adenocarcinoma(39.0%) in males an squamous cell carcinoma(56.2%) in females. Among the cancer patients initially diagnosed in this hospital, the proportion of malignant neoplasms by the extent of disease was 4.6% for patient with carcinoma-in-situ, 76.3% for patients with localized involvement, 11.6% for patients with regional involvement and 7.5% for patients with distant involvement. Among,the cancer patients initially treatment in this hospital, the proportion of malignant neoplasms by the method of treatment was 19.0% for surgery, 27.7 for radiotherapy and 24.2% for chemotherapy. Among the cancer patients confirmed by medical records, 11.2% was traced more than 5 years. (Author)

  20. Episodic and Binge Gambling: An Exploration and Preliminary Quantitative Study.

    Science.gov (United States)

    Cowlishaw, S; Nespoli, E; Jebadurai, J K; Smith, N; Bowden-Jones, H

    2018-03-01

    The DSM-5 includes provisions for episodic forms of gambling disorder, with such changes aligned with earlier accounts of potential binge gambling behaviours. However, there is little research that indicates the utility of these classifications of episodic or binge gambling, and this study considered their characteristics in a clinical sample. It involved administration of a new binge gambling screening tool, along with routine measures, to n = 214 patients entering a specialist treatment clinic for gambling problems. Results indicated that episodic gambling was common in this clinical context, with 28 and 32% of patients reporting gambling episodes that were (a) regular and alternating, and (b) irregular and intermittent, respectively. These patterns were distinguished by factors including associations with covariates that indicated differences from continuous gamblers. For example, the irregular episodic gamblers, but not the regular pattern, demonstrated lower levels of problem gambling severity and comorbidity. Rates of potential binge gambling, which was defined in terms of additional criteria, were around 4% and numbers were insufficient for comparable analyses. The findings support inclusion of episodic forms of gambling disorder in the DSM-5, but highlight the need for improved recognition and research on heterogeneous forms of episodic gambling.

  1. White matter structural connectivity and episodic memory in early childhood

    Directory of Open Access Journals (Sweden)

    Chi T. Ngo

    2017-12-01

    Full Text Available Episodic memory undergoes dramatic improvement in early childhood; the reason for this is poorly understood. In adults, episodic memory relies on a distributed neural network. Key brain regions that supporting these processes include the hippocampus, portions of the parietal cortex, and portions of prefrontal cortex, each of which shows different developmental profiles. Here we asked whether developmental differences in the axonal pathways connecting these regions may account for the robust gains in episodic memory in young children. Using diffusion weighted imaging, we examined whether white matter connectivity between brain regions implicated in episodic memory differed with age, and were associated with memory performance differences in 4- and 6-year-old children. Results revealed that white matter connecting the hippocampus to the inferior parietal lobule significantly predicted children’s performance on episodic memory tasks. In contrast, variation in the white matter connecting the hippocampus to the medial prefrontal cortex did not relate to memory performance. These findings suggest that structural connectivity between the hippocampus and lateral parietal regions is relevant to the development of episodic memory. Keywords: White matter, Memory development, Episodic memory, Diffusion weighted imaging

  2. Prediction of hospital mortality by changes in the estimated glomerular filtration rate (eGFR).

    LENUS (Irish Health Repository)

    Berzan, E

    2015-03-01

    Deterioration of physiological or laboratory variables may provide important prognostic information. We have studied whether a change in estimated glomerular filtration rate (eGFR) value calculated using the (Modification of Diet in Renal Disease (MDRD) formula) over the hospital admission, would have predictive value. An analysis was performed on all emergency medical hospital episodes (N = 61964) admitted between 1 January 2002 and 31 December 2011. A stepwise logistic regression model examined the relationship between mortality and change in renal function from admission to discharge. The fully adjusted Odds Ratios (OR) for 5 classes of GFR deterioration showed a stepwise increased risk of 30-day death with OR\\'s of 1.42 (95% CI: 1.20, 1.68), 1.59 (1.27, 1.99), 2.71 (2.24, 3.27), 5.56 (4.54, 6.81) and 11.9 (9.0, 15.6) respectively. The change in eGFR during a clinical episode, following an emergency medical admission, powerfully predicts the outcome.

  3. Using health statistics: a Nightingale legacy.

    Science.gov (United States)

    Schloman, B F

    2001-01-01

    No more forceful example of the value of using health statistics to understand and improve health conditions exists than displayed by Florence Nightingale. The recent book by Dossey (1999), Florence Nightingale: Mystic, Visionary, Healer, relates the dramatic tale of Nightingale s use of statistics to understand the causes of deaths in the Crimean War and of her advocacy to standardize the collection of medical data within the army and in civilian hospitals. For her, the use of health statistics was a major tool to improve health and influence public opinion.

  4. Episodic and semantic memory in children with mesial temporal sclerosis.

    Science.gov (United States)

    Rzezak, Patricia; Guimarães, Catarina; Fuentes, Daniel; Guerreiro, Marilisa M; Valente, Kette Dualibi Ramos

    2011-07-01

    The aim of this study was to analyze semantic and episodic memory deficits in children with mesial temporal sclerosis (MTS) and their correlation with clinical epilepsy variables. For this purpose, 19 consecutive children and adolescents with MTS (8 to 16 years old) were evaluated and their performance on five episodic memory tests (short- and long-term memory and learning) and four semantic memory tests was compared with that of 28 healthy volunteers. Patients performed worse on tests of immediate and delayed verbal episodic memory, visual episodic memory, verbal and visual learning, mental scanning for semantic clues, object naming, word definition, and repetition of sentences. Clinical variables such as early age at seizure onset, severity of epilepsy, and polytherapy impaired distinct types of memory. These data confirm that children with MTS have episodic memory deficits and add new information on semantic memory. The data also demonstrate that clinical variables contribute differently to episodic and semantic memory performance. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Epidemiological Study of Hospital-Acquired Bacterial Conjunctivitis in a Level III Neonatal Unit

    Directory of Open Access Journals (Sweden)

    Catarina Dias

    2013-01-01

    Full Text Available Background. Conjunctivitis is one of the most frequently occurring hospital-acquired infections among neonates, although it is less studied than potentially life-threatening infections, such as sepsis and pneumonia. Objectives. The aims of our work were to identify epidemiologic characteristics, pathogens, and susceptibility patterns of bacterial hospital-acquired conjunctivitis (HAC in a level III neonatal unit. Materials and Methods. Data were collected retrospectively from patient charts and laboratory databases. Hospital-acquired conjunctivitis was defined in accordance with the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN diagnostic criteria. Results. One or more episodes of HAC were diagnosed in 4,0% ( of 1492 neonates admitted during the study period. Most of the episodes involved premature (75,4% and low birth weight (75,4% neonates. Infection rates were higher among patients undergoing noninvasive mechanical ventilation (46,7%, parenteral nutrition (13,6%, and phototherapy (6,8%. Predominant pathogens included Serratia marcescens (27,9%, Escherichia coli (23%, and Pseudomonas aeruginosa (18%. Susceptibility patterns revealed bacterial resistances to several antibiotic classes. Gentamicin remains the adequate choice for empirical treatment of HAC in our NICU. Conclusion. It is important to know the local patterns of the disease in order to adjust prevention strategies. Our work contributes to the epidemiological characterization of a sometimes overlooked disease.

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

    Science.gov (United States)

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

    2017-10-01

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

  7. Asthma exacerbations: risk factors for hospital readmissions.

    Science.gov (United States)

    Gonzalez-Barcala, F-J; Calvo-Alvarez, U; Garcia-Sanz, M-T; Garcia-Couceiro, N; Martin-Lancharro, P; Pose, A; Carreira, J-M; Moure-Gonzalez, J-D; Valdes-Cuadrado, L; Muñoz, X

    2018-02-01

    The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase. We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge. This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment. About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation.

  8. [MELAS: Mitochondrial Encephalomyopathy, Lactic Acidosis and Stroke-Like Episodes].

    Science.gov (United States)

    Murakami, Hidetomo; Ono, Kenjiro

    2017-02-01

    Mitochondrial disease is caused by a deficiency in the energy supply to cells due to mitochondrial dysfunction. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) is a mitochondrial disease that presents with stroke-like episodes such as acute onset of neurological deficits and characteristic imaging findings. Stroke-like episodes in MELAS have the following features: 1) neurological deficits due to localization of lesions in the brain, 2) episodes often accompany epilepsy, 3) lesions do not follow the vascular supply area, 4) lesions are more often seen in the posterior brain than in the anterior brain, 5) lesions spread to an adjacent area in the brain, and 6) neurological symptoms often disappear together with imaging findings, but later relapse. About 80% of patients with MELAS have an A-to-G transition mutation at the nucleotide pair 3243 in the dihydrouridine loop of mitochondrial tRNALeu(UUR), which causes the absence of posttranscriptional taurine modification at the wobble nucleotide of mitochondrial tRNALeu(UUR) and disrupts protein synthesis. However, the precise pathophysiology of stroke-like episodes is under investigation, with possible hypotheses for these episodes including mitochondrial angiopathy, mitochondrial cytopathy, and neuron-astrocyte uncoupling. With regard to treatment, L-arginine and taurine have recently been suggested for relief of clinical symptoms.

  9. Autobiographical thinking interferes with episodic memory consolidation.

    Directory of Open Access Journals (Sweden)

    Michael Craig

    Full Text Available New episodic memories are retained better if learning is followed by a few minutes of wakeful rest than by the encoding of novel external information. Novel encoding is said to interfere with the consolidation of recently acquired episodic memories. Here we report four experiments in which we examined whether autobiographical thinking, i.e. an 'internal' memory activity, also interferes with episodic memory consolidation. Participants were presented with three wordlists consisting of common nouns; one list was followed by wakeful rest, one by novel picture encoding and one by autobiographical retrieval/future imagination, cued by concrete sounds. Both novel encoding and autobiographical retrieval/future imagination lowered wordlist retention significantly. Follow-up experiments demonstrated that the interference by our cued autobiographical retrieval/future imagination delay condition could not be accounted for by the sound cues alone or by executive retrieval processes. Moreover, our results demonstrated evidence of a temporal gradient of interference across experiments. Thus, we propose that rich autobiographical retrieval/future imagination hampers the consolidation of recently acquired episodic memories and that such interference is particularly likely in the presence of external concrete cues.

  10. The effect of episodic retrieval on inhibition in task switching.

    Science.gov (United States)

    Grange, James A; Kowalczyk, Agnieszka W; O'Loughlin, Rory

    2017-08-01

    Inhibition in task switching is inferred from n-2 repetition costs: the observation that ABA task switching sequences are responded to slower than CBA sequences. This is thought to reflect the persisting inhibition of Task A, which slows reactivation attempts. Mayr (2002) reported an experiment testing a critical noninhibitory account of this effect, namely episodic retrieval: If the trial parameters for Task A match across an ABA sequence, responses should be facilitated because of priming from episodic retrieval; a cost would occur if trial parameters mismatch. In a rule-switching paradigm, Mayr reported no significant difference in n-2 repetition cost when the trial parameters repeated or switched across an ABA sequence, in clear contrast to the episodic retrieval account. What remains unclear is whether successful episodic retrieval modulates the n-2 repetition cost. Across 3 experiments-including a close replication of Mayr-we find clear evidence of reduced n-2 task repetition costs when episodic retrieval is controlled. We find that the effect of episodic retrieval on the n-2 task repetition cost is increased when the cue-task relationship is made more abstract, suggesting the effect is because of interference in establishing the relevant attentional set. We also demonstrate that the episodic retrieval effect is not influenced by retrieval of low-level, perceptual, elements. Together, the data suggest the n-2 task repetition cost-typically attributable to an inhibitory mechanism-also reflects episodic retrieval effects. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  11. Neural changes underlying the development of episodic memory during middle childhood.

    Science.gov (United States)

    Ghetti, Simona; Bunge, Silvia A

    2012-10-01

    Episodic memory is central to the human experience. In typically developing children, episodic memory improves rapidly during middle childhood. While the developmental cognitive neuroscience of episodic memory remains largely uncharted, recent research has begun to provide important insights. It has long been assumed that hippocampus-dependent binding mechanisms are in place by early childhood, and that improvements in episodic memory observed during middle childhood result from the protracted development of the prefrontal cortex. We revisit the notion that binding mechanisms are age-invariant, and propose that changes in the hippocampus and its projections to cortical regions also contribute to the development of episodic memory. We further review the role of developmental changes in lateral prefrontal and parietal cortices in this development. Finally, we discuss changes in white matter tracts connecting brain regions that are critical for episodic memory. Overall, we argue that changes in episodic memory emerge from the concerted effort of a network of relevant brain structures. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Neural Changes Underlying the Development of Episodic Memory During Middle Childhood

    Science.gov (United States)

    Ghetti, Simona; Bunge, Silvia A.

    2012-01-01

    Episodic memory is central to the human experience. In typically developing children, episodic memory improves rapidly during middle childhood. While the developmental cognitive neuroscience of episodic memory remains largely uncharted, recent research has begun to provide important insights. It has long been assumed that hippocampus-dependent binding mechanisms are in place by early childhood, and that improvements in episodic memory observed during middle childhood result from the protracted development of the prefrontal cortex. We revisit the notion that binding mechanisms are age-invariant, and propose that changes in the hippocampus and its projections to cortical regions also contribute to the development of episodic memory. We further review the role of developmental changes in lateral prefrontal and parietal cortices in this development. Finally, we discuss changes in white matter tracts connecting brain regions that are critical for episodic memory. Overall, we argue that changes in episodic memory emerge from the concerted effort of a network of relevant brain structures. PMID:22770728

  13. [Direct hospitalization costs associated with chronic Hepatitis C in the Valencian Community in 2013].

    Science.gov (United States)

    Barrachina Martínez, Isabel; Giner Durán, Remedios; Vivas-Consuelo, David; López Rodado, Antonio; Maldonado Segura, José Alberto

    2018-04-23

    Hospital costs associated with Chronic Hepatitis C (HCC) arise in the final stages of the disease. Its quantification is very helpful in order to estimate and check the burden of the disease and to make financial decisions for new antivirals. The highest costs are due to the decompensation of cirrosis. Cross-sectional observational study of hospital costs of HCC diagnoses in the Valencian Community in 2013 (n= 4,486 hospital discharges). Information source: Minimum basic set of data/ Basic Minimum Data Set. The costs were considered according to the rates established for the DRG (Diagnosis related group) associated with the episodes with diagnosis of hepatitis C. The average survival of patients since the onset of the decom- pensation of their cirrhosis was estimated by a Markov model, according to the probabilities of evolution of the disease existing in Literatura. There were 4,486 hospital episodes, 1,108 due to complications of HCC, which generated 6,713 stays, readmission rate of 28.2% and mortality of 10.2%. The hospital cost amounted to 8,788,593EUR: 3,306,333EUR corresponded to Cirrhosis (5,273EUR/patient); 1,060,521EUR to Carcinoma (6,350EUR/ patient) and 2,962,873EUR to transplantation (70,544EUR/paciente. Comorbidity was 1,458,866EUR. These costs are maintai- ned for an average of 4 years once the cirrhosis decompensation begins. Cirrhosis due to HCC generates a very high hospitalization's costs. The methodology used in the estimation of these costs from the DRG can be very useful to evaluate the trend and economic impact of this disease.

  14. Episodic memory impairment in systemic lupus erythematosus: involvement of thalamic structures.

    Science.gov (United States)

    Zimmermann, Nicolle; Corrêa, Diogo Goulart; Netto, Tania Maria; Kubo, Tadeu; Pereira, Denis Batista; Fonseca, Rochele Paz; Gasparetto, Emerson Leandro

    2015-02-01

    Episodic memory deficits in systemic lupus erythematosus (SLE) have been frequently reported in the literature; however, little is known about the neural correlates of these deficits. We investigated differences in the volumes of different brain structures of SLE patients with and without episodic memory impairments diagnosed by the Rey Auditory Verbal Learning Test (RAVLT). Groups were paired based on age, education, sex, Mini Mental State Examination score, accumulation of disease burden (SLICC), and focused attention dimension score. Patients underwent magnetic resonance imaging (MRI). Cortical volumetric reconstruction and segmentation of the MR images were performed with the FreeSurfer software program. SLE patients with episodic memory deficits presented shorter time of diagnosis than SLE patients without episodic memory deficits. ANOVA revealed that SLE patients with episodic memory deficits had a larger third ventricle volume than SLE patients without episodic memory deficits and controls. Additionally, covariance analysis indicated group effects on the bilateral thalamus and on the third ventricle. Our findings indicate that episodic memory may be impaired in SLE patients with normal hippocampal volume. In addition, the thalamus may undergo volumetric changes associated with episodic memory loss in SLE.

  15. Obesity and episodic memory function.

    Science.gov (United States)

    Loprinzi, Paul D; Frith, Emily

    2018-04-17

    Obesity-related lifestyle factors, such as physical activity behavior and dietary intake, have been shown to be associated with episodic memory function. From animal work, there is considerable biological plausibility linking obesity with worse memory function. There are no published systematic reviews evaluating the effects of obesity on episodic memory function among humans, and examining whether physical activity and diet influences this obesity-memory link. Thus, the purpose of this systematic review was to evaluate the totality of research examining whether obesity is associated with episodic memory function, and whether physical activity and dietary behavior confounds this relationship. A review approach was employed, using PubMed, PsychInfo, and Sports Discus databases. Fourteen studies met our criteria. Among these 14 reviewed studies, eight were cross-sectional, four were prospective, and two employed a randomized controlled experimental design. Twelve of the 14 studies did not take into consideration dietary behavior in their analysis, and similarly, nine of the 14 studies did not take into consideration participant physical activity behavior. Among the 14 studies, ten found an inverse association of weight status on memory function, but for one of these studies, this association was attenuated after controlling for physical activity. Among the 14 evaluated studies, four did not find a direct effect of weight status on memory. Among the four null studies, one, however, found an indirect effect of BMI on episodic memory and another found a moderation effect of BMI and age on memory function. It appears that obesity may be associated with worse memory function, with the underlying mechanisms discussed herein. At this point, it is uncertain whether adiposity, itself, is influencing memory changes, or rather, whether adiposity-related lifestyle behaviors (e.g., physical inactivity and diet) are driving the obesity-memory relationship.

  16. Neural Mechanisms of Episodic Retrieval Support Divergent Creative Thinking.

    Science.gov (United States)

    Madore, Kevin P; Thakral, Preston P; Beaty, Roger E; Addis, Donna Rose; Schacter, Daniel L

    2017-11-17

    Prior research has indicated that brain regions and networks that support semantic memory, top-down and bottom-up attention, and cognitive control are all involved in divergent creative thinking. Kernels of evidence suggest that neural processes supporting episodic memory-the retrieval of particular elements of prior experiences-may also be involved in divergent thinking, but such processes have typically been characterized as not very relevant for, or even a hindrance to, creative output. In the present study, we combine functional magnetic resonance imaging with an experimental manipulation to test formally, for the first time, episodic memory's involvement in divergent thinking. Following a manipulation that facilitates detailed episodic retrieval, we observed greater neural activity in the hippocampus and stronger connectivity between a core brain network linked to episodic processing and a frontoparietal brain network linked to cognitive control during divergent thinking relative to an object association control task that requires little divergent thinking. Stronger coupling following the retrieval manipulation extended to a subsequent resting-state scan. Neural effects of the episodic manipulation were consistent with behavioral effects of enhanced idea production on divergent thinking but not object association. The results indicate that conceptual frameworks should accommodate the idea that episodic retrieval can function as a component process of creative idea generation, and highlight how the brain flexibly utilizes the retrieval of episodic details for tasks beyond simple remembering. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  17. Cortical Thickness and Episodic Memory Impairment in Systemic Lupus Erythematosus.

    Science.gov (United States)

    Bizzo, Bernardo Canedo; Sanchez, Tiago Arruda; Tukamoto, Gustavo; Zimmermann, Nicolle; Netto, Tania Maria; Gasparetto, Emerson Leandro

    2017-01-01

    The purpose of this study was to investigate differences in brain cortical thickness of systemic lupus erythematosus (SLE) patients with and without episodic memory impairment and healthy controls. We studied 51 patients divided in 2 groups (SLE with episodic memory deficit, n = 17; SLE without episodic memory deficit, n = 34) by the Rey Auditory Verbal Learning Test and 34 healthy controls. Groups were paired based on sex, age, education, Mini-Mental State Examination score, and accumulation of disease burden. Cortical thickness from magnetic resonance imaging scans was determined using the FreeSurfer software package. SLE patients with episodic memory deficits presented reduced cortical thickness in the left supramarginal cortex and superior temporal gyrus when compared to the control group and in the right superior frontal, caudal, and rostral middle frontal and precentral gyri when compared to the SLE group without episodic memory impairment considering time since diagnosis of SLE as covaried. There were no significant differences in the cortical thickness between the SLE without episodic memory and control groups. Different memory-related cortical regions thinning were found in the episodic memory deficit group when individually compared to the groups of patients without memory impairment and healthy controls. Copyright © 2016 by the American Society of Neuroimaging.

  18. Multiparametric statistical investigation of seismicity occurred at El Hierro (Canary Islands) from 2011 to 2014

    Science.gov (United States)

    Telesca, Luciano; Lovallo, Michele; Lopez, Carmen; Marti Molist, Joan

    2016-03-01

    A detailed statistical investigation of the seismicity occurred at El Hierro volcano (Canary Islands) from 2011 to 2014 has been performed by analysing the time variation of four parameters: the Gutenberg-Richter b-value, the local coefficient of variation, the scaling exponent of the magnitude distribution and the main periodicity of the earthquake sequence calculated by using the Schuster's test. These four parameters are good descriptors of the time and magnitude distributions of the seismic sequence, and their variation indicate dynamical changes in the volcanic system. These variations can be attributed to the causes and types of seismicity, thus allowing to distinguish between different host-rock fracturing processes caused by intrusions of magma at different depths and overpressures. The statistical patterns observed among the studied unrest episodes and between them and the eruptive episode of 2011-2012 indicate that the response of the host rock to the deformation imposed by magma intrusion did not differ significantly from one episode to the other, thus suggesting that no significant local stress changes induced by magma intrusion occurred when comparing between all them. Therefore, despite the studied unrest episodes were caused by intrusions of magma at different depths and locations below El Hierro island, the mechanical response of the lithosphere was similar in all cases. This suggests that the reason why the first unrest culminated in an eruption while the other did not, may be related to the role of the regional/local tectonics acting at that moment, rather than to the forceful of magma intrusion.

  19. Two-Year Diagnostic Stability in Early-Onset First-Episode Psychosis

    Science.gov (United States)

    Castro-Fornieles, Josefina; Baeza, Immaculada; de la Serna, Elena; Gonzalez-Pinto, Ana; Parellada, Mara; Graell, Montserrat; Moreno, Dolores; Otero, Soraya; Arango, Celso

    2011-01-01

    Background: Only one study has used a prospective method to analyze the diagnostic stability of first psychotic episodes in children and adolescents. The Child and Adolescent First-Episode Psychosis Study (CAFEPS) is a 2-year, prospective longitudinal study of early-onset first episodes of psychosis (EO-FEP). Aim: To describe diagnostic stability…

  20. Hospital services and casemix in Western Australia.

    Science.gov (United States)

    Hendrie, Delia; Boldy, Duncan

    2002-01-01

    The Health Department of WA currently operates as a single integrated funder and purchaser of health services for the State. Health Service Agreements defining the level of health provision are negotiated with the various health services in WA. During the latter part of the 1990s, the funding of public hospitals for acute inpatient care moved away from a historical basis to output-based funding using a casemix approach based on Diagnosis Related Groups (DRGs). Other hospital services are still mainly purchased using historical funding levels, negotiated block funding or bedday payments, with output-based funding mechanisms under investigation. WA has developed its own approach to classifying admitted patients that recognises differences in complexity of care among episodes grouped to the same DRG. WA also has a unique cost estimation model for calculating DRG cost weights, which is based on a linear estimate of the relationship between nights of stay in hospital and the cost of hospital care for each DRG. Another emerging trend in the provision of public hospital services in WA has been the greater involvement of the private sector through the contracting of private providers to operate public hospitals. While no close examination has been undertaken of the outcomes of these changes in terms of their effect on efficiency or other relevant indicators of hospital performance, current purchasing arrangements are being reviewed following recommendations made in a report by the Health Administrative Review Committee. No decision has yet been made as to future changes to the funding policy of WA public hospitals.

  1. Vection Modulates Emotional Valence of Autobiographical Episodic Memories

    Science.gov (United States)

    Seno, Takeharu; Kawabe, Takahiro; Ito, Hiroyuki; Sunaga, Shoji

    2013-01-01

    We examined whether illusory self-motion perception ("vection") induced by viewing upward and downward grating motion stimuli can alter the emotional valence of recollected autobiographical episodic memories. We found that participants recollected positive episodes more often while perceiving upward vection. However, when we tested a small moving…

  2. Episodic memory for human-like agents and human-like agents for episodic memory

    Czech Academy of Sciences Publication Activity Database

    Brom, C.; Lukavský, Jiří; Kadlec, R.

    2010-01-01

    Roč. 2, č. 2 (2010), s. 227-244 ISSN 1793-8473 Institutional research plan: CEZ:AV0Z70250504 Keywords : episodic memory * virtual agent * modelling Subject RIV: AN - Psychology http://www.worldscinet.com/ijmc/02/0202/S1793843010000461.html

  3. Microbiology of Peritonitis in Peritoneal Dialysis Patients with Multiple Episodes

    Science.gov (United States)

    Nessim, Sharon J.; Nisenbaum, Rosane; Bargman, Joanne M.; Jassal, Sarbjit V.

    2012-01-01

    ♦ Background: Peritoneal dialysis (PD)–associated peritonitis clusters within patients. Patient factors contribute to peritonitis risk, but there is also entrapment of organisms within the biofilm that forms on PD catheters. It is hypothesized that this biofilm may prevent complete eradication of organisms, predisposing to multiple infections with the same organism. ♦ Methods: Using data collected in the Canadian multicenter Baxter POET (Peritonitis, Organism, Exit sites, Tunnel infections) database from 1996 to 2005, we studied incident PD patients with 2 or more peritonitis episodes. We determined the proportion of patients with 2 or more episodes caused by the same organism. In addition, using a multivariate logistic regression model, we tested whether prior peritonitis with a given organism predicted the occurrence of a subsequent episode with the same organism. ♦ Results: During their time on PD, 558 patients experienced 2 or more peritonitis episodes. Of those 558 patients, 181 (32%) had at least 2 episodes with the same organism. The organism most commonly causing repeat infection was coagulase-negative Staphylococcus (CNS), accounting for 65.7% of cases. Compared with peritonitis caused by other organisms, a first CNS peritonitis episode was associated with an increased risk of subsequent CNS peritonitis within 1 year (odds ratio: 2.1; 95% confidence interval: 1.5 to 2.8; p peritonitis, 48% of repeat episodes occurred within 6 months of the earlier episode. ♦ Conclusions: In contrast to previous data, we did not find a high proportion of patients with multiple peritonitis episodes caused by the same organism. Coagulase-negative Staphylococcus was the organism most likely to cause peritonitis more than once in a given patient, and a prior CNS peritonitis was associated with an increased risk of CNS peritonitis within the subsequent year. PMID:22215659

  4. [Concordance between hospital prescriptions and recommendations in the treatment of mania].

    Science.gov (United States)

    Laforgue, Edouard-Jules; Bulteau, Samuel; Cholet, Jennyfer; Victorri-Vigneau, Caroline; Guitteny, Marie; Mauduit, Nicolas; Vanelle, Jean-Marie; Sauvaget, Anne

    2017-06-01

    There are differences between recommendations and practice in the pharmacological treatment of acute mania. The objective was to assess conformity of the anti-manic prescription between national recommendations (Haute Autorité de santé [French health authority, HAS] and "résumé des caractéristiques du produit" [product characteristics, RCP]) and clinical practice. We observed the drug prescriptions of in-patients for a manic episode. The main outcome measure was the concordance rate with the recommendations of the drugs prescriptions at the 48th hour. The secondary outcome repeated the same process with the hospital discharge statement of switches, associations, the presence of symptomatic and antidepressant treatments. Sixty-six episodes were included, 40 patients (60%) had a prescription complies with RCP recommendations H48 and 46 patients (70%) to HAS. These rates fall at hospital discharge. Off-label prescriptions, drug combinations and choices of not listed molecules are the most common reasons for non-conformity. Copyright © 2016 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  5. Episodic and Semantic Aspects of Memory for Prose.

    Science.gov (United States)

    Dooling, D. James

    This report describes research on Bartlett's theory of constructive memory. In experiment one, schematic retention is related to Tulving's distinction between episodic and semantic memory. With the passage of time, memory for prose reflects decreasing output from episodic memory and increasing output from semantic memory. In experiment two,…

  6. Episode forecasting in bipolar disorder: Is energy better than mood?

    Science.gov (United States)

    Ortiz, Abigail; Bradler, Kamil; Hintze, Arend

    2018-01-22

    Bipolar disorder is a severe mood disorder characterized by alternating episodes of mania and depression. Several interventions have been developed to decrease high admission rates and high suicides rates associated with the illness, including psychoeducation and early episode detection, with mixed results. More recently, machine learning approaches have been used to aid clinical diagnosis or to detect a particular clinical state; however, contradictory results arise from confusion around which of the several automatically generated data are the most contributory and useful to detect a particular clinical state. Our aim for this study was to apply machine learning techniques and nonlinear analyses to a physiological time series dataset in order to find the best predictor for forecasting episodes in mood disorders. We employed three different techniques: entropy calculations and two different machine learning approaches (genetic programming and Markov Brains as classifiers) to determine whether mood, energy or sleep was the best predictor to forecast a mood episode in a physiological time series. Evening energy was the best predictor for both manic and depressive episodes in each of the three aforementioned techniques. This suggests that energy might be a better predictor than mood for forecasting mood episodes in bipolar disorder and that these particular machine learning approaches are valuable tools to be used clinically. Energy should be considered as an important factor for episode prediction. Machine learning approaches provide better tools to forecast episodes and to increase our understanding of the processes that underlie mood regulation. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Antipsychotic medication for early episode schizophrenia

    Science.gov (United States)

    Bola, John; Kao, Dennis; Soydan, Haluk; Adams, Clive E

    2014-01-01

    Background Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment. Objectives To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders. Search methods We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data. Selection criteria Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment. Data collection and analysis Working independently, we critically appraised records from 681 studies, of which five studies met inclusion criteria. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. Main results Five studies (combined total n=998) met inclusion criteria. Four studies (n=724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs n=353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT n=240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT n=236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT n=94, RR 0.96 CI 0.3 to 3.6). Two studies contributed data to assessment of adverse effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications

  8. Optional thinking ability among hospital-treated deliberate self-harm patients: a 1-year follow-up study.

    Science.gov (United States)

    McAuliffe, Carmel; Corcoran, Paul; Hickey, Portia; McLeavey, Breda C

    2008-03-01

    To investigate the association between optional thinking (the ability to generate alternative solutions to interpersonal problems) in deliberate self-harm (DSH) patients and repeated self-harm. A prospective study of the association between optional thinking in interpersonal problem solving and repeated DSH within 12 months. A non-consecutive sample (N=152) of DSH patients presenting to the Accident and Emergency department of an acute hospital in Cork city, Ireland, was assessed using a structured interview schedule including the Suicide Intent Scale, the Hopelessness Scale, and the Optional Thinking Test. Repetition within 1 year was established by checking Accident and Emergency records at all three city hospitals. Participants were categorized as repeaters if they engaged in at least one further hospital-treated DSH episode, or non-repeaters. Approximately two-thirds (63.1%) of the sample had engaged in at least one act of DSH prior to their index episode. During follow-up 31 individuals (20.4%) repeated. History of self-harm was significantly associated with prospective repetition when considered alongside all the other predictor variables. Among first evers, low scores on the optional thinking test were significantly associated with the increased risk of repetition within 12 months. Among those with previous DSH, there was no evidence of an association between optional thinking and repetition within 12 months. Poor optional thinking is associated with increased risk of repeated deliberate self-harm in those who present with a first self-harm episode. Interventions to improve optional thinking skills, delivered soon after a first DSH presentation, may be useful in preventing repetition.

  9. Phenomenology of future-oriented mind-wandering episodes

    OpenAIRE

    David eStawarczyk; Helena eCassol; Arnaud eD'Argembeau

    2013-01-01

    Recent research suggests that prospective and non-prospective forms of mind-wandering possess distinct properties, yet little is known about what exactly differentiates between future-oriented and non-future-oriented mind-wandering episodes. In the present study, we used multilevel exploratory factor analyses to examine the factorial structure of various phenomenological dimensions of mind-wandering, and we then investigated whether future-oriented mind-wandering episodes differ from other cl...

  10. Alcohol Storylines in Television Episodes: The Preventive Effect of Countering Epilogues.

    Science.gov (United States)

    Russell, Cristel Antonia; Russell, Dale Wesley; Grube, Joel W; McQuarrie, Edward

    2017-08-01

    This experimental study assessed whether alcohol television storylines impact youth drinking attitudes and intentions and whether corrective epilogues can potentially moderate this impact. Television episodes were professionally produced to depict heavy drinking leading to either positive or negative consequences. The pro- and anti-alcohol episodes were shown alone or with an epilogue where a main character discussed the deleterious effects of excessive drinking. Attitudes toward drinkers and drinking intentions were measured subsequently, along with reactions to the episode and demographic data, among participants aged 14-17 using an online study. Exposure to the pro-alcohol episode was related to more positive attitudes toward drinkers. Including an epilogue after a pro-alcohol episode was related to more negative viewers' attitudes toward drinkers and lower drinking intentions compared to a pro-alcohol episode with no epilogue. By contrast, including an epilogue after an anti-alcohol episode was unrelated to attitudes toward drinkers or drinking intentions. Viewing a single television episode with a pro-alcohol message may lead to more positive attitudes toward drinkers. The finding that a brief epilogue may reduce the impact of the pro-alcohol storyline suggests easily implemented preventive strategies to counter the adverse impact of substance use portrayals in entertainment programming.

  11. Determinants of Hospital Pharmacists’ Job Satisfaction in Romanian Hospitals

    Directory of Open Access Journals (Sweden)

    Magdalena Iorga

    2017-12-01

    Full Text Available Aim: The purpose of this study is to identify the level of job satisfaction among hospital pharmacists in Romania in relation to environmental, socio-demographic, and individual factors. Material and Methods: Seventy-eight hospital pharmacists were included in the research. The Job Satisfaction Scale was used to measure the level of satisfaction with their current jobs, and the TAS-20 was used to evaluate emotional experience and awareness. Additionally, 12 items were formulated in order to identify the reasons for dissatisfaction with jobs, such as budget, number of working hours, legislation, relationships with colleagues, hospital departments, or stakeholders. Data were analyzed using IBM SPSS Statistics version 23. Results: The analyses of the data revealed a low level of satisfaction regarding the pay–promotion subscale, a high level of satisfaction with the management–interpersonal relationship dimension, and a high level of satisfaction regarding the organization–communication subscale. Seventy-four percent of subjects are dissatisfied about the annual budget, and 86.3% are not at all satisfied with present legislation. Conclusions: These results are important for hospital pharmacists and hospital management in order to focus on health policies, management, and environmental issues, with the purpose of increasing the level of satisfaction among hospital pharmacists.

  12. Determinants of Hospital Pharmacists' Job Satisfaction in Romanian Hospitals.

    Science.gov (United States)

    Iorga, Magdalena; Dondaș, Corina; Soponaru, Camelia; Antofie, Ioan

    2017-12-11

    Aim : The purpose of this study is to identify the level of job satisfaction among hospital pharmacists in Romania in relation to environmental, socio-demographic, and individual factors. Material and Methods : Seventy-eight hospital pharmacists were included in the research. The Job Satisfaction Scale was used to measure the level of satisfaction with their current jobs, and the TAS-20 was used to evaluate emotional experience and awareness. Additionally, 12 items were formulated in order to identify the reasons for dissatisfaction with jobs, such as budget, number of working hours, legislation, relationships with colleagues, hospital departments, or stakeholders. Data were analyzed using IBM SPSS Statistics version 23. Results : The analyses of the data revealed a low level of satisfaction regarding the pay-promotion subscale, a high level of satisfaction with the management-interpersonal relationship dimension, and a high level of satisfaction regarding the organization-communication subscale. Seventy-four percent of subjects are dissatisfied about the annual budget, and 86.3% are not at all satisfied with present legislation. Conclusions : These results are important for hospital pharmacists and hospital management in order to focus on health policies, management, and environmental issues, with the purpose of increasing the level of satisfaction among hospital pharmacists.

  13. Functional brain imaging of episodic memory decline in ageing.

    Science.gov (United States)

    Nyberg, L

    2017-01-01

    The episodic long-term memory system supports remembering of events. It is considered to be the most age-sensitive system, with an average onset of decline around 60 years of age. However, there is marked interindividual variability, such that some individuals show faster than average change and others show no or very little change. This variability may be related to the risk of developing dementia, with elevated risk for individuals with accelerated episodic memory decline. Brain imaging with functional magnetic resonance imaging (MRI) of blood oxygen level-dependent (BOLD) signalling or positron emission tomography (PET) has been used to reveal the brain bases of declining episodic memory in ageing. Several studies have demonstrated a link between age-related episodic memory decline and the hippocampus during active mnemonic processing, which is further supported by studies of hippocampal functional connectivity in the resting state. The hippocampus interacts with anterior and posterior neocortical regions to support episodic memory, and alterations in hippocampus-neocortex connectivity have been shown to contribute to impaired episodic memory. Multimodal MRI studies and more recently hybrid MRI/PET studies allow consideration of various factors that can influence the association between the hippocampal BOLD signal and memory performance. These include neurovascular factors, grey and white matter structural alterations, dopaminergic neurotransmission, amyloid-Β and glucose metabolism. Knowledge about the brain bases of episodic memory decline can guide interventions to strengthen memory in older adults, particularly in those with an elevated risk of developing dementia, with promising results for combinations of cognitive and physical stimulation. © 2016 The Association for the Publication of the Journal of Internal Medicine.

  14. Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study.

    Directory of Open Access Journals (Sweden)

    Joanna Murray

    Full Text Available To examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission.A population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database.71 hospitals across England.We identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first year of life.In our cohort there were 7189 hospital admissions with a diagnosis of bronchiolitis, 24.2 admissions per 1000 infants under 1 year (95%CI 23.7-24.8, of which 15% (1050/7189 were born preterm (47.3 bronchiolitis admissions per 1000 preterm infants (95% CI 44.4-50.2. The peak age group for bronchiolitis admissions was infants aged 1 month and the median was age 120 days (IQR = 61-209 days. The median length of stay was 1 day (IQR = 0-3. The relative risk (RR of a bronchiolitis admission was higher among infants with known risk factors for severe RSV infection, including those born preterm (RR = 1.9, 95% CI 1.8-2.0 compared with infants born at term. Other conditions also significantly increased risk of bronchiolitis admission, including Down's syndrome (RR = 2.5, 95% CI 1.7-3.7 and cerebral palsy (RR = 2.4, 95% CI 1.5-4.0.Most (85% of the infants who are admitted to hospital with bronchiolitis in England are born at term, with no known predisposing risk factors for severe RSV infection, although risk of admission is higher in known risk groups. The early age of bronchiolitis admissions has important implications for the potential impact and timing of future active and passive immunisations. More research is needed to explain why babies born with Down's syndrome and cerebral palsy are also at higher risk of hospital admission with RSV bronchiolitis.

  15. Imaging episodic memory: implications for cognitive theories and phenomena.

    Science.gov (United States)

    Nyberg, L

    1999-01-01

    Functional neuroimaging studies are beginning to identify neuroanatomical correlates of various cognitive functions. This paper presents results relevant to several theories and phenomena of episodic memory, including component processes of episodic retrieval, encoding specificity, inhibition, item versus source memory, encoding-retrieval overlap, and the picture-superiority effect. Overall, by revealing specific activation patterns, the results provide support for existing theoretical views and they add some unique information which may be important to consider in future attempts to develop cognitive theories of episodic memory.

  16. Medial temporal lobe damage causes deficits in episodic memory and episodic future thinking not attributable to deficits in narrative construction.

    Science.gov (United States)

    Race, Elizabeth; Keane, Margaret M; Verfaellie, Mieke

    2011-07-13

    The medial temporal lobe (MTL) makes critical contributions to episodic memory, but its contributions to episodic future thinking remain a matter of debate. By one view, imagining future events relies on MTL mechanisms that also support memory for past events. Alternatively, it has recently been suggested that future thinking is independent of MTL-mediated processes and can be supported by regions outside the MTL. The current study investigated the nature and necessity of MTL involvement in imagining the future and tested the novel hypothesis that the MTL contributes to future thinking by supporting online binding processes related to narrative construction. Human amnesic patients with well characterized MTL damage and healthy controls constructed narratives about (1) future events, (2) past events, and (3) visually presented pictures. While all three tasks place similar demands on narrative construction, only the past and future conditions require memory/future thinking to mentally generate relevant narrative information. Patients produced impoverished descriptions of both past and future events but were unimpaired at producing detailed picture narratives. In addition, future-thinking performance positively correlated with episodic memory performance but did not correlate with picture narrative performance. Finally, future-thinking impairments were present when MTL lesions were restricted to the hippocampus and did not depend on the presence of neural damage outside the MTL. These results indicate that the ability to generate and maintain a detailed narrative is preserved in amnesia and suggest that a common MTL mechanism supports both episodic memory and episodic future thinking.

  17. Statistical study on cancer patients of cancer research hospital

    International Nuclear Information System (INIS)

    Shim, Yun Sang; Choi, Soo Yong; Kim, Ki Wha; Kang, Sung Mok

    1993-01-01

    The total number of malignant neoplasms included in this study 15,737 cases(11.8%) among 133,251 cases for 3 years. On sex, females with 52.9% were much more than males with 47.1%. The highest proportion of cancer patients by age was 33.7% in males and 28.5% in females, respectivelty for 50-59 age group. The most frequent primary site among males was found to be stomach with 35.5%, followed by liver(14.7%), lung(13.0%), esophagus(5.4%) and colon (3.2%). In females, the first order was uterine cervix with 40.6%, followed by stomach(17.2%), breast(14.4), rectum(3.7%) and lung(3.4%). The most common type of morphology of malignant neoplasms was adenocarcinoma(47.4%) in males an squamous cell carcinoma(58.0%) in females. Among the cancer patients initially diagnosed in this hospital, the proportion of malignant neoplasms by the exent of disease was 2.5% for patient with carcinoma-in-situ, 54.1% for patients with localized involvement, 13.3% for patients with regional involvement and 8.5% for patients with distant involvement. Among the cancer patients initially treatment in this hospital, the proportion of malignant neoplasms by the method of treatment was 23.6% for surgery, 25.3% for radiotherapy and 30.3% for chemotherapy. Among the cancer patients confirmed by medical records, 7.7% was traced more than 5 years. (Author)

  18. The effects of health information technology adoption and hospital-physician integration on hospital efficiency.

    Science.gov (United States)

    Cho, Na-Eun; Chang, Jongwha; Atems, Bebonchu

    2014-11-01

    To determine the impact of health information technology (HIT) adoption and hospital-physician integration on hospital efficiency. Using 2010 data from the American Hospital Association's (AHA) annual survey, the AHA IT survey, supplemented by the CMS Case Mix Index, and the US Census Bureau's small area income and poverty estimates, we examined how the adoption of HIT and employment of physicians affected hospital efficiency and whether they were substitutes or complements. The sample included 2173 hospitals. We employed a 2-stage approach. In the first stage, data envelopment analysis was used to estimate technical efficiency of hospitals. In the second stage, we used instrumental variable approaches, notably 2-stage least squares and the generalized method of moments, to examine the effects of IT adoption and integration on hospital efficiency. We found that HIT adoption and hospital-physician integration, when considered separately, each have statistically significant positive impacts on hospital efficiency. Also, we found that hospitals that adopted HIT with employed physicians will achieve less efficiency compared with hospitals that adopted HIT without employed physicians. Although HIT adoption and hospital-physician integration both seem to be key parts of improving hospital efficiency when one or the other is utilized individually, they can hurt hospital efficiency when utilized together.

  19. Episodes, events, and models

    Directory of Open Access Journals (Sweden)

    Sangeet eKhemlani

    2015-10-01

    Full Text Available We describe a novel computational theory of how individuals segment perceptual information into representations of events. The theory is inspired by recent findings in the cognitive science and cognitive neuroscience of event segmentation. In line with recent theories, it holds that online event segmentation is automatic, and that event segmentation yields mental simulations of events. But it posits two novel principles as well: first, discrete episodic markers track perceptual and conceptual changes, and can be retrieved to construct event models. Second, the process of retrieving and reconstructing those episodic markers is constrained and prioritized. We describe a computational implementation of the theory, as well as a robotic extension of the theory that demonstrates the processes of online event segmentation and event model construction. The theory is the first unified computational account of event segmentation and temporal inference. We conclude by demonstrating now neuroimaging data can constrain and inspire the construction of process-level theories of human reasoning.

  20. [Bacteremia and sepsis in patients hospitalized at the Dr. Fran Mihaljevíc Clinic for Infectious Diseases in Zagreb 1987-1991].

    Science.gov (United States)

    Skerk, V; Schönwald, S; Bobinac, E; Bejuk, D; Zrinsćak, J

    1995-01-01

    A total number of 836 episodes of bacteremia and fungemia were examined in 823 hospitalized patients in the University Hospital of Infectious Diseases "Dr Fran Mihaljević" Zagreb from the beginning of 1987 to the end of 1991. Twenty-five percent of them were nosocomial bacteremias and 5% were polymicrobial bacteremias. The most frequently isolated causative agents were Salmonella spp. (26%), Escherichia coli (17%), Streptococcus pneumoniae (11%) and Staphylococcus aureus (8%). There were 34% of gram-positive bacteremias. The increased frequency of nosocomial bacteremias caused by coagulase-negative staphylococci was recorded. The frequency of coagulase-negative staphylococci strains resistant to gentamicin and Klebsiella spp. strains resistant to cefotaxime was increased. Shock was present in 19% of episodes. Relation between septic shock occurrence and causative agent of bacteremia was not proved. Mortality in patients with bacteremia was 13%, and total mortality was 20%. The outcome of the disease was in direct relation with causative agent of bacteremia. The initial empiric antimicrobial therapy was prolonged in 91% of episodes of bacteremia after blood culture results were known.

  1. Why do we remember? The communicative function of episodic memory

    Science.gov (United States)

    Mahr, Johannes B.; Csibra, Gergely

    2017-01-01

    Short Abstract We propose a novel account of episodic memory function based on a conceptual and empirical analysis of its role in belief formation. We provide a critique of the view that episodic memory serves future-directed imagination, and argue that the central features of this capacity can instead be explained by the role it plays in human communication. On this view, episodic memory allows us to communicatively support our interpretations of the past by gauging when we can assert epistemic authority. This capacity is ineliminable in justification of, and negotiations about, social commitments established by past interactions. Long Abstract Episodic memory has been analyzed in a number of different ways in both philosophy and psychology, and most controversy has centered on its self-referential, ‘autonoetic’ character. Here, we offer a comprehensive characterization of episodic memory in representational terms, and propose a novel functional account on this basis. We argue that episodic memory should be understood as a distinctive epistemic attitude taken towards an event simulation. On this view, episodic memory has a metarepresentational format and should not be equated with beliefs about the past. Instead, empirical findings suggest that the contents of human episodic memory are often constructed in the service of the explicit justification of such beliefs. Existing accounts of episodic memory function that have focused on explaining its constructive character through its role in ‘future-oriented mental time travel’ neither do justice to its capacity to ground veridical beliefs about the past nor to its representational format. We provide an account of the metarepresentational structure of episodic memory in terms of its role in communicative interaction. The generative nature of recollection allows us to represent and communicate the reasons for why we hold certain beliefs about the past. In this process, autonoesis corresponds to the capacity to

  2. Clinico-statistical study on the patients who were applied preoperative CT imaging for dental implant treatment in Iwate Medical University Hospital

    International Nuclear Information System (INIS)

    Shoji, Satoru; Izumisawa, Mitsuru; Satoh, Hitoshi; Hoshino, Masayuki; Takahashi, Noriaki; Shozushima, Masanori; Nakasato, Tatsuhiko

    2007-01-01

    The diagnosis of jaw bones using X-ray computed tomography (CT) is important to determine placement of dental implants. A Clinico-statistical study were made on 490 cases which applied preoperative dental mutiplannar reconstructing CT (dental MPR) imaging for dental implant treatment in Iwate Medical University Hospital, during a five-year period from 2002 to 2006. The following results were obtained: The 490 cases consisted of 179 males and 311 females. They ranged in age from 16 to 80 years, the average age was 53.6 years old. The largest number of cases were in their 50's and, in most generations, there were more female cases than male. Similar cases have been increasing every year. Most patients were referred from other clinics to our hospital. Of the cases that underwent CT scanning more were mandible than maxilla. Implantation prearranged region revealed a predominance of mandible in anterior teeth, and maxilla in molar teeth. The cases that were using diagnostic surgical stents increased in the first three years, but were constant afterwards. (author)

  3. Characterization of intense aerosol episodes in the Mediterranean basin from satellite observations

    Science.gov (United States)

    Gkikas, Antonis; Hatzianastassiou, Nikos; Mihalopoulos, Nikolaos

    2014-05-01

    The properties and distribution of aerosols over the broader Mediterranean region are complex since particles of different nature are either produced within its boundaries or transported from other regions. Thus, coarse dust aerosols are transported primarily from Sahara and secondarily from Middle East, while fine polluted aerosols are either produced locally from anthropogenic activities or they are transported from neighbouring or remote European areas. Also during summer biomass aerosols are transported towards the Mediterranean, originating from massive and extended fires occurring in northern Balkans and Eastern Europe and favoured by the prevailing synoptic conditions. In addition, sea-salt aerosols originate from the Mediterranean Sea or the Atlantic Ocean. Occasionally, aerosols are encountered at very high concentrations (aerosol episodes or events) significantly affecting atmospheric dynamics and climate as well as human health. Given the coexistence of different aerosols as internal and external mixtures characterizing and discriminating between the different types of aerosol episodes is a big challenge. A characterization and classification of intense aerosol episodes in the Mediterranean basin (March 2000 - February 2007) is attempted in the present study. This is achieved by implementing an objective and dynamic algorithm which uses daily aerosol optical properties derived from satellite measurements, namely MODIS-Terra, Earth Probe (EP)-TOMS and OMI-Aura. The aerosol episodes are first classified into strong and extreme ones, according to their intensity, by means of aerosol optical depth at 550nm (AOD550nm). Subsequently, they are discriminated into the following aerosol types: (i) biomass/urban-industrial (BU), (ii) desert dust (DD), (iii) sea-salt like (SS), (iv) mixed (MX) and (v) undetermined (UN). The classification is based on aerosol optical properties accounting for the particles' size (Ångström exponent, Effective radius), the

  4. White matter structural connectivity and episodic memory in early childhood.

    Science.gov (United States)

    Ngo, Chi T; Alm, Kylie H; Metoki, Athanasia; Hampton, William; Riggins, Tracy; Newcombe, Nora S; Olson, Ingrid R

    2017-12-01

    Episodic memory undergoes dramatic improvement in early childhood; the reason for this is poorly understood. In adults, episodic memory relies on a distributed neural network. Key brain regions that supporting these processes include the hippocampus, portions of the parietal cortex, and portions of prefrontal cortex, each of which shows different developmental profiles. Here we asked whether developmental differences in the axonal pathways connecting these regions may account for the robust gains in episodic memory in young children. Using diffusion weighted imaging, we examined whether white matter connectivity between brain regions implicated in episodic memory differed with age, and were associated with memory performance differences in 4- and 6-year-old children. Results revealed that white matter connecting the hippocampus to the inferior parietal lobule significantly predicted children's performance on episodic memory tasks. In contrast, variation in the white matter connecting the hippocampus to the medial prefrontal cortex did not relate to memory performance. These findings suggest that structural connectivity between the hippocampus and lateral parietal regions is relevant to the development of episodic memory. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Environmental impacts on human health during a Saharan dust episode at Crete Island, Greece

    Energy Technology Data Exchange (ETDEWEB)

    Nastos, P.T. [Univ. of Athens, Athen (Greece). Lab. of Climatology and Atmospheric Environment; Kampanis, N.A. [Foundation for Research and Technology, Hellas (Greece). Inst of Applied and Computational Mathematics; Giaouzaki, K.N. [Univ. of Crete, Iraklion (Greece). Dept. of Cardiology; Matzarakis, A. [Univ. of Freiburg (Germany). Meteorological Inst.

    2011-10-15

    The objective of this study is to examine the synergistic environmental impacts (thermal bioclimatic conditions and air quality due to particulate pollution) with cardiovascular and respiratory syndromes, in Heraklion in the northern part of Crete Island, during a Saharan dust episode on March 22-23, 2008. Daily counts of admissions for cardiovascular and respiratory syndromes were obtained from the two main hospitals in Heraklion. The corresponding daily meteorological parameters, such as maximum and minimum air temperature, relative humidity, wind speed and cloud cover, from the meteorological station of Heraklion (Hellenic National Meteorological Service), were processed in order to estimate and analyze the bioclimatic conditions expressed by the Physiologically Equivalent Temperature (PET), which is based on the energy balance models of the human body. Dust concentrations were derived from the SKIRON forecast model of the University of Athens, while Moderate Resolution Imaging Spectroradiometer (MODIS) products such as aerosol optical depth at 550 nm (AOD550), aerosol small mode fraction (SM), Aangstroem exponent in the 550-865 nm band and mass concentration, were used for the episode. Besides, daily composite anomalies (reference period: 1968-1996) of the air temperature and vector wind from the middle to the lower atmospheric levels (500 hPa - mean sea level) on March 23, 2008, were calculated from the reanalysis datasets of the National Centers for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR). The analysis of MODIS and SKIRON products showed that high AOD{sub 550} values (>0.9) and high dust concentration (>250 {mu}g/m{sup 3}), respectively, appear on March 23, 2008, while the respiratory admissions were five-fold than the mean daily admissions on the same day of the emergence of the Saharan dust episode (key day). According to the analysis, this is due to the existence of coarse-mode particles along the dust pathway, which

  6. Cognitive profiles of three clusters of patients with a first-episode psychosis.

    Science.gov (United States)

    Ochoa, Susana; Huerta-Ramos, Elena; Barajas, Ana; Iniesta, Raquel; Dolz, Montserrat; Baños, Iris; Sánchez, Bernardo; Carlson, Janina; Foix, Alexandrina; Pelaez, Trinidad; Coromina, Marta; Pardo, Marta; Usall, Judith

    2013-10-01

    The primary objective was to identify specific groups of patients with a first-episode psychosis based on family history, obstetric complications, neurological soft signs, and premorbid functioning. The secondary objective was to relate these groups with cognitive variables. A total of 62 first-episode psychoses were recruited from adult and child and adolescent mental health services. The inclusion criteria were patients between 7 and 65 years old (real range of the samples was 13-35 years old), two or more psychotic symptoms and less than one year from the onset of the symptoms. Premorbid functioning (PAS), soft signs (NES), obstetric complications and a neuropsychological battery (CPT, TMTA/TMTB, TAVEC/TAVECI, Stroop, specific subtest of WAIS-III/WISC-IV) were administered. We found three clusters: 1) higher neurodevelopment contribution (N=14), 2) higher genetic contribution (N=30), and 3) lower neurodevelopment contribution (N=18). Statistical differences were found between groups in TMTB, learning curve of the TAVEC, digits of the WAIS and premorbid estimated IQ, the cluster 1 being the most impaired. A cluster approach could differentiate several groups of patients with different cognitive performance. Neuropsychological interventions, as cognitive remediation, should be addressed specifically to patients with more impaired results. © 2013 Elsevier B.V. All rights reserved.

  7. Statistical observation on autopsy cases of malignancy at the Japanese Red Cross, Nagasaki Atomic Bomb Hospital

    Energy Technology Data Exchange (ETDEWEB)

    Takahara, O; Toyoda, S; Tsuno, S; Mukai, H; Uemura, S [Nagasaki Atomic Bomb Hospital (Japan)

    1976-09-01

    Statistical observation was made as to autopsy cases of atomic-bomb survivors in Nagasaki. The total of autopsy cases at the Japanese Red Cross, Nagasaki Atomic Bomb Hospital from the opening of the hospital, 1968, to December in 1975 was 1,486 cases (autopsy rate, 65.1%) in which 880 cases of atomic bomb survivors (autopsy rate, 68.0%) were contained. Cases of malignancy totaled 829 and 528 cases of those were atomic bomb survivors. Cases of malignancy were divided into three groups, that is, group exposured to atomic bomb at place within 2 km from the explosion place, group exposured at place from more than 2 km or entering after explosion into the city, and not-exposured group. Relationship between main malignancies and exposure was discussed, and the following results were obtained. 1) Obvious relationship was found to exist between exposure and acute and chronic medullary leukemia. 2) Malignant lymphoma was scarcely correlated with exposure, but its occurrence rate was higher than the mean rate in Japan in reflection the region where this disease occurs much geographically. 3) Relationship between exposure and stomach cancer, lung cancer, cancer of the large intestine, and double cancer was not found obviously, but occurrence rate of hepatic cancer was higher than the mean rate in Japan in three groups. The reason was supposed to be geographical factor. 4) Cases of thyroid gland cancer were a small number in female of the group exposured within 2 km, and cases of prostate cancer were a small number in the group within 2 km, but their occurrence rate was high specifically.

  8. Statistical observation on autopsy cases of malignancy at the Japanese Red Cross, Nagasaki Atomic Bomb Hospital

    International Nuclear Information System (INIS)

    Takahara, Osamu; Toyoda, Shigeki; Tsuno, Sumio; Mukai, Hideaki; Uemura, Seiji

    1976-01-01

    Statistical observation was made as to autopsy cases of atomic-bomb survivors in Nagasaki. The total of autopsy cases at the Japanese Red Cross, Nagasaki Atomic Bomb Hospital from the opening of the hospital, 1968, to December in 1975 was 1,486 cases (autopsy rate, 65.1%) in which 880 cases of atomic bomb survivors (autopsy rate, 68.0%) were contained. Cases of malignancy totaled 829 and 528 cases of those were atomic bomb survivors. Cases of malignancy were divided into three groups, that is, group exposured to atomic bomb at place within 2 km from the explosion place, group exposured at place from more than 2 km or entering after explosion into the city, and not-exposured group. Relationship between main malignancies and exposure was discussed, and the following results were obtained. 1) Obvious relationship was found to exist between exposure and acute and chronic medullary leukemia. 2) Malignant lymphoma was scarecely correlated with exposure, but its occurrence rate was higher than the mean rate in Japan in reflection the region where this disease occurs much geographically. 3) Relationship between exposure and stomach cancer, lung cancer, cancer of the large intestine, and double cancer was not found obviously, but occurrence rate of hepatic cancer was higher than the mean rate in Japan in three groups. The reason was supposed to be geographical factor. 4) Cases of thyroid gland cancer were a small number in female of the group exposured within 2 km, and cases of prostate cancer were a small number in the group within 2 km, but their occurrence rate was high specifically. (Tsunoda, M.)

  9. The relative effectiveness of managed care penetration and the healthcare safety net in reducing avoidable hospitalizations.

    Science.gov (United States)

    Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia

    2011-01-01

    Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.

  10. Interventions for men and women with their first episode of genital herpes.

    Science.gov (United States)

    Heslop, Rachel; Roberts, Helen; Flower, Deralie; Jordan, Vanessa

    2016-08-30

    ; largely due to lack of information supplied in the publications, and due to the age of the trials. This review found low quality evidence from two studies of oral acyclovir, when compared to placebo, reduced the duration of symptoms in individuals undergoing their first episode of genital herpes (mean difference (MD) -3.22, 95% confidence interval (CI) -5.91 to -0.54; I(2) = 52%). In two studies (112 participants), intravenous acyclovir decreased the median number of days that patients with first-episode herpes suffered symptoms. Oral valaciclovir (converted to acyclovir) also showed a similar length of symptom duration when compared to acyclovir in two studies.There is currently no evidence that topical acyclovir reduces symptoms (MD -0.61 days, 95% CI -2.16 to 0.95; 3 RCTs, 195 participants, I(2) statistic = 56%). There is also no current evidence that the topical treatments of cicloxolone cream, carbenoxolone sodium cream, adenosine arabinoside, idoxuridine in dimethyl sulfoxide, when compared to placebo reduced the duration of symptoms in people undergoing their first episode of herpes.Two studies reported no evidence of a reduction in the number of median days to recurrence following treatment with oral acyclovir versus placebo. Adverse events were generally poorly reported by all of the included studies and we were unable to quantitatively analyse this outcome. For those taking acyclovir, there were no serious adverse events; the most common adverse events reported for oral acyclovir were coryza, dizziness, tiredness, diarrhoea and renal colic. For intravenous acyclovir these were phlebitis, nausea and abnormal liver function tests and for topical acyclovir there was pain with the topical application.Those undergoing interferon treatment had significantly more adverse events compared to those taking placebo. There is low quality evidence from this review that oral acyclovir reduced the duration of symptoms for genital herpes. However, there is low quality evidence

  11. Economic costs of hospitalized diarrheal disease in Bangladesh: a societal perspective.

    Science.gov (United States)

    Sarker, Abdur Razzaque; Sultana, Marufa; Mahumud, Rashidul Alam; Ali, Nausad; Huda, Tanvir M; Salim Uzzaman, M; Haider, Sabbir; Rahman, Hafizur; Islam, Ziaul; Khan, Jahangir A M; Van Der Meer, Robert; Morton, Alec

    2018-01-01

    Diarrheal diseases are a major threat to human health and still represent a leading cause of morbidity and mortality worldwide. Although the burden of the diarrheal diseases is much lower in developed countries, it is a significant public health problem in low and middle-income countries like Bangladesh. Though diarrhea is preventable and managed with low-cost interventions, it is still the leading cause of morbidity according to the patient who sought care from public hospitals in Bangladesh indicating that significant resources are consumed in treating those patients. The aim of the study is to capture the inpatients and outpatient treatment cost of diarrheal disease and to measure the cost burden and coping mechanisms associated with diarrheal illness. This study was conducted in six randomly selected district hospitals from six divisions (larger administrative units) in Bangladesh. The study was performed from the societal perspective which means all types of costs were identified, measured and valued no matter who incurred them. Cost analysis was estimated using the guideline proposed by the World Health Organization for estimating the economic burden of diarrheal diseases. The study adopted quantitative techniques to collect the household and hospital level data including structured and semi-structured questionnaires, observation checklists, analysis of hospital database, telephone interviews and compilation of service statistics. The average total societal cost of illness per episode was BDT 5274.02 (US $ 67.18) whereas the average inpatient and outpatient costs were BDT 8675.09 (US $ 110.51) and BDT 1853.96 (US $ 23.62) respectively. The cost burden was significantly highest for poorest households, 21.45% of household income, compared to 4.21% of the richest quintile. Diarrheal diseases continue to be an overwhelming problem in Bangladesh. The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence

  12. Episodic memory and future thinking during early childhood: Linking the past and future.

    Science.gov (United States)

    Cuevas, Kimberly; Rajan, Vinaya; Morasch, Katherine C; Bell, Martha Ann

    2015-07-01

    Despite extensive examination of episodic memory and future thinking development, little is known about the concurrent emergence of these capacities during early childhood. In Experiment 1, 3-year-olds participated in an episodic memory hiding task ("what, when, where" [WWW] components) with an episodic future thinking component. In Experiment 2, a group of 4-year-olds (including children from Experiment 1) participated in the same task (different objects and locations), providing the first longitudinal investigation of episodic memory and future thinking. Although children exhibited age-related improvements in recall, recognition, and binding of the WWW episodic memory components, there were no age-related changes in episodic future thinking. At both ages, WWW episodic memory performance was higher than future thinking performance, and episodic future thinking and WWW memory components were unrelated. These findings suggest that the WWW components of episodic memory are potentially less fragile than the future components when assessed in a cognitively demanding task. © 2015 Wiley Periodicals, Inc.

  13. Visual perspective in remembering and episodic future thought.

    Science.gov (United States)

    McDermott, Kathleen B; Wooldridge, Cynthia L; Rice, Heather J; Berg, Jeffrey J; Szpunar, Karl K

    2016-01-01

    According to the constructive episodic simulation hypothesis, remembering and episodic future thinking are supported by a common set of constructive processes. In the present study, we directly addressed this assertion in the context of third-person perspectives that arise during remembering and episodic future thought. Specifically, we examined the frequency with which participants remembered past events or imagined future events from third-person perspectives. We also examined the different viewpoints from which third-person perspective events were remembered or imagined. Although future events were somewhat more likely to be imagined from a third-person perspective, the spatial viewpoint distributions of third-person perspectives characterizing remembered and imagined events were highly similar. These results suggest that a similar constructive mechanism may be at work when people remember events from a perspective that could not have been experienced in the past and when they imagine events from a perspective that could not be experienced in the future. The findings are discussed in terms of their consistency with--and as extensions of--the constructive episodic simulation hypothesis.

  14. Memory sources of dreams: the incorporation of autobiographical rather than episodic experiences.

    Science.gov (United States)

    Malinowski, Josie E; Horton, Caroline L

    2014-08-01

    The present study aimed to explore autobiographical memories (long-lasting memories about the self) and episodic memories (memories about discrete episodes or events) within dream content. We adapted earlier episodic memory study paradigms and reinvestigated the incorporation of episodic memory sources into dreams, operationalizing episodic memory as featuring autonoetic consciousness, which is the feeling of truly re-experiencing or reliving a past event. Participants (n = 32) recorded daily diaries and dream diaries, and reported on wake-dream relations for 2 weeks. Using a new scale, dreams were rated for their episodic richness, which categorized memory sources of dreams as being truly episodic (featuring autonoetic consciousness), autobiographical (containing segregated features of experiences that pertained to waking life) or otherwise. Only one dream (0.5%) was found to contain an episodic memory. However, the majority of dreams (>80%) were found to contain low to moderate incorporations of autobiographical memory features. These findings demonstrate the inactivity of intact episodic memories, and emphasize the activity of autobiographical memory and processing within dreams. Taken together, this suggests that memories for personal experiences are experienced fragmentarily and selectively during dreaming, perhaps in order to assimilate these memories into the autobiographical memory schema. © 2014 European Sleep Research Society.

  15. Border Collie Collapse: Owner Survey Results and Veterinary Description of Videotaped Episodes.

    Science.gov (United States)

    Taylor, Susan; Minor, Katie; Shmon, Cindy L; Shelton, G Diane; Patterson, Edward E; Mickelson, James R

    Completed surveys were obtained from owners of 165 border collies experiencing repeated episodes of abnormal gait or collapse during strenuous exercise. Unremarkable veterinary evaluation and lack of disease progression over time made common systemic, cardiac, and neurologic causes of exercise intolerance unlikely. Survey questions addressed signalment, age of onset, description of episodes, and owner perception of factors associated with collapse. Most dogs were young adults (median 2 yr) when episodes began, and they had experienced from 2 to more than 100 episodes (median 6) prior to their owners completing the survey. Retrieving was the activity most commonly associated with episodes (112/165 dogs, 68%), followed by herding stock (39/165 dogs, 24%). Owners reported that high environmental temperatures (111/165 dogs, 67%) and excitement (67/165 dogs, 41%) increased the likelihood of their dog having an episode during strenuous activity. Veterinary evaluation of videotapes of presumed border collie collapse (BCC) episodes (40 dogs) were used to provide a description of the typical features of BCC episodes. Altered mentation, symmetrical ataxia affecting all four limbs, increased pelvic limb extensor tone and toe scuffing or knuckling, truncal swaying, and falling to the side were common features, suggesting that BCC may be an episodic diffuse central nervous system disorder.

  16. Longitudinal association between hippocampus atrophy and episodic-memory decline.

    Science.gov (United States)

    Gorbach, Tetiana; Pudas, Sara; Lundquist, Anders; Orädd, Greger; Josefsson, Maria; Salami, Alireza; de Luna, Xavier; Nyberg, Lars

    2017-03-01

    There is marked variability in both onset and rate of episodic-memory decline in aging. Structural magnetic resonance imaging studies have revealed that the extent of age-related brain changes varies markedly across individuals. Past studies of whether regional atrophy accounts for episodic-memory decline in aging have yielded inconclusive findings. Here we related 15-year changes in episodic memory to 4-year changes in cortical and subcortical gray matter volume and in white-matter connectivity and lesions. In addition, changes in word fluency, fluid IQ (Block Design), and processing speed were estimated and related to structural brain changes. Significant negative change over time was observed for all cognitive and brain measures. A robust brain-cognition change-change association was observed for episodic-memory decline and atrophy in the hippocampus. This association was significant for older (65-80 years) but not middle-aged (55-60 years) participants and not sensitive to the assumption of ignorable attrition. Thus, these longitudinal findings highlight medial-temporal lobe system integrity as particularly crucial for maintaining episodic-memory functioning in older age. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Intake of Wild Blueberry Powder Improves Episodic-Like and Working Memory during Normal Aging in Mice.

    Science.gov (United States)

    Beracochea, Daniel; Krazem, Ali; Henkouss, Nadia; Haccard, Guillaume; Roller, Marc; Fromentin, Emilie

    2016-08-01

    The number of Americans older than 65 years old is projected to more than double in the next 40 years. Cognitive changes associated to aging can affect an adult's day-to-day functioning. Among these cognitive changes, reasoning, episodic memory, working memory, and processing speed decline gradually over time. Early memory changes include a decline in both working and episodic memory. The aim of the present study was to determine whether chronic (up to 75 days) daily administration of wild blueberry extract or a wild blueberry full spectrum powder would help prevent memory failure associated with aging in tasks involving various forms of memory. Both blueberry ingredients were used in a study comparing young mice (6 months old) to aged mice (18 months old). At this age, mice exhibit memory decline due to aging, which is exacerbated first by a loss in working and contextual (episodic-like) memory. Contextual memory (episodic-like memory) was evaluated using the contextual serial discrimination test. Working and spatial memory were evaluated using the Morris-Water maze test and the sequential alternation test. Statistical analysis was performed using an ANOVA with the Bonferroni post-hoc test. Supplementation with wild blueberry full spectrum powder and wild blueberry extract resulted in significant improvement of contextual memory, while untreated aged mice experienced a decline in such memory. Only the wild blueberry full spectrum powder significantly contributed to an improvement of spatial and working memory versus untreated aged mice. These improvements of cognitive performance may be related to brain oxidative status, acetylcholinesterase activity, neuroprotection, or attenuation of immunoreactivity. Georg Thieme Verlag KG Stuttgart · New York.

  18. Why do we remember? The communicative function of episodic memory.

    Science.gov (United States)

    Mahr, Johannes; Csibra, Gergely

    2017-01-19

    Episodic memory has been analyzed in a number of different ways in both philosophy and psychology, and most controversy has centered on its self-referential, 'autonoetic' character. Here, we offer a comprehensive characterization of episodic memory in representational terms, and propose a novel functional account on this basis. We argue that episodic memory should be understood as a distinctive epistemic attitude taken towards an event simulation. On this view, episodic memory has a metarepresentational format and should not be equated with beliefs about the past. Instead, empirical findings suggest that the contents of human episodic memory are often constructed in the service of the explicit justification of such beliefs. Existing accounts of episodic memory function that have focused on explaining its constructive character through its role in 'future-oriented mental time travel' neither do justice to its capacity to ground veridical beliefs about the past nor to its representational format. We provide an account of the metarepresentational structure of episodic memory in terms of its role in communicative interaction. The generative nature of recollection allows us to represent and communicate the reasons for why we hold certain beliefs about the past. In this process, autonoesis corresponds to the capacity to determine when and how to assert epistemic authority in making claims about the past. A domain where such claims are indispensable are human social engagements. Such engagements commonly require the justification of entitlements and obligations, which is often possible only by explicit reference to specific past events.

  19. Evaluation of episodic acidification and amphibian declines in the Rocky Mountains

    Science.gov (United States)

    Frank A. Vertucci; Paul Stephen Corn

    1996-01-01

    We define criteria for documenting episodic acidification of amphibian breeding habitats and examine whether episodic acidification is responsible for observed declines of amphibian populations in the Rocky Mountains. Anthropogenic episodic acidification, caused by atmospheric deposition of sulfate and nitrate, occurs when the concentration of acid anions increases...

  20. The Development of On-Line Statistics Program for Radiation Oncology

    International Nuclear Information System (INIS)

    Kim, Yoon Jong; Lee, Dong Hoon; Ji, Young Hoon; Lee, Dong Han; Jo, Chul Ku; Kim, Mi Sook; Ru, Sung Rul; Hong, Seung Hong

    2001-01-01

    Purpose : By developing on-line statistics program to record the information of radiation oncology to share the information with internet. It is possible to supply basic reference data for administrative plans to improve radiation oncology. Materials and methods : The information of radiation oncology statistics had been collected by paper forms about 52 hospitals in the past. Now, we can input the data by internet web browsers. The statistics program used windows NT 4.0 operation system, Internet Information Server 4.0 (IIS4.0) as a web server and the Microsoft Access MDB. We used Structured Query Language (SQL), Visual Basic, VBScript and JAVAScript to display the statistics according to years and hospitals. Results : This program shows present conditions about man power, research, therapy machines, technic, brachytherapy, clinic statistics, radiation safety management, institution, quality assurance and radioisotopes in radiation oncology department. The database consists of 38 inputs and 6 outputs windows. Statistical output windows can be increased continuously according to user need. Conclusion : We have developed statistics program to process all of the data in department of radiation oncology for reference information. Users easily could input the data by internet web browsers and share the information

  1. Spatial navigation, episodic memory, episodic future thinking, and theory of mind in children with autism spectrum disorder: evidence for impairments in mental simulation?

    Science.gov (United States)

    Lind, Sophie E; Bowler, Dermot M; Raber, Jacob

    2014-01-01

    This study explored spatial navigation alongside several other cognitive abilities that are thought to share common underlying neurocognitive mechanisms (e.g., the capacity for self-projection, scene construction, or mental simulation), and which we hypothesized may be impaired in autism spectrum disorder (ASD). Twenty intellectually high-functioning children with ASD (with a mean age of ~8 years) were compared to 20 sex, age, IQ, and language ability matched typically developing children on a series of tasks to assess spatial navigation, episodic memory, episodic future thinking (also known as episodic foresight or prospection), theory of mind (ToM), relational memory, and central coherence. This is the first study to explore these abilities concurrently within the same sample. Spatial navigation was assessed using the "memory island" task, which involves finding objects within a realistic, computer simulated, three-dimensional environment. Episodic memory and episodic future thinking were assessed using a past and future event description task. ToM was assessed using the "animations" task, in which children were asked to describe the interactions between two animated triangles. Relational memory was assessed using a recognition task involving memory for items (line drawings), patterned backgrounds, or combinations of items and backgrounds. Central coherence was assessed by exploring differences in performance across segmented and unsegmented versions of block design. Children with ASD were found to show impairments in spatial navigation, episodic memory, episodic future thinking, and central coherence, but not ToM or relational memory. Among children with ASD, spatial navigation was found to be significantly negatively related to the number of repetitive behaviors. In other words, children who showed more repetitive behaviors showed poorer spatial navigation. The theoretical and practical implications of the results are discussed.

  2. Spatial navigation, episodic memory, episodic future thinking, and theory of mind in children with autism spectrum disorder: Evidence for impairments in mental simulation?

    Directory of Open Access Journals (Sweden)

    Sophie Elizabeth Lind

    2014-12-01

    Full Text Available This study explored spatial navigation alongside several other cognitive abilities that are thought to share common underlying neurocognitive mechanisms (e.g., the capacity for self-projection, scene construction, or mental simulation, and which we hypothesised may be impaired in autism spectrum disorder (ASD. Twenty intellectually high-functioning children with ASD (with a mean age of ~8 years were compared to 20 sex, age, IQ, and language ability matched typically developing children on a series of tasks to assess spatial navigation, episodic memory, episodic future thinking (also known as episodic foresight or prospection, theory of mind, relational memory, and central coherence. This is the first study to explore these abilities concurrently within the same sample. Spatial navigation was assessed using the memory island task, which involves finding objects within a realistic, computer simulated, three-dimensional environment. Episodic memory and episodic future thinking were assessed using a past and future event description task. Theory of mind was assessed using the animations task, in which children were asked to describe the interactions between two animated triangles. Relational memory was assessed using a recognition task involving memory for items (line drawings, patterned backgrounds, or combinations of items and backgrounds. Central coherence was assessed by exploring differences in performance across segmented and unsegmented versions of block design. Children with ASD were found to show impairments in spatial navigation, episodic memory, episodic future thinking, and central coherence, but not theory of mind or relational memory. Among children with ASD, spatial navigation was found to be significantly negatively related to number of repetitive behaviours. In other words, children who showed more repetitive behaviours showed poorer spatial navigation. The theoretical and practical implications of the results are discussed.

  3. Spatial navigation, episodic memory, episodic future thinking, and theory of mind in children with autism spectrum disorder: evidence for impairments in mental simulation?

    Science.gov (United States)

    Lind, Sophie E.; Bowler, Dermot M.; Raber, Jacob

    2014-01-01

    This study explored spatial navigation alongside several other cognitive abilities that are thought to share common underlying neurocognitive mechanisms (e.g., the capacity for self-projection, scene construction, or mental simulation), and which we hypothesized may be impaired in autism spectrum disorder (ASD). Twenty intellectually high-functioning children with ASD (with a mean age of ~8 years) were compared to 20 sex, age, IQ, and language ability matched typically developing children on a series of tasks to assess spatial navigation, episodic memory, episodic future thinking (also known as episodic foresight or prospection), theory of mind (ToM), relational memory, and central coherence. This is the first study to explore these abilities concurrently within the same sample. Spatial navigation was assessed using the “memory island” task, which involves finding objects within a realistic, computer simulated, three-dimensional environment. Episodic memory and episodic future thinking were assessed using a past and future event description task. ToM was assessed using the “animations” task, in which children were asked to describe the interactions between two animated triangles. Relational memory was assessed using a recognition task involving memory for items (line drawings), patterned backgrounds, or combinations of items and backgrounds. Central coherence was assessed by exploring differences in performance across segmented and unsegmented versions of block design. Children with ASD were found to show impairments in spatial navigation, episodic memory, episodic future thinking, and central coherence, but not ToM or relational memory. Among children with ASD, spatial navigation was found to be significantly negatively related to the number of repetitive behaviors. In other words, children who showed more repetitive behaviors showed poorer spatial navigation. The theoretical and practical implications of the results are discussed. PMID:25538661

  4. Medial Temporal Lobe Damage Causes Deficits in Episodic Memory and Episodic Future Thinking Not Attributable to Deficits in Narrative Construction

    Science.gov (United States)

    Race, Elizabeth; Keane, Margaret M.; Verfaellie, Mieke

    2015-01-01

    The medial temporal lobe (MTL) makes critical contributions to episodic memory, but its contributions to episodic future thinking remain a matter of debate. By one view, imagining future events relies on MTL mechanisms that also support memory for past events. Alternatively, it has recently been suggested that future thinking is independent of MTL-mediated processes and can be supported by regions outside the MTL. The current study investigated the nature and necessity of MTL involvement in imagining the future and tested the novel hypothesis that the MTL contributes to future thinking by supporting online binding processes related to narrative construction. Human amnesic patients with well-characterized MTL damage and healthy controls constructed narratives about (a) future events, (b) past events, and (c) visually-presented pictures. While all three tasks place similar demands on narrative construction, only the past and future conditions require memory/future thinking to mentally generate relevant narrative information. Patients produced impoverished descriptions of both past and future events but were unimpaired at producing detailed picture narratives. In addition, future-thinking performance positively correlated with episodic memory performance but did not correlate with picture narrative performance. Finally, future-thinking impairments were present when MTL lesions were restricted to the hippocampus and did not depend on the presence of neural damage outside the MTL. These results indicate that the ability to generate and maintain a detailed narrative is preserved in amnesia and suggest that a common MTL mechanism supports both episodic memory and episodic future thinking. PMID:21753003

  5. Episodic Memory and Beyond: The Hippocampus and Neocortex in Transformation.

    Science.gov (United States)

    Moscovitch, Morris; Cabeza, Roberto; Winocur, Gordon; Nadel, Lynn

    2016-01-01

    The last decade has seen dramatic technological and conceptual changes in research on episodic memory and the brain. New technologies, and increased use of more naturalistic observations, have enabled investigators to delve deeply into the structures that mediate episodic memory, particularly the hippocampus, and to track functional and structural interactions among brain regions that support it. Conceptually, episodic memory is increasingly being viewed as subject to lifelong transformations that are reflected in the neural substrates that mediate it. In keeping with this dynamic perspective, research on episodic memory (and the hippocampus) has infiltrated domains, from perception to language and from empathy to problem solving, that were once considered outside its boundaries. Using the component process model as a framework, and focusing on the hippocampus, its subfields, and specialization along its longitudinal axis, along with its interaction with other brain regions, we consider these new developments and their implications for the organization of episodic memory and its contribution to functions in other domains.

  6. Hippocampal Structure Predicts Statistical Learning and Associative Inference Abilities during Development.

    Science.gov (United States)

    Schlichting, Margaret L; Guarino, Katharine F; Schapiro, Anna C; Turk-Browne, Nicholas B; Preston, Alison R

    2017-01-01

    Despite the importance of learning and remembering across the lifespan, little is known about how the episodic memory system develops to support the extraction of associative structure from the environment. Here, we relate individual differences in volumes along the hippocampal long axis to performance on statistical learning and associative inference tasks-both of which require encoding associations that span multiple episodes-in a developmental sample ranging from ages 6 to 30 years. Relating age to volume, we found dissociable patterns across the hippocampal long axis, with opposite nonlinear volume changes in the head and body. These structural differences were paralleled by performance gains across the age range on both tasks, suggesting improvements in the cross-episode binding ability from childhood to adulthood. Controlling for age, we also found that smaller hippocampal heads were associated with superior behavioral performance on both tasks, consistent with this region's hypothesized role in forming generalized codes spanning events. Collectively, these results highlight the importance of examining hippocampal development as a function of position along the hippocampal axis and suggest that the hippocampal head is particularly important in encoding associative structure across development.

  7. Analysis of meteorology and emission in haze episode prevalence over mountain-bounded region for early warning.

    Science.gov (United States)

    Kim Oanh, Nguyen Thi; Leelasakultum, Ketsiri

    2011-05-01

    This study investigated the main causes of haze episodes in the northwestern Thailand to provide early warning and prediction. In an absence of emission input data required for chemical transport modeling to predict the haze, the climatological approach in combination with statistical analysis was used. An automatic meteorological classification scheme was developed using regional meteorological station data of 8years (2001-2008) which classified the prevailing synoptic patterns over Northern Thailand into 4 patterns. Pattern 2, occurring with high frequency in March, was found to associate with the highest levels of 24h PM(10) in Chiangmai, the largest city in Northern Thailand. Typical features of this pattern were the dominance of thermal lows over India, Western China and Northern Thailand with hot, dry and stagnant air in Northern Thailand. March 2007, the month with the most severe haze episode in Chiangmai, was found to have a high frequency of occurrence of pattern 2 coupled with the highest emission intensities from biomass open burning. Backward trajectories showed that, on haze episode days, air masses passed over the region of dense biomass fire hotspots before arriving at Chiangmai. A stepwise regression model was developed to predict 24h PM(10) for days of meteorology pattern 2 using February-April data of 2007-2009 and tested with 2004-2010 data. The model performed satisfactorily for the model development dataset (R(2)=87%) and test dataset (R(2)=81%), which appeared to be superior over a simple persistence regression of 24h PM(10) (R(2)=76%). Our developed model had an accuracy over 90% for the categorical forecast of PM(10)>120μg/m(3). The episode warning procedure would identify synoptic pattern 2 and predict 24h PM(10) in Chiangmai 24h in advance. This approach would be applicable for air pollution episode management in other areas with complex terrain where similar conditions exist. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. Episodic future thinking in semantic dementia: a cognitive and FMRI study.

    Directory of Open Access Journals (Sweden)

    Armelle Viard

    Full Text Available Semantic dementia (SD is characterized by gradual loss of semantic memory. While episodic autobiographical memory seems relatively preserved, behavioral studies suggest that episodic future thinking is impaired. We used fMRI to measure brain activity in four SD patients (JPL, EP, LL, EG while they envisioned future events and remembered personal past events. Twelve healthy elders served as controls. Episodic quality, emotion, mental imagery and level of consciousness (via remember/know judgements were checked at debriefing. We analyzed the future compared to the past for each patient. All patients presented lateral temporal atrophy, but varied in terms of frontal and anterior hippocampal atrophy. Patient JPL presented atrophy in bilateral superior medial frontal gyri and left anterior hippocampus and was unable to engage in episodic future thinking, despite hyperactivations in frontal and occipital regions. Patient EP presented no atrophy in the anterior hippocampus, but atrophy in bilateral superior medial frontal gyrus and had difficulties to engage in episodic future thinking. Patient LL presented atrophy in left anterior hippocampus, but hyperactivated its right counterpart for future compared to past thinking, permitting her to project efficiently in the future in an episodic way. Patient EG presented no atrophy in the superior medial frontal gyri or anterior hippocampi and was able to engage in episodic future thinking. Altogether, patients' future projections differed depending on the severity and localization of their atrophy. The functional integrity of bilateral superior medial frontal gyri and anterior hippocampus appear crucial for episodic future thinking: atrophy of both structures strongly impairs future projection, while integrity of these structures or hyperactivation of residual tissue normalizes episodic future projection.

  9. Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification.

    Science.gov (United States)

    Cavusoglu, M; Ciloglu, T; Serinagaoglu, Y; Kamasak, M; Erogul, O; Akcam, T

    2008-08-01

    In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong

  10. Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification

    International Nuclear Information System (INIS)

    Cavusoglu, M; Ciloglu, T; Serinagaoglu, Y; Kamasak, M; Erogul, O; Akcam, T

    2008-01-01

    In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong

  11. Episodic reinstatement in the medial temporal lobe.

    Science.gov (United States)

    Staresina, Bernhard P; Henson, Richard N A; Kriegeskorte, Nikolaus; Alink, Arjen

    2012-12-12

    The essence of episodic memory is our ability to reexperience past events in great detail, even in the absence of external stimulus cues. Does the phenomenological reinstatement of past experiences go along with reinstating unique neural representations in the brain? And if so, how is this accomplished by the medial temporal lobe (MTL), a brain region intimately linked to episodic memory? Computational models suggest that such reinstatement (also termed "pattern completion") in cortical regions is mediated by the hippocampus, a key region of the MTL. Although recent functional magnetic resonance imaging studies demonstrated reinstatement of coarse item properties like stimulus category or task context across different brain regions, it has not yet been shown whether reinstatement can be observed at the level of individual, discrete events-arguably the defining feature of episodic memory-nor whether MTL structures like the hippocampus support this "true episodic" reinstatement. Here we show that neural activity patterns for unique word-scene combinations encountered during encoding are reinstated in human parahippocampal cortex (PhC) during retrieval. Critically, this reinstatement occurs when word-scene combinations are successfully recollected (even though the original scene is not visually presented) and does not encompass other stimulus domains (such as word-color associations). Finally, the degree of PhC reinstatement across retrieval events correlated with hippocampal activity, consistent with a role of the hippocampus in coordinating pattern completion in cortical regions.

  12. Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation.

    Science.gov (United States)

    Daras, Laura Coots; Ingber, Melvin J; Carichner, Jessica; Barch, Daniel; Deutsch, Anne; Smith, Laura M; Levitt, Alan; Andress, Joel

    2017-08-09

    To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs). Observational design. Inpatient rehabilitation facilities. Medicare fee-for-service beneficiaries (N=567,850 patient-stays). Not applicable. The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission. The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0±8.6 days and varied by rehabilitation diagnosis. Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates. Published by Elsevier Inc.

  13. Episodic Spin-up and Spin-down Torque on Earth

    Science.gov (United States)

    Slabinski, Victor J.; Mendonca, Antonio A.

    2018-04-01

    Variations in Earth rotation angle are traditionally expressed by the time difference (ΔT=TT-UT1) between Terrestrial Time (TT) as told by atomic clocks and Universal Time UT1, the time variable used by the Earth-rotation formula. A plot of ΔT versus TT over the past 160 years shows a continuous curve with approximate straight-line segments with different spans of order ~20 years. Removing the tidal and seasonal variations from the data gives these line segments which represent the “decadal variations” in Earth rotation.The slope of a straight-line segment is proportional to the departure of Earth rotation rate from a reference value at the time. The change in slope over the relatively short time between segments indicates an episodic spin-up or spin-down in Earth rotation. The daily combination of VLBI, SLR, and other modern data available since 1973 gives us accurate, daily values of ΔT and the corresponding LOD (Length Of Day) values during these episodes. These allow us to determine the rotational acceleration occurring then.The three largest spin-speed changes found during the VLBI era have the following characteristics:Episode _____________ Duration__ ΔLOD__LOD Rate1983 Dec 30-1984 Jan 28 ... 29 d ...-0.65 ms ..-8.3 ms/y ..........spin-up1989 Mar 15-1989 May 23 ...69 d ....0.68 .......+3.6 ..............spin-down1994 Jan 21-2001 Apr 01 ... 6.5 y ...-2.2 .........-0.36 ..extended spin-upFor the first two episodes listed, we find the acceleration grows from zero (or at least a relatively small value) to its extreme value in ~1 day, stays approximately constant at this value for 29 or 69 days, and then decays back to zero over ~1 day. The acceleration, while it occurs, gives an LOD rate much greater than the 0.02 ms/y rate from tidal friction.The third episode shows that occasionally a several-year-long episode occurs. The acceleration magnitude is smaller but can make a larger total change in LOD (and spin rate). Tidal friction requires >100 y to equal

  14. Recovery from episodic acidification delayed by drought and high sea salt deposition

    Directory of Open Access Journals (Sweden)

    H. Laudon

    2008-03-01

    Full Text Available For the prediction of episodic acidification large uncertainties are connected to climatic variability and its effect on drought conditions and sea-salt episodes. In this study data on 342 hydrological episodes in 25 Swedish streams, sampled over 10 years, have been analyzed using a recently developed episode model. The results demonstrate that drought is the most important factor modulating the magnitude of the anthropogenic influence on pH and ANC during episodes. These modulating effects are especially pronounced in southern and central Sweden, where the historically high acid deposition has resulted in significant S pools in catchment soils. The results also suggest that the effects of episodic acidification are becoming less severe in many streams, but this amelioration is less clear in coastal streams subject to high levels of sea-salt deposition. Concurrently with the amelioration of the effects of episodic acidification, regional climate models predict that temperatures will increase in Sweden during the coming decades, accompanied by reductions in summer precipitation and more frequent storms during fall and winter in large areas of the country. If these predictions are realized delays in streams' recovery from episodic acidification events can be expected.

  15. Volume of hippocampal subfields and episodic memory in childhood and adolescence.

    Science.gov (United States)

    Lee, Joshua K; Ekstrom, Arne D; Ghetti, Simona

    2014-07-01

    Episodic memory critically depends on the hippocampus to bind the features of an experience into memory. Episodic memory develops in childhood and adolescence, and hippocampal changes during this period may contribute to this development. Little is known, however, about how the hippocampus contributes to episodic memory development. The hippocampus is comprised of several cytoarchitectural subfields with functional significance for episodic memory. However, hippocampal subfields have not been assessed in vivo during child development, nor has their relation with episodic memory been assessed during this period. In the present study, high-resolution T2-weighted images of the hippocampus were acquired in 39 children and adolescents aged 8 to 14 years (M=11.30, SD=2.38), and hippocampal subfields were segmented using a protocol previously validated in adult populations. We first validated the method in children and adolescents and examined age-related differences in hippocampal subfields and correlations between subfield volumes and episodic memory. Significant age-related increases in the subfield volume were observed into early adolescence in the right CA3/DG and CA1. The right CA3/DG subfield volumes were positively correlated with accurate episodic memory for item-color relations, and the right CA3/DG and subiculum were negatively correlated with item false alarm rates. Subfield development appears to follow a protracted developmental trajectory, and likely plays a pivotal role in episodic memory development. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Emotion episodes during psychotherapy sessions among women newly diagnosed with gynecological cancers.

    Science.gov (United States)

    Myers Virtue, Shannon; Manne, Sharon L; Darabos, Kathleen; Heckman, Carolyn J; Ozga, Melissa; Kissane, David; Rubin, Stephen; Rosenblum, Norman

    2015-09-01

    The aim of this study was to describe emotion episodes during early and late psychotherapy sessions among women newly diagnosed with gynecological cancer and to examine whether the total number of emotion episodes during early and later sessions was associated with baseline psychological distress, dispositional emotion expressivity, and patient-rated therapeutic progress. The study utilized data from an ongoing study examining the efficacy of two psychotherapy interventions, a coping and communication intervention and a supportive counseling intervention, for women diagnosed with gynecological cancer. Emotion episode coding was completed for the first and sixth psychotherapy sessions for each patient randomized to receive psychotherapy (N = 173). Patients completed baseline survey measures of psychological distress and dispositional emotional expressivity and post-session ratings of therapeutic progress. The average number of emotion episodes was 7.4 in the first session and 5.2 episodes in the sixth session. In both sessions, the majority of emotion episodes contained only negative emotions and focused on a cancer-related topic. A higher number of emotion episodes in the first session was associated with higher psychological distress reported in the baseline survey (p = 0.02). A higher number of emotion episodes in the sixth session was associated with a higher number of emotion episodes in the first session (p psychotherapy among women diagnosed with gynecological cancer. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Effect of Taurine on Febrile Episodes in Acute Lymphoblastic Leukemia

    Directory of Open Access Journals (Sweden)

    Mina Islambulchilar

    2015-03-01

    Full Text Available Purpose: The purpose of our study was to evaluate the effect of oral taurine on the incidence of febrile episodes during chemotherapy in young adults with acute lymphoblastic leukemia. Methods: Forty young adults with acute lymphoblastic leukemia, at the beginning of maintenance course of their chemotherapy, were eligible for this study. The study population was randomized in a double blind manner to receive either taurine or placebo (2 gram per day orally. Life quality and side effects including febrile episodes were assessed using questionnaire. Data were analyzed using Pearson’s Chi square test. Results: Of total forty participants, 43.8% were female and 56.3 % were male. The mean age was 19.16±1.95 years (ranges: 16-23 years. The results indicated that the levels of white blood cells are significantly (P<0.05 increased in taurine treated group. There was no elevation in blasts count. A total of 70 febrile episodes were observed during study, febrile episodes were significantly (P<0.05 lower in taurine patients in comparison to the control ones. Conclusion: The overall incidence of febrile episodes and infectious complications in acute lymphoblastic leukemia patients receiving taurine was lower than placebo group. Taurine’s ability to increase leukocyte count may result in lower febrile episodes.

  18. [Optical properties of aerosol during haze-fog episodes in Beijing].

    Science.gov (United States)

    Yu, Xing-Na; Li, Xin-Mei; Deng, Zen-Grandeng; De, Qing-Yangzong; Yuan, Shuai

    2012-04-01

    The purpose of this study is to investigate the optical properties of aerosol during haze-fog episodes in Beijing. The aerosol optical depth (AOD), Angstrom exponent (alpha), size distribution and single scattering albedo (omega) during haze-fog episodes were analyzed between 2002 and 2008 using AERONENT data. During haze-fog episodes, the aerosol optical depth showed a decreasing trend with wavelengths, and showed high values with an average 1.34 at 440 nm. The magnitude of Angstrom exponent was relatively high during haze-fog episodes and the mean values reached 1.11. The frequency distribution of alpha was up to 94% when alpha > 0.9, indicating the predominance of fine particles during haze-fog episodes in Beijing. The aerosol volume size distributions presented a bimodal structure (fine and coarse modes). The maxima (peaks) radius of fine mode showed an increasing trend with AOD, however, those of coarse mode showed a decreasing trend with AOD. The size distribution showed a distinct difference in dominant mode for the different AOD. The single scattering albedo showed an increasing trend with AOD during haze-fog episodes in Beijing. The mean value of omega was 0.89 at the four wavelengths and the omega exhibited a low sensitivity to wavelengths.

  19. Subjective Experience of Episodic Memory and Metacognition: A Neurodevelopmental Approach

    Science.gov (United States)

    Souchay, Céline; Guillery-Girard, Bérengère; Pauly-Takacs, Katalin; Wojcik, Dominika Zofia; Eustache, Francis

    2013-01-01

    Episodic retrieval is characterized by the subjective experience of remembering. This experience enables the co-ordination of memory retrieval processes and can be acted on metacognitively. In successful retrieval, the feeling of remembering may be accompanied by recall of important contextual information. On the other hand, when people fail (or struggle) to retrieve information, other feelings, thoughts, and information may come to mind. In this review, we examine the subjective and metacognitive basis of episodic memory function from a neurodevelopmental perspective, looking at recollection paradigms (such as source memory, and the report of recollective experience) and metacognitive paradigms such as the feeling of knowing). We start by considering healthy development, and provide a brief review of the development of episodic memory, with a particular focus on the ability of children to report first-person experiences of remembering. We then consider neurodevelopmental disorders (NDDs) such as amnesia acquired in infancy, autism, Williams syndrome, Down syndrome, or 22q11.2 deletion syndrome. This review shows that different episodic processes develop at different rates, and that across a broad set of different NDDs there are various types of episodic memory impairment, each with possibly a different character. This literature is in agreement with the idea that episodic memory is a multifaceted process. PMID:24399944

  20. Constructive episodic simulation, flexible recombination, and memory errors.

    Science.gov (United States)

    Schacter, Daniel L; Carpenter, Alexis C; Devitt, Aleea; Roberts, Reece P; Addis, Donna Rose

    2018-01-01

    According to Mahr & Csibra (M&C), the view that the constructive nature of episodic memory is related to its role in simulating future events has difficulty explaining why memory is often accurate. We hold this view, but disagree with their conclusion. Here we consider ideas and evidence regarding flexible recombination processes in episodic retrieval that accommodate both accuracy and distortion.

  1. Reducing the duration of untreated first-episode psychosis

    DEFF Research Database (Denmark)

    Melle, Ingrid; Larsen, Tor K; Haahr, Ulrik

    2004-01-01

    Most studies on first-episode psychosis show an association between a long duration of untreated psychosis (DUP) and poorer short-term outcome, but the mechanisms of this relationship are poorly understood.......Most studies on first-episode psychosis show an association between a long duration of untreated psychosis (DUP) and poorer short-term outcome, but the mechanisms of this relationship are poorly understood....

  2. Elements of episodic-like memory in animals.

    OpenAIRE

    Clayton, N S; Griffiths, D P; Emery, N J; Dickinson, A

    2001-01-01

    A number of psychologists have suggested that episodic memory is a uniquely human phenomenon and, until recently, there was little evidence that animals could recall a unique past experience and respond appropriately. Experiments on food-caching memory in scrub jays question this assumption. On the basis of a single caching episode, scrub jays can remember when and where they cached a variety of foods that differ in the rate at which they degrade, in a way that is inexplicable by relative fam...

  3. Does a hospital's quality depend on the quality of other hospitals? A spatial econometrics approach.

    Science.gov (United States)

    Gravelle, Hugh; Santos, Rita; Siciliani, Luigi

    2014-11-01

    We examine whether a hospital's quality is affected by the quality provided by other hospitals in the same market. We first sketch a theoretical model with regulated prices and derive conditions on demand and cost functions which determine whether a hospital will increase its quality if its rivals increase their quality. We then apply spatial econometric methods to a sample of English hospitals in 2009-10 and a set of 16 quality measures including mortality rates, readmission, revision and redo rates, and three patient reported indicators, to examine the relationship between the quality of hospitals. We find that a hospital's quality is positively associated with the quality of its rivals for seven out of the sixteen quality measures. There are no statistically significant negative associations. In those cases where there is a significant positive association, an increase in rivals' quality by 10% increases a hospital's quality by 1.7% to 2.9%. The finding suggests that for some quality measures a policy which improves the quality in one hospital will have positive spillover effects on the quality in other hospitals.

  4. Cognitive-perceptual deficits and symptom correlates in first-episode schizophrenia

    Directory of Open Access Journals (Sweden)

    Riaan M. Olivier

    2017-08-01

    Full Text Available Background: Thought disorder and visual-perceptual deficits have been well documented, but their relationships with clinical symptoms and cognitive function remain unclear. Cognitive-perceptual deficits may underscore clinical symptoms in schizophrenia patients. Aim: This study aimed to explore how thought disorder and form perception are related with clinical symptoms and cognitive dysfunction in first-episode schizophrenia. Setting: Forty-two patients with a first-episode of schizophrenia, schizophreniform or schizoaffective disorder were recruited from community clinics and state hospitals in the Cape Town area. Methods: Patients were assessed at baseline with the Rorschach Perceptual Thinking Index (PTI, the Positive and Negative Syndrome Scale (PANSS and the MATRICS Cognitive Consensus Battery (MCCB. Spearman correlational analyses were conducted to investigate relationships between PTI scores, PANSS factor analysis-derived domain scores and MCCB composite and subscale scores. Multiple regression models explored these relationships further. Results: Unexpectedly, poor form perception (X- % was inversely correlated with the severity of PANSS positive symptoms (r = -0.42, p = 0.02. Good form perception (XA% correlated significantly with speed of processing (r = 0.59, p < 0.01, working memory (r = 0.48, p < 0.01 and visual learning (r = 0.55, p < 0.01. PTI measures of thought disorder did not correlate significantly with PANSS symptom scores or cognitive performance. Conclusions: Form perception is associated with positive symptoms and impairment in executive function during acute psychosis. These findings suggest that there may be clinical value in including sensory-perceptual processing tasks in cognitive remediation and social cognitive training programmes for schizophrenia patients.

  5. Cost drivers for breast, lung, and colorectal cancer care in a commercially insured population over a 6-month episode: an economic analysis from a health plan perspective.

    Science.gov (United States)

    Sagar, Bhuvana; Lin, Yu Shen; Castel, Liana D

    2017-10-01

    In the absence of clinical data, accurate identification of cost drivers is needed for economic comparison in an alternate payment model. From a health plan perspective using claims data in a commercial population, the objective was to identify and quantify the effects of cost drivers in economic models of breast, lung, and colorectal cancer costs over a 6-month episode following initial chemotherapy. This study analyzed claims data from 9,748 Cigna beneficiaries with diagnosis of breast, lung, and colorectal cancer following initial chemotherapy from January 1, 2014 to December 31, 2015. We used multivariable regression models to quantify the impact of key factors on cost during the initial 6-month cancer care episode. Metastasis, facility provider affiliation, episode risk group (ERG) risk score, and radiation were cost drivers for all three types of cancer (breast, lung, and colorectal). In addition, younger age (p < .0001) and human epidermal growth factor receptor-2 oncogene overexpression (HER2+)-directed therapy (p < .0001) were associated with higher costs in breast cancer. Younger age (p < .0001) and female gender (p < .0001) were also associated with higher costs in colorectal cancer. Metastasis was also associated with 50% more hospital admissions and increased hospital length of stay (p < .001) in all three cancers over the 6-month episode duration. Chemotherapy and supportive drug therapies accounted for the highest proportion (48%) of total medical costs among beneficiaries observed. Value-based reimbursement models in oncology should appropriately account for key cost drivers. Although claims-based methodologies may be further augmented with clinical data, this study recommends adjusting for the factors identified in these models to predict costs in breast, lung, and colorectal cancers.

  6. Long-Term Patterns in C-Q Relations in an Adirondack Stream Reveal Decreasing Severity of Episodic Acidification

    Science.gov (United States)

    Burns, D. A.; Lawrence, G. B.; Driscoll, C. T.; Sullivan, T. J.; Shao, S.; McDonnell, T. C.

    2017-12-01

    Episodic acidification occurs when surface water pH and ANC decrease temporarily during rain events and snowmelt. The principal drivers of episodic acidification are increases in sulfuric acid, nitric acid, organic acids, and dilution of base cations. In regions where surface waters are sensitive to acid deposition, ANC values may approach or decline below 0 µeq/L during high flows, which may result in deleterious effects to sensitive aquatic biota. The Adirondack Mountains of New York have abundant streams and lakes, many of which are highly sensitive to the effects of acid deposition. Long-term monitoring data indicate that pH and ANC in regional surface waters are increasing in response to decreases in the acidity of atmospheric deposition that result from decreasing SO2 and NOx emissions as the Clean Air Act and its ancillary rules and amendments have been implemented. Most surface-water monitoring focuses on low-flow and broad seasonal patterns, and less is known about how episodic acidification has responded to emissions decreases. Here, we report on spatial and temporal patterns in episodic acidification through analysis of C-Q relations from surveys that target varying flow conditions as well as data from a few long-term intensively sampled stream monitoring sites. Each stream sample was assigned a Q percentile value based on a resident or nearby gage, and a statistical relation between ANC values and Q percentile was developed. The magnitude of episodic decreases in ANC increases as low-flow ANC increases, a pattern that likely results from an increasing influence of dilution, especially evident when low-flow ANC values exceed 100 µeq/L. Chronically acidic streams with low-flow ANC near 0 µeq/L show little episodic acidification, whereas streams with low-flow ANC values of about 50 µeq/L generally show ANC decreases to less than 0 µeq/L at high flow. Preliminary analysis of a 24-yr data set (1991-2014) at Buck Creek indicates that increases in high

  7. Physical Activity Is Positively Associated with Episodic Memory in Aging.

    Science.gov (United States)

    Hayes, Scott M; Alosco, Michael L; Hayes, Jasmeet P; Cadden, Margaret; Peterson, Kristina M; Allsup, Kelly; Forman, Daniel E; Sperling, Reisa A; Verfaellie, Mieke

    2015-11-01

    Aging is associated with performance reductions in executive function and episodic memory, although there is substantial individual variability in cognition among older adults. One factor that may be positively associated with cognition in aging is physical activity. To date, few studies have objectively assessed physical activity in young and older adults, and examined whether physical activity is differentially associated with cognition in aging. Young (n=29, age 18-31 years) and older adults (n=31, ages 55-82 years) completed standardized neuropsychological testing to assess executive function and episodic memory capacities. An experimental face-name relational memory task was administered to augment assessment of episodic memory. Physical activity (total step count and step rate) was objectively assessed using an accelerometer, and hierarchical regressions were used to evaluate relationships between cognition and physical activity. Older adults performed more poorly on tasks of executive function and episodic memory. Physical activity was positively associated with a composite measure of visual episodic memory and face-name memory accuracy in older adults. Physical activity associations with cognition were independent of sedentary behavior, which was negatively correlated with memory performance. Physical activity was not associated with cognitive performance in younger adults. Physical activity is positively associated with episodic memory performance in aging. The relationship appears to be strongest for face-name relational memory and visual episodic memory, likely attributable to the fact that these tasks make strong demands on the hippocampus. The results suggest that physical activity relates to cognition in older, but not younger adults.

  8. What if? Neural activity underlying semantic and episodic counterfactual thinking.

    Science.gov (United States)

    Parikh, Natasha; Ruzic, Luka; Stewart, Gregory W; Spreng, R Nathan; De Brigard, Felipe

    2018-05-25

    Counterfactual thinking (CFT) is the process of mentally simulating alternative versions of known facts. In the past decade, cognitive neuroscientists have begun to uncover the neural underpinnings of CFT, particularly episodic CFT (eCFT), which activates regions in the default network (DN) also activated by episodic memory (eM) recall. However, the engagement of DN regions is different for distinct kinds of eCFT. More plausible counterfactuals and counterfactuals about oneself show stronger activity in DN regions compared to implausible and other- or object-focused counterfactuals. The current study sought to identify a source for this difference in DN activity. Specifically, self-focused counterfactuals may also be more plausible, suggesting that DN core regions are sensitive to the plausibility of a simulation. On the other hand, plausible and self-focused counterfactuals may involve more episodic information than implausible and other-focused counterfactuals, which would imply DN sensitivity to episodic information. In the current study, we compared episodic and semantic counterfactuals generated to be plausible or implausible against episodic and semantic memory reactivation using fMRI. Taking multivariate and univariate approaches, we found that the DN is engaged more during episodic simulations, including eM and all eCFT, than during semantic simulations. Semantic simulations engaged more inferior temporal and lateral occipital regions. The only region that showed strong plausibility effects was the hippocampus, which was significantly engaged for implausible CFT but not for plausible CFT, suggestive of binding more disparate information. Consequences of these findings for the cognitive neuroscience of mental simulation are discussed. Published by Elsevier Inc.

  9. Episodic spontaneous hypothermia: a periodic childhood syndrome.

    Science.gov (United States)

    Ruiz, Cynthia; Gener, Blanca; Garaizar, Carmen; Prats, José M

    2003-04-01

    Episodic spontaneous hypothermia is an infrequent disorder, with unknown pathogenic mechanisms. A systemic cause or underlying brain lesion has not been found for the disease. We report four new patients, 3-9 years old, with episodic hypothermia lower than 35 degrees C, marked facial pallor, and absent shivering. The episodes could last a few hours or four days, and recurred once a week or every 2-3 months. Two patients also demonstrated bradycardia, mild hypertension, and somnolence during the events; in one of them, profuse sweating was also a feature, and all four presented with either headache, a periodic childhood syndrome, or both (recurrent abdominal pain, cyclic vomiting, or vertigo). Three patients reported a family history of migraine. Neurologic examination, endocrine function, and imaging studies were normal. Migraine prophylactic therapy was of moderate efficacy. Spontaneous resolution was observed in one patient. The clinical characteristics of the syndrome allow for its inclusion as a childhood periodic syndrome related to migraine.

  10. Executive function, episodic memory, and Medicare expenditures.

    Science.gov (United States)

    Bender, Alex C; Austin, Andrea M; Grodstein, Francine; Bynum, Julie P W

    2017-07-01

    We examined the relationship between health care expenditures and cognition, focusing on differences across cognitive systems defined by global cognition, executive function, or episodic memory. We used linear regression models to compare annual health expenditures by cognitive status in 8125 Nurses' Health Study participants who completed a cognitive battery and were enrolled in Medicare parts A and B. Adjusting for demographics and comorbidity, executive impairment was associated with higher total annual expenditures of $1488 per person (P episodic memory impairment was found. Expenditures exhibited a linear relationship with executive function, but not episodic memory ($584 higher for every 1 standard deviation decrement in executive function; P < .01). Impairment in executive function is specifically and linearly associated with higher health care expenditures. Focusing on management strategies that address early losses in executive function may be effective in reducing costly services. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  11. Preschool children's proto-episodic memory assessed by deferred imitation.

    Science.gov (United States)

    Burns, Patrick; Russell, Charlotte; Russell, James

    2015-01-01

    In two experiments, both employing deferred imitation, we studied the developmental origins of episodic memory in two- to three-year-old children by adopting a "minimalist" view of episodic memory based on its What-When-Where ("WWW": spatiotemporal plus semantic) content. We argued that the temporal element within spatiotemporal should be the order/simultaneity of the event elements, but that it is not clear whether the spatial content should be egocentric or allocentric. We also argued that episodic recollection should be configural (tending towards all-or-nothing recall of the WWW elements). Our first deferred imitation experiment, using a two-dimensional (2D) display, produced superior-to-chance performance after 2.5 years but no evidence of configural memory. Moreover, performance did not differ from that on a What-What-What control task. Our second deferred imitation study required the children to reproduce actions on an object in a room, thereby affording layout-based spatial cues. In this case, not only was there superior-to-chance performance after 2.5 years but memory was also configural at both ages. We discuss the importance of allocentric spatial cues in episodic recall in early proto-episodic memory and reflect on the possible role of hippocampal development in this process.

  12. 77 FR 2548 - Board of Scientific Counselors, National Center for Health Statistics

    Science.gov (United States)

    2012-01-18

    ... Scientific Counselors, National Center for Health Statistics In accordance with section 10(a)(2) of the...), National Center for Health Statistics (NCHS) announces the following meeting of the aforementioned...; review of the ambulatory and hospital care statistics program; a discussion of the NHANES genetics...

  13. Temporal Trends of Reperfusion Strategies and Hospital Mortality for Patients With STEMI in Percutaneous Coronary Intervention-Capable Hospitals.

    Science.gov (United States)

    Tran, Dat T; Welsh, Robert C; Ohinmaa, Arto; Thanh, Nguyen X; Kaul, Padma

    2017-04-01

    The aim of this study was to examine temporal trends and provincial variations in reperfusion strategies and in-hospital mortality among patients presenting with ST-segment elevation myocardial infarction (STEMI) at hospitals in Canada capable of performing percutaneous coronary intervention (PCI). We included patients aged ≥ 20 years who were hospitalized between fiscal years 2009 and 2013 in all provinces except Quebec. We categorized patients as receiving fibrinolysis (lysis), primary PCI (pPCI), or no reperfusion. Patients undergoing lysis were further categorized as (1) lysis + PCI ≤ 90 minutes, (2) lysis + PCI > 90 minutes, and (3) lysis only. Patients undergoing pPCI were further categorized as (1) pPCI ≤ 90 minutes and (2) pPCI > 90 minutes. We used logistic regression to examine the baseline-adjusted association between reperfusion strategy and in-hospital mortality. Among 44,650 STEMI episodes in 44,373 patients, 66.3% received pPCI (annual increase of 7.8%; P 90 minutes (adjusted odds ratio of 0.42; 95% confidence interval, 0.32-0.55 compared with pPCI ≤ 90 minutes). The use of pPCI in STEMI has increased significantly in Canada; however, significant interprovincial variation remains. Changes in reperfusion strategies do not appear to have had an impact on in-hospital mortality rates. Patients who underwent lysis followed by PCI in a systematic fashion had the lowest mortality. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  14. Dynamic switching between semantic and episodic memory systems.

    Science.gov (United States)

    Kompus, Kristiina; Olsson, Carl-Johan; Larsson, Anne; Nyberg, Lars

    2009-09-01

    It has been suggested that episodic and semantic long-term memory systems interact during retrieval. Here we examined the flexibility of memory retrieval in an associative task taxing memories of different strength, assumed to differentially engage episodic and semantic memory. Healthy volunteers were pre-trained on a set of 36 face-name pairs over a 6-week period. Another set of 36 items was shown only once during the same time period. About 3 months after the training period all items were presented in a randomly intermixed order in an event-related fMRI study of face-name memory. Once presented items differentially activated anterior cingulate cortex and a right prefrontal region that previously have been associated with episodic retrieval mode. High-familiar items were associated with stronger activation of posterior cortices and a left frontal region. These findings fit a model of memory retrieval by which early processes determine, on a trial-by-trial basis, if the task can be solved by the default semantic system. If not, there is a dynamic shift to cognitive control processes that guide retrieval from episodic memory.

  15. Rural hospital wages

    Science.gov (United States)

    Hendricks, Ann M.

    1989-01-01

    Average fiscal year 1982 wages from 2,302 rural American hospitals were used to test for a gradient descending from hospitals in counties adjacent to metropolitan areas to those not adjacent. Considerable variation in the ratios of adjacent to nonadjacent averages existed. No statistically significant difference was found, however. Of greater importance in explaining relative wages within States were occupational mix, mix of part-time and full-time workers, case mix, presence of medical residencies, and location in a high-rent county within the State. Medicare already adjusts payments for only two of these variables. PMID:10313454

  16. Household costs among patients hospitalized with malaria: evidence from a national survey in Malawi, 2012.

    Science.gov (United States)

    Hennessee, Ian; Chinkhumba, Jobiba; Briggs-Hagen, Melissa; Bauleni, Andy; Shah, Monica P; Chalira, Alfred; Moyo, Dubulao; Dodoli, Wilfred; Luhanga, Misheck; Sande, John; Ali, Doreen; Gutman, Julie; Lindblade, Kim A; Njau, Joseph; Mathanga, Don P

    2017-10-02

    With 71% of Malawians living on malaria are likely a major economic burden for low income families and may constitute an important barrier to care seeking. Nevertheless, few efforts have been made to examine these costs. This paper describes household costs associated with seeking and receiving inpatient care for malaria in health facilities in Malawi. A cross-sectional survey was conducted in a representative nationwide sample of 36 health facilities providing inpatient treatment for malaria from June-August, 2012. Patients admitted at least 12 h before study team visits who had been prescribed an antimalarial after admission were eligible to provide cost information for their malaria episode, including care seeking at previous health facilities. An ingredients-based approach was used to estimate direct costs. Indirect costs were estimated using a human capital approach. Key drivers of total household costs for illness episodes resulting in malaria admission were assessed by fitting a generalized linear model, accounting for clustering at the health facility level. Out of 100 patients who met the eligibility criteria, 80 (80%) provided cost information for their entire illness episode to date and were included: 39% of patients were under 5 years old and 75% had sought care for the malaria episode at other facilities prior to coming to the current facility. Total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively. Facility management type, household distance from the health facility, patient age, high household wealth, and duration of hospital stay were all significant drivers of overall costs. Although malaria treatment is supposed to be free in public health facilities, households in Malawi still incur high direct and indirect costs for malaria illness episodes that result in hospital admission. Finding ways to minimize the economic burden of inpatient malaria care is crucial to protect

  17. A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia.

    Directory of Open Access Journals (Sweden)

    Kheng Chheng

    Full Text Available Febrile illnesses are pre-eminent contributors to morbidity and mortality among children in South-East Asia but the causes are poorly understood. We determined the causes of fever in children hospitalised in Siem Reap province, Cambodia.A one-year prospective study of febrile children admitted to Angkor Hospital for Children, Siem Reap. Demographic, clinical, laboratory and outcome data were comprehensively analysed. Between October 12(th 2009 and October 12(th 2010 there were 1225 episodes of febrile illness in 1180 children. Median (IQR age was 2.0 (0.8-6.4 years, with 850 (69% episodes in children <5 years. Common microbiological diagnoses were dengue virus (16.2%, scrub typhus (7.8%, and Japanese encephalitis virus (5.8%. 76 (6.3% episodes had culture-proven bloodstream infection, including Salmonella enterica serovar Typhi (22 isolates, 1.8%, Streptococcus pneumoniae (13, 1.1%, Escherichia coli (8, 0.7%, Haemophilus influenzae (7, 0.6%, Staphylococcus aureus (6, 0.5% and Burkholderia pseudomallei (6, 0.5%. There were 69 deaths (5.6%, including those due to clinically diagnosed pneumonia (19, dengue virus (5, and melioidosis (4. 10 of 69 (14.5% deaths were associated with culture-proven bloodstream infection in logistic regression analyses (odds ratio for mortality 3.4, 95% CI 1.6-6.9. Antimicrobial resistance was prevalent, particularly in S. enterica Typhi, (where 90% of isolates were resistant to ciprofloxacin, and 86% were multi-drug resistant. Comorbid undernutrition was present in 44% of episodes and a major risk factor for acute mortality (OR 2.1, 95% CI 1.1-4.2, as were HIV infection and cardiac disease.We identified a microbiological cause of fever in almost 50% of episodes in this large study of community-acquired febrile illness in hospitalized children in Cambodia. The range of pathogens, antimicrobial susceptibility, and co-morbidities associated with mortality described will be of use in the development of rational guidelines

  18. A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia.

    Science.gov (United States)

    Chheng, Kheng; Carter, Michael J; Emary, Kate; Chanpheaktra, Ngoun; Moore, Catrin E; Stoesser, Nicole; Putchhat, Hor; Sona, Soeng; Reaksmey, Sin; Kitsutani, Paul; Sar, Borann; van Doorn, H Rogier; Uyen, Nguyen Hanh; Van Tan, Le; Paris, Daniel H; Paris, Daniel; Blacksell, Stuart D; Amornchai, Premjit; Wuthiekanun, Vanaporn; Parry, Christopher M; Day, Nicholas P J; Kumar, Varun

    2013-01-01

    Febrile illnesses are pre-eminent contributors to morbidity and mortality among children in South-East Asia but the causes are poorly understood. We determined the causes of fever in children hospitalised in Siem Reap province, Cambodia. A one-year prospective study of febrile children admitted to Angkor Hospital for Children, Siem Reap. Demographic, clinical, laboratory and outcome data were comprehensively analysed. Between October 12(th) 2009 and October 12(th) 2010 there were 1225 episodes of febrile illness in 1180 children. Median (IQR) age was 2.0 (0.8-6.4) years, with 850 (69%) episodes in children <5 years. Common microbiological diagnoses were dengue virus (16.2%), scrub typhus (7.8%), and Japanese encephalitis virus (5.8%). 76 (6.3%) episodes had culture-proven bloodstream infection, including Salmonella enterica serovar Typhi (22 isolates, 1.8%), Streptococcus pneumoniae (13, 1.1%), Escherichia coli (8, 0.7%), Haemophilus influenzae (7, 0.6%), Staphylococcus aureus (6, 0.5%) and Burkholderia pseudomallei (6, 0.5%). There were 69 deaths (5.6%), including those due to clinically diagnosed pneumonia (19), dengue virus (5), and melioidosis (4). 10 of 69 (14.5%) deaths were associated with culture-proven bloodstream infection in logistic regression analyses (odds ratio for mortality 3.4, 95% CI 1.6-6.9). Antimicrobial resistance was prevalent, particularly in S. enterica Typhi, (where 90% of isolates were resistant to ciprofloxacin, and 86% were multi-drug resistant). Comorbid undernutrition was present in 44% of episodes and a major risk factor for acute mortality (OR 2.1, 95% CI 1.1-4.2), as were HIV infection and cardiac disease. We identified a microbiological cause of fever in almost 50% of episodes in this large study of community-acquired febrile illness in hospitalized children in Cambodia. The range of pathogens, antimicrobial susceptibility, and co-morbidities associated with mortality described will be of use in the development of rational

  19. Recording of hospitalizations for acute exacerbations of COPD in UK electronic health care records

    Directory of Open Access Journals (Sweden)

    Rothnie KJ

    2016-11-01

    Full Text Available Kieran J Rothnie,1,2 Hana Müllerová,3 Sara L Thomas,2 Joht S Chandan,4 Liam Smeeth,2 John R Hurst,5 Kourtney Davis,3 Jennifer K Quint1,2 1Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK; 2Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; 3Respiratory Epidemiology, GlaxoSmithKline R&D, Uxbridge, London; 4Medical School, 5UCL Respiratory, University College London, London, UK Background: Accurate identification of hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD within electronic health care records is important for research, public health, and to inform health care utilization and service provision. We aimed to develop a strategy to identify hospitalizations for AECOPD in secondary care data and to investigate the validity of strategies to identify hospitalizations for AECOPD in primary care data. Methods: We identified patients with chronic obstructive pulmonary disease (COPD in the Clinical Practice Research Datalink (CPRD with linked Hospital Episodes Statistics (HES data. We used discharge summaries for recent hospitalizations for AECOPD to develop a strategy to identify the recording of hospitalizations for AECOPD in HES. We then used the HES strategy as a reference standard to investigate the positive predictive value (PPV and sensitivity of strategies for identifying AECOPD using general practice CPRD data. We tested two strategies: 1 codes for hospitalization for AECOPD and 2 a code for AECOPD other than hospitalization on the same day as a code for hospitalization due to unspecified reason. Results: In total, 27,182 patients with COPD were included. Our strategy to identify hospitalizations for AECOPD in HES had a sensitivity of 87.5%. When compared with HES, using a code suggesting hospitalization for AECOPD in CPRD resulted in a PPV of 50.2% (95

  20. A critical evaluation of the validity of episodic future thinking: A clinical neuropsychology perspective.

    Science.gov (United States)

    Ward, Amanda M

    2016-11-01

    Episodic future thinking is defined as the ability to mentally simulate a future event. Although episodic future thinking has been studied extensively in neuroscience, this construct has not been explored in depth from the perspective of clinical neuropsychology. The aim of this critical narrative review is to assess the validity and clinical implications of episodic future thinking. A systematic review of episodic future thinking literature was conducted. PubMed and PsycInfo were searched through July 2015 for review and empirical articles with the following search terms: "episodic future thinking," "future mental simulation," "imagining the future," "imagining new experiences," "future mental time travel," "future autobiographical experience," and "prospection." The review discusses evidence that episodic future thinking is important for adaptive functioning, which has implications for neurological populations. To determine the validity of episodic future thinking, the construct is evaluated with respect to related constructs, such as imagination, episodic memory, autobiographical memory, prospective memory, narrative construction, and working memory. Although it has been minimally investigated, there is evidence of convergent and discriminant validity for episodic future thinking. Research has not addressed the incremental validity of episodic future thinking. Practical considerations of episodic future thinking tasks and related constructs in a clinical neuropsychological setting are considered. The utility of episodic future thinking is currently unknown due to the lack of research investigating the validity of episodic future thinking. Future work is discussed, which could determine whether episodic future thinking is an important missing piece in standard clinical neuropsychological assessment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  1. Oxcarbazepine for acute affective episodes in bipolar disorder.

    Science.gov (United States)

    Vasudev, Akshya; Macritchie, Karine; Vasudev, Kamini; Watson, Stuart; Geddes, John; Young, Allan H

    2011-12-07

    groups, SMD=0.18, 95% CI -0.24 to 0.59, 2 studies, n=90, P=0.40). No primary or secondary efficacy outcome measures were found comparing oxcarbazepine with lithium monotherapy.As an adjunctive treatment to lithium, oxcarbazepine reduced depression rating scale scores more than carbamazepine in a group of manic participants on the Montgomery-Åsberg Depression Rating Scale (MADRS) (SMD=- 1.12, 95% CI -1.71 to -0.53, 1 study, n=52, P=0.0002) and on the Hamilton Depression Rating Scale (HDRS) (SMD=- 0.77, 95% CI -1.35 to -0.20, 1 study, n=52, P=0.008).There was a higher incidence of adverse effects, particularly neuropsychiatric, in participants randomised to oxcarbazepine compared to those on placebo (1 study, n=115, 17% to 39% of participants on oxcarbazepine had at least one such event compared to 7% to 10% on placebo).There was no difference in adverse events rates between oxcarbazepine and other mood stabilisers or haloperidol. Currently, there are insufficient trials of adequate methodological quality on oxcarbazepine in the acute treatment of bipolar disorder to inform us on its efficacy and acceptability. Studies predominantly examine the treatment of mania: there are data from subgroup analysis on mixed affective, hypomania and rapid-cycling states.From the few studies included in this review, oxcarbazepine did not differ in efficacy compared to placebo in children and adolescents. It did not differ from other active agents in adults. It may have a poorer tolerability profile compared to placebo. No data were found on outcomes relevant to patients and clinicians, such as length of hospital admission.  There is a need for adequately powered randomised controlled trials of good methodological quality to inform us of the therapeutic potential of oxcarbazepine across the spectrum of acute episodes in bipolar disorder.

  2. Investigating the episodic buffer

    Directory of Open Access Journals (Sweden)

    Alan Baddeley

    2010-10-01

    Full Text Available A brief account is presented of the three-component working memory model proposed by Baddeley and Hitch. This is followed by an account of some of the problems it encountered in explaining how information from different subsystems with different codes could be combined, and how it was capable of communicating with long-term memory. In order to account for these, a fourth component was proposed, the episodic buffer. This was assumed to be a multidimensional store of limited capacity that can be accessed through conscious awareness. In an attempt to test and develop the concept, a series of experiments have explored the role of working memory in the binding of visual features into objects and verbal sequences into remembered sentences. The experiments use a dual task paradigm to investigate the role of the various subcomponents of working memory in binding. In contrast to our initial assumption, the episodic buffer appears to be a passive store, capable of storing bound features and making them available to conscious awareness, but not itself responsible for the process of binding.

  3. White matter integrity as a predictor of response to treatment in first episode psychosis.

    Science.gov (United States)

    Reis Marques, Tiago; Taylor, Heather; Chaddock, Chris; Dell'acqua, Flavio; Handley, Rowena; Reinders, A A T Simone; Mondelli, Valeria; Bonaccorso, Stefania; Diforti, Marta; Simmons, Andrew; David, Anthony S; Murray, Robin M; Pariante, Carmine M; Kapur, Shitij; Dazzan, Paola

    2014-01-01

    The integrity of brain white matter connections is central to a patient's ability to respond to pharmacological interventions. This study tested this hypothesis using a specific measure of white matter integrity, and examining its relationship to treatment response using a prospective design in patients within their first episode of psychosis. Diffusion tensor imaging data were acquired in 63 patients with first episode psychosis and 52 healthy control subjects (baseline). Response was assessed after 12 weeks and patients were classified as responders or non-responders according to treatment outcome. At this second time-point, they also underwent a second diffusion tensor imaging scan. Tract-based spatial statistics were used to assess fractional anisotropy as a marker of white matter integrity. At baseline, non-responders showed lower fractional anisotropy than both responders and healthy control subjects (P psychosis. These data, together with earlier findings on cortical grey matter, suggest that grey and white matter integrity at the start of treatment is an important moderator of response to antipsychotics. These findings can inform patient stratification to anticipate care needs, and raise the possibility that antipsychotics may restore white matter integrity as part of the therapeutic response.

  4. Study of cluster headache: A hospital-based study

    Directory of Open Access Journals (Sweden)

    Amita Bhargava

    2014-01-01

    Full Text Available Introduction: Cluster headache (CH is uncommon and most painful of all primary headaches, and continues to be managed suboptimally because of wrong diagnosis. It needs to be diagnosed correctly and specifically treated. There are few studies and none from this region on CH. Materials and Methods: To study the detailed clinical profile of CH patients and to compare them among both the genders. Study was conducted at Mahatma Gandhi hospital, Jodhpur (from January 2011to December 2013. Study comprises 30 CH patients diagnosed according to International Headache Society guidelines (ICHD-II. Routine investigations and MRI brain was done in all patients. All measurements were reported as mean ± SD. Categorical variables were compared using the Chi-square test, and continuous variables were compared using Student′s t-test. SPSS for Windows, Version 16.0, was used for statistical analyses with the significance level set at P = 0.05. Results: M: F ratio was 9:1. Age at presentation was from 22-60 years (mean - 38 years. Latency before diagnosis was 3 months-12 years (mean - 3.5 years. All suffered from episodic CH and aura was found in none. Pain was strictly unilateral (right-19, left-11, predominantly over temporal region-18 (60%. Pain intensity was severe in 27 (90% and moderate in 3 (10%. Pain quality was throbbing in 12 (40%. Peak intensity was reached in 5 minutes-30 minutes and attack duration varied from 30 minutes to 3 hours (mean - 2.45 hours. Among autonomic features, conjunctival injection-23 (76.6% and lacrimation-25 (83.3% were most common. Restlessness during episode was found in 80%. CH duration varied from 10 days to 12 weeks. Circadian periodicity for attacks was noted in 24 (80%. Conclusion: Results are consistent with other studies on many accounts, but is different from Western studies with respect to low frequency of family history, chronic CH, restlessness and aura preceeding the attack. Detailed elicitation of history is

  5. Five-year economic evaluation of non-melanoma skin cancer surgery at the Costa del Sol Hospital (2006-2010).

    Science.gov (United States)

    Aguilar-Bernier, M; González-Carrascosa, M; Padilla-España, L; Rivas-Ruiz, F; Jiménez-Puente, A; de Troya-Martín, M

    2014-03-01

    The cost associated with treatment of non-melanoma skin cancer is expected to rise considerably over the coming decades. This important public health problem is therefore expected to have an enormous economic impact for the various public health services. To estimate the cost of the surgical-care process of non-melanoma skin cancer at the Costa del Sol Hospital and seek areas to improve its efficiency, using the activity-based costing (ABC) method and the tools designed for decision analysis. To compare the costs for hospitalized patients obtained using the ABC method with the data published by the Spanish Ministry of Health, using the diagnosis-related groups (DRG) classification system. Retrospective analysis of the cost of non-melanoma skin cancer surgery at the Costa del Sol Hospital. The total estimated cost from 2006 to 2010 was 3 398 540€. Most of the episodes (47.3%) corresponded to minor outpatient surgery. The costs of the episodes varied greatly according to the type of admission: 423€ (minor outpatient surgery), 1267€ (major outpatient surgery), and 1832€ (inpatient surgery). The average cost of an inpatient episode varied significantly depending on the calculation system used (ABC: 2328€ vs. DRG: 5674€). The ABC cost analysis system favours standardization of the care process for these tumours and the detection of areas to improve efficiency. This would enable more reliable economic studies than those obtained using traditional methods, such as the DRG. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.

  6. Modelling episodic acidification of surface waters: the state of science.

    Science.gov (United States)

    Eshleman, K N; Wigington, P J; Davies, T D; Tranter, M

    1992-01-01

    Field studies of chemical changes in surface waters associated with rainfall and snowmelt events have provided evidence of episodic acidification of lakes and streams in Europe and North America. Modelling these chemical changes is particularly challenging because of the variability associated with hydrological transport and chemical transformation processes in catchments. This paper provides a review of mathematical models that have been applied to the problem of episodic acidification. Several empirical approaches, including regression models, mixing models and time series models, support a strong hydrological interpretation of episodic acidification. Regional application of several models has suggested that acidic episodes (in which the acid neutralizing capacity becomes negative) are relatively common in surface waters in several regions of the US that receive acid deposition. Results from physically based models have suggested a lack of understanding of hydrological flowpaths, hydraulic residence times and biogeochemical reactions, particularly those involving aluminum. The ability to better predict episodic chemical responses of surface waters is thus dependent upon elucidation of these and other physical and chemical processes.

  7. Determinants of Market Share of For-Profit Hospitals: An Empirical Examination

    Directory of Open Access Journals (Sweden)

    Seungchul Lee

    2017-10-01

    Full Text Available This study estimates the effects of a prospective payment system on the growth of for-profit hospitals. The empirical results show that the proportion of patient care paid for by Medicare managed care has a positive, statistically significant relationship with the market share of for-profit hospitals. Medicare managed care reimburses health care providers prospectively, and a larger portion of prospective reimbursements is received by for-profit hospitals, whose market share consequently increases. In addition, the proportion of patients with Medi-Cal and third party managed care has a positive, statistically significant relationship with the market share of for-profit hospitals.

  8. Sleep benefits in parallel implicit and explicit measures of episodic memory

    Science.gov (United States)

    Weber, Frederik D.; Wang, Jing-Yi; Born, Jan; Inostroza, Marion

    2014-01-01

    Research in rats using preferences during exploration as a measure of memory has indicated that sleep is important for the consolidation of episodic-like memory, i.e., memory for an event bound into specific spatio-temporal context. How these findings relate to human episodic memory is unclear. We used spontaneous preferences during visual exploration and verbal recall as, respectively, implicit and explicit measures of memory, to study effects of sleep on episodic memory consolidation in humans. During encoding before 10-h retention intervals that covered nighttime sleep or daytime wakefulness, two groups of young adults were presented with two episodes that were 1-h apart. Each episode entailed a spatial configuration of four different faces in a 3 × 3 grid of locations. After the retention interval, implicit spatio-temporal recall performance was assessed by eye-tracking visual exploration of another configuration of four faces of which two were from the first and second episode, respectively; of the two faces one was presented at the same location as during encoding and the other at another location. Afterward explicit verbal recall was assessed. Measures of implicit and explicit episodic memory retention were positively correlated (r = 0.57, P memory recall was associated with increased fast spindles during nonrapid eye movement (NonREM) sleep (r = 0.62, P memory benefits from sleep. PMID:24634354

  9. Hospital pharmacy workforce in Brazil.

    Science.gov (United States)

    Santos, Thiago R; Penm, Jonathan; Baldoni, André O; Ayres, Lorena Rocha; Moles, Rebekah; Sanches, Cristina

    2018-01-04

    This study aims to describe the distribution of the hospital pharmacy workforce in Brazil. Data were acquired, during 2016, through the Brazilian National Database of Healthcare Facilities (CNES). The following variables were extracted: hospital name, registry number, telephone, e-mail, state, type of institution, subtype, management nature, ownership, presence of research/teaching activities, complexity level, number of hospital beds, presence of pharmacists, number of pharmacists, pharmacist specialization. All statistical analyses were performed by IBM SPSS v.19. The number of hospitals with a complete registry in the national database was 4790. The majority were general hospitals (77.9%), managed by municipalities (66.1%), under public administration (44.0%), had no research/teaching activities (90.5%), classified as medium complexity (71.6%), and had no pharmacist in their team (50.6%). Furthermore, almost 60.0% of hospitals did not comply with the minimum recommendations of having a pharmacist per 50 hospital beds. The Southeast region had the highest prevalence of pharmacists, with 64.4% of hospitals having a pharmaceutical professional. This may have occurred as this region had the highest population to hospital ratio. Non-profit hospitals were more likely to have pharmacists compared to those under public administration and private hospitals. This study mapped the hospital pharmacy workforce in Brazil, showing a higher prevalence of hospital pharmacists in the Southeast region, and in non-profit specialized hospitals.

  10. Evaluation of service quality of hospital outpatient department services.

    Science.gov (United States)

    Chakravarty, Abhijit

    2011-07-01

    It has become essential for hospital managers to understand and measure consumer perspectives and service quality gaps, so that any perceived gap in delivery of service is identified and suitably addressed. A study was conducted at a peripheral service hospital to ascertain any service gap between consumer expectations and perceptions in respect of the hospital outpatient department (OPD) services. A cross-sectional study was conducted using SERVQUAL as the survey instrument, the instrument being validated for use in the hospital environment. Consumer ratings across 22 items of the survey instrument were collected in paired expectation and perception scores and then service quality gaps were identified and statistically analysed. Service quality gaps were identified to exist across all the five dimensions of the survey instrument, with statistically significant gaps across the dimensions of 'tangibles' and 'responsiveness.' The quality gaps were further validated by a total unweighted SERVQUAL score of (-) 1.63. The study concludes that significant service quality gaps existed in the delivery of the hospital OPD services, which need to be addressed by focused improvement efforts by the hospital management.

  11. Suicide attempts in major depressive episode: evidence from the BRIDGE-II-Mix study.

    Science.gov (United States)

    Popovic, Dina; Vieta, Eduard; Azorin, Jean-Michel; Angst, Jules; Bowden, Charles L; Mosolov, Sergey; Young, Allan H; Perugi, Giulio

    2015-11-01

    The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality. A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts. The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p suicide attempts. In the MDE-SA group, 75 patients (11.9%) fulfilled Diagnostic and Statistical Manual (DSM)-5 criteria for MDE with mixed features, and 250 patients (39.8%) fulfilled research-based diagnostic criteria for a mixed depressive episode. Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed depressive states could represent a major step in suicide prevention. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Implementation of Learning Organization Components in Ardabil Social Security Hospital

    OpenAIRE

    Azadeh Zirak

    2015-01-01

    This study aimed to investigate the implementation of learning organization characteristics based on Marquardt systematic model in Ardabil Social Security Hospital. The statistical population of this research was 234 male and female employees of Ardabil Social Security Hospital. For data collection, Marquardt questionnaire was used in the present study which its validity and reliability had been confirmed. Statistical analysis of hypotheses based on independent samples t-test showed that lear...

  13. Renal Impairment and Complication After Kidney Transplant at Queen Rania Abdulla Children's Hospital.

    Science.gov (United States)

    Almardini, Reham Issa; Salita, Ghazi Mohamad; Farah, Mahdi Qasem; Katatbeh, Issa Ahmad; Al-Rabadi, Katibh

    2017-02-01

    Kidney transplant is the treatment of choice for end-stage renal disease, but it is not without complications. We review the medical cause of significant renal impairment and complications that developed after kidney transplant in pediatric patients who required hospital admission and intervention and/or who were followed between 2007 and 2016. A retrospective noninterventional chart review study was conducted in pediatric patients who received a kidney transplant and/or followed at the nephrology clinic at Queen Rania Abdulla Children's Hospital between 2007 and 2016. In this study, 101 pediatric patients received a total of 103 transplants. Forty-eight patients (47%) experienced deterioration of kidney function out of a total of 53 episodes of complications; 37 of these episodes occurred early (0-6 mo after transplant), and 26 episodes occurred late. The causes of kidney function deterioration were surgical complications, acute tubular necrosis, cell- or antibody-mediated rejection, diabetes mellitus, urinary leak, recurrence of original disease, and chronic allograft nephropathy. Thirteen patients experienced graft loss; 50% of these losses were secondary to noncompliance to immunosuppressant medication treatment after transplant. A total of six patients died; 2 (23%) of these deaths occurred in the first week after transplant, whereas the other 4 patients died over a period of 10 years. Pediatric kidney transplant is not without complications; however, most of these complications are treatable and reversible. The most serious complications leading to graft loss and death occur early, in the first week after transplant. Improving immunosuppressant compliance after transplant would prevent 50% of graft losses.

  14. Considering the role of semantic memory in episodic future thinking: evidence from semantic dementia.

    Science.gov (United States)

    Irish, Muireann; Addis, Donna Rose; Hodges, John R; Piguet, Olivier

    2012-07-01

    Semantic dementia is a progressive neurodegenerative condition characterized by the profound and amodal loss of semantic memory in the context of relatively preserved episodic memory. In contrast, patients with Alzheimer's disease typically display impairments in episodic memory, but with semantic deficits of a much lesser magnitude than in semantic dementia. Our understanding of episodic memory retrieval in these cohorts has greatly increased over the last decade, however, we know relatively little regarding the ability of these patients to imagine and describe possible future events, and whether episodic future thinking is mediated by divergent neural substrates contingent on dementia subtype. Here, we explored episodic future thinking in patients with semantic dementia (n=11) and Alzheimer's disease (n=11), in comparison with healthy control participants (n=10). Participants completed a battery of tests designed to probe episodic and semantic thinking across past and future conditions, as well as standardized tests of episodic and semantic memory. Further, all participants underwent magnetic resonance imaging. Despite their relatively intact episodic retrieval for recent past events, the semantic dementia cohort showed significant impairments for episodic future thinking. In contrast, the group with Alzheimer's disease showed parallel deficits across past and future episodic conditions. Voxel-based morphometry analyses confirmed that atrophy in the left inferior temporal gyrus and bilateral temporal poles, regions strongly implicated in semantic memory, correlated significantly with deficits in episodic future thinking in semantic dementia. Conversely, episodic future thinking performance in Alzheimer's disease correlated with atrophy in regions associated with episodic memory, namely the posterior cingulate, parahippocampal gyrus and frontal pole. These distinct neuroanatomical substrates contingent on dementia group were further qualified by correlational

  15. The social location of heavy episodic alcohol consumption in the Victorian population.

    Science.gov (United States)

    Matthews, Sharon; Dietze, Paul; Room, Robin; Chikritzhs, Tanya; Jolley, Damien

    2013-03-01

    To examine heavy episodic drinking across demographic subgroups to identify where heavy episodic drinking is socially located in an Australian state. Cross-sectional survey, 2483 adult Victorians using Computer Assisted Telephone Interviewing. Two measures of heavy drinking were used: (i) heavy episodic drinking-more than five standard drinks at least weekly; and (ii) typically heavy drinking-50% or more of all drinking occasions involving consumption of 5+ standard drinks. Associations between heavy episodic drinking and eight potential sociodemographic correlates (gender, age, education, income, marital status, ethnic origin, religion and geographical remoteness) were examined. There were few significant correlates of heavy episodic drinking apart from gender and age, once gender and age were controlled. Men were more likely to report heavy episodic drinking than women, but this was attenuated in the measure of typically heavy drinking, suggesting that women reporting heavy episodic drinking were more likely to typically drink that much when they drank. Younger people were more likely to report weekly heavy episodic drinking and more likely to report engaging in this pattern on at least half of their drinking occasions, and this was also true for those unmarried or in de facto relationships. Those of Asian background were less likely to report heavy drinking. In multivariate analysis, the remaining sociodemographic variables were largely unrelated to the drinking measures. The study clearly shows that the prevalence of heavy episodic drinking varies particularly across gender and age groups in Victoria. These variations appear to hold across key sociodemographic variables such as income and education. © 2012 Australasian Professional Society on Alcohol and other Drugs.

  16. Intravenous magnesium sulfate for vaso-occlusive episodes in sickle cell disease.

    Science.gov (United States)

    Goldman, Ran D; Mounstephen, William; Kirby-Allen, Melanie; Friedman, Jeremy N

    2013-12-01

    Vaso-occlusive episodes (VOEs) are the most common complication of sickle cell disease in children. Treatment with magnesium seems to improve cellular hydration and may result in reduced vaso-occlusion. This study aimed to determine if intravenous (IV) magnesium sulfate (MgSO4) reduces length of stay (LOS) in hospital, pain scores, and cumulative analgesia when compared with placebo. Randomized, double-blind, placebo-controlled trial in children aged 4 to 18 years requiring admission to hospital with a sickle cell disease VOE requiring IV analgesia. Participating children received IV MgSO4 (100 mg/kg) every 8 hours or placebo in addition to standard therapy. We used a t test or Mann-Whitney test (continuous variables), Fisher's exact test, or χ2 test (frequencies). P values were considered significant if <.05, and 95% confidence intervals were calculated for the difference between groups. One hundred six children were randomly assigned to the study, and 104 were included. Fifty-one (49%) received MgSO4. Children's mean age was 12.4 years (range: 4-18 years; SD: 3.8 years), and 56 (54%) were females. There was no significant difference in the primary outcome measure, LOS in hospital, with a mean of 132.6 and 117.7 hours in the MgSO4 and placebo groups, respectively (P = .41). There was no significant difference between groups for the secondary outcomes of mean pain scores (4.9 ± 2.6 vs 4.8 ± 2.6, respectively; P = .92) or analgesic requirements (continuous morphine infusion [P = .928], boluses of IV morphine [P = .82], acetaminophen [P = .34], ibuprofen [P = .15], naproxen [P = .10]). Only minor adverse events were recorded in both groups. Pain at the infusion site was more common in the MgSO4 group. IV MgSO4 was well tolerated but had no effect on the LOS in hospital, pain scores, or cumulative analgesia use in admitted children with a VOE.

  17. The characteristics of Beijing aerosol during two distinct episodes: Impacts of biomass burning and fireworks

    International Nuclear Information System (INIS)

    Cheng, Yuan; Engling, Guenter; He, Ke-bin; Duan, Feng-kui; Du, Zhen-yu; Ma, Yong-liang; Liang, Lin-lin; Lu, Zi-feng; Liu, Jiu-meng; Zheng, Mei; Weber, Rodney J.

    2014-01-01

    The chemical composition of Beijing aerosol was measured during summer and winter. Two distinct episodes were identified. Water-soluble potassium (K + ) increased significantly during the firework episode in winter with an episode to non-episode ratio of 4.97, whereas the biomass burning (BB) episode in summer was characterized by high episode to non-episode ratios of levoglucosan (6.38) and K + (6.90). The BB and firework episodes had only a minor influence on the water-soluble OC (organic carbon) to OC ratio. Based on separate investigations of episode and non-episode periods, it was found that: (i) sulfate correlated strongly with both relative humidity and nitrate during the typical winter period presumably indicating the importance of the aqueous-phase oxidation of sulfur dioxide by nitrogen dioxide, (ii) oxalate and WSOC during both winter and summer in Beijing were mainly due to secondary formation, and (iii) high humidity can significantly enhance the formation potential of WSOC in winter. -- Highlights: • Two episodes were identified based on the chemical composition of Beijing aerosol. • Levoglucosan and K + increased significantly during the biomass burning episode. • The firework episode was characterized by high concentrations of K + . • WSOC and oxalate exhibited secondary nature during both summer and winter. • High humidity can significantly enhance the formation of WSOC in winter. -- This study suggests the benefits of investigating aerosol composition separately during episode and non-episode periods, and introducing organic tracers to the speciation measurements of PM 2.5

  18. A statistical survey of x-ray CT cases at the Clinic of Oral and Maxillofacial Radiology, Chiba Hospital, Tokyo Dental College

    International Nuclear Information System (INIS)

    Kitagawa, Hiromi; Wakoh, Mamoru; Shibuya, Hitoshi; Yamada, Masayuki; Harada, Takuya; Yamamoto, Kazuhiro; Makihara, Masahiro; Kuroyanagi, Kinya

    1997-01-01

    Statistical study was performed of x-ray CT cases at the Clinic of Oral and Maxillofacial Radiology, Chiba Hospital, Tokyo Dental College since a Toshiba CT Scanner TCT-700S was settled in 1988, until December 1994. Total number of cases photographed was 2645 cases, Male; 1447 (54.7%), Female; 1198 cases (45.3%). Total number of cases yearly photographed have increased every year. 95.43% of the cases were the diseases of oral surgery regions. X-ray CT has been used to malignant tumors (730 cases; 29.7%), cyst (435 cases; 17.7%), inflammation (362 cases; 14.7%), benign tumors (261 cases; 10.6%), injury (171 cases; 7.0%), salivary gland diseases (126 cases; 5.1%) and others. The number of tumors and cyst have been increasing every year. Average number of slices in every diseases were counted. Malignant tumor, injury, temporomandibular joint diseases, and congenital anomalies and malformations were counted many slices. Percentages of number of enhanced CT cases have been increased every year. Recently, number of enhanced CT cases have more number than non-enhanced CT cases. This attitude is correlated with the number of malignant tumors which have been increasing every year. Total number of cases of three dimensional imaging CT (3D-CT) was 316 cases. 3D-CT has been used to injury (146 cases; 46.2%), temporomandibular joint diseases (52 cases; 16.4%), congenital anomalies and malformations (49 cases; 15.5%), tumors (21 cases; 6.7%), cyst (13 cases; 4.1%) and others. The need of x-ray CT in our field and the tendency of dental treatment at Chiba Hospital might be changed in the future. In order to this situation, this type of statistical study will be performed again. (author)

  19. Retrospective study on structural neuroimaging in first-episode psychosis

    Directory of Open Access Journals (Sweden)

    Ricardo Coentre

    2016-05-01

    Full Text Available Background. No consensus between guidelines exists regarding neuroimaging in first-episode psychosis. The purpose of this study is to assess anomalies found in structural neuroimaging exams (brain computed tomography (CT and magnetic resonance imaging (MRI in the initial medical work-up of patients presenting first-episode psychosis. Methods. The study subjects were 32 patients aged 18–48 years (mean age: 29.6 years, consecutively admitted with first-episode psychosis diagnosis. Socio-demographic and clinical data and neuroimaging exams (CT and MRI were retrospectively studied. Diagnostic assessments were made using the Operational Criteria Checklist +. Neuroimaging images (CT and MRI and respective reports were analysed by an experienced consultant psychiatrist. Results. None of the patients had abnormalities in neuroimaging exams responsible for psychotic symptoms. Thirty-seven percent of patients had incidental brain findings not causally related to the psychosis (brain atrophy, arachnoid cyst, asymmetric lateral ventricles, dilated lateral ventricles, plagiocephaly and falx cerebri calcification. No further medical referral was needed for any of these patients. No significant differences regarding gender, age, diagnosis, duration of untreated psychosis, in-stay and cannabis use were found between patients who had neuroimaging abnormalities versus those without. Discussion. This study suggests that structural neuroimaging exams reveal scarce abnormalities in young patients with first-episode psychosis. Structural neuroimaging is especially useful in first-episode psychosis patients with neurological symptoms, atypical clinical picture and old age.

  20. Infectious episodes in runners before and after a roadrace.

    Science.gov (United States)

    Nieman, D C; Johanssen, L M; Lee, J W

    1989-09-01

    Various researchers have implied that regular and moderate exercise training may improve the ability of the immune system to protect the host from infection. In contrast, acute, maximal, and exhaustive exercise may have negative effects of the immune system. This study compared the incidence of infectious episodes in 273 runners during a two month training period prior to a 5 K, 10 K, or half-marathon race. In addition, the effect of the race experience on infectious episodes was studied. Twenty-five percent of the runners training more than 15 miles per week reported at least one infectious episode as compared with 34.3% of runners training less than 15 miles per week (p = 0.09). Only 6.8% of the runners preparing for the half-marathon race reported becoming sick with the flu versus 17.9% of the 5 K and 10 K runners (p = 0.067). During the week following the roadrace, runners did not report an increase in infectious episodes as compared to the week prior to the race. These trends suggest that runners with a more serious commitment to regular exercise may experience less infectious episodes than recreational runners because of both direct and indirect affects on immunosurveillance. In addition, the stressful race experience does not appear to increase risk of acquiring an acute respiratory infection.

  1. Career Decision-Making Processes of Young Adults With First-Episode Psychosis.

    Science.gov (United States)

    Boychuk, Christa; Lysaght, Rosemary; Stuart, Heather

    2018-05-01

    The first episode of psychosis often emerges during young adulthood, when individuals are pursuing important educational and career goals that can become derailed because of the development of major impairments. Past research has neglected the developmental nature of employment and education decisions that young adults with first-episode psychosis make within the context of their lives. The purpose of this grounded theory study was to advance a model of the career decision-making processes of young adults with first-episode psychosis, and the influences that affect their career decision-making. The career decision-making of young adults with first-episode psychosis emerged as a multistaged, iterative process that unfolded over three phases of illness, and was affected by several internal and environmental influences. These findings suggest the phase of illness and career decision-making stage should be considered in future vocational programming for young adults with first-episode psychosis.

  2. A comparative study of olanzapine versus asenapine in acute treatment of manic episode: A 3-week prospective study

    Directory of Open Access Journals (Sweden)

    Ajeet Sidana

    2014-01-01

    Full Text Available Introduction: Treatment of bipolar disorders has evolved over the years from conventional mood stabilizers to second-generation antipsychotics. Among the atypical antipsychotics, few have been approved by Food and Drug Administration as treatment of bipolar disorders. Aim: To study the efficacy and tolerability of olanzapine and asenapine in the acute treatment of bipolar disorder-manic episode in a 3-week randomized prospective study. Materials and Methods: A 3-week randomized, prospective, comparative, flexible doses of olanzapine (5-30 mg/day and asenapine (10-20 mg/day for acute treatment of bipolar disorder-current manic episode with or without psychotic symptoms in hospitalized patients. Results: The end-point reduction in mean score of Young Mania rating scale in the olanzapine group was 15.82 in comparison to 6.88 in the asenapine group. Mean score on clinical global impression for bipolar disorder and positive and negative syndrome scale was significantly less in the olanzapine group at the end of the study. 81.81% patients in olanzapine group and 17.60% patients in asenapine group had clinical response. There was significant average weight gain in the olanzapine group - 1.9 kg in comparison to 0.87 kg in asenapine group. Conclusion: The clinical response with olanzapine is significantly higher than the asenapine in the treatment of bipolar disorder-manic episode with or without psychotic symptoms. However, there is significant weight gain in olanzapine-treated patients.

  3. Large Variability in the Diversity of Physiologically Complex Surgical Procedures Exists Nationwide Among All Hospitals Including Among Large Teaching Hospitals.

    Science.gov (United States)

    Dexter, Franklin; Epstein, Richard H; Thenuwara, Kokila; Lubarsky, David A

    2017-11-22

    Multiple previous studies have shown that having a large diversity of procedures has a substantial impact on quality management of hospital surgical suites. At hospitals with substantial diversity, unless sophisticated statistical methods suitable for rare events are used, anesthesiologists working in surgical suites will have inaccurate predictions of surgical blood usage, case durations, cost accounting and price transparency, times remaining in late running cases, and use of intraoperative equipment. What is unknown is whether large diversity is a feature of only a few very unique set of hospitals nationwide (eg, the largest hospitals in each state or province). The 2013 United States Nationwide Readmissions Database was used to study heterogeneity among 1981 hospitals in their diversities of physiologically complex surgical procedures (ie, the procedure codes). The diversity of surgical procedures performed at each hospital was quantified using a summary measure, the number of different physiologically complex surgical procedures commonly performed at the hospital (ie, 1/Herfindahl). A total of 53.9% of all hospitals commonly performed 3-fold larger diversity (ie, >30 commonly performed physiologically complex procedures). Larger hospitals had greater diversity than the small- and medium-sized hospitals (P 30 procedures (lower 99% CL, 71.9% of hospitals). However, there was considerable variability among the large teaching hospitals in their diversity (interquartile range of the numbers of commonly performed physiologically complex procedures = 19.3; lower 99% CL, 12.8 procedures). The diversity of procedures represents a substantive differentiator among hospitals. Thus, the usefulness of statistical methods for operating room management should be expected to be heterogeneous among hospitals. Our results also show that "large teaching hospital" alone is an insufficient description for accurate prediction of the extent to which a hospital sustains the

  4. Episodic foresight and anxiety: Proximate and ultimate perspectives.

    Science.gov (United States)

    Miloyan, Beyon; Bulley, Adam; Suddendorf, Thomas

    2016-03-01

    In this paper, we examine the relationship between episodic foresight and anxiety from an evolutionary perspective, proposing that together they confer an advantage for modifying present moment decision-making and behaviour in the light of potential future threats to fitness. We review the body of literature on the role of episodic foresight in anxiety, from both proximate and ultimate perspectives. We propose that anxious feelings associated with episodic simulation of possible threat-related future events serve to imbue these simulations with motivational currency. Episodic and semantic details of a future threat may be insufficient for motivating its avoidance, but anxiety associated with a simulation can provoke adaptive threat management. As such, we detail how anxiety triggered by a self-generated, threat-related future simulation prepares the individual to manage that threat (in terms of its likelihood and/or consequences) over greater temporal distances than observed in other animals. We then outline how anxiety subtypes may represent specific mechanisms for predicting and managing particular classes of fitness threats. This approach offers an inroad for understanding the nature of characteristic future thinking patterns in anxiety disorders and serves to illustrate the adaptive function of the mechanism from which clinical anxiety deviates. © 2015 The British Psychological Society.

  5. Functional mapping of the neural basis for the encoding and retrieval of human episodic memory using H{sub 2}{sup 15}O PET

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Sung; Nam, Hyun Woo; Lee, Dong Soo; Lee, Sang Kun; Jang, Myoung Jin; Ahn, Ji Young; Park, Kwang Suk; Chung, June Key; Lee, Myung Chul [Seoul National Univ., Seoul (Korea, Republic of)

    2000-02-01

    Episodic memory is described as an 'autobiographical' memory responsible for storing a record of the events in our lives. We performed functional brain activation study using H{sub 2}{sup 1}5O PET to reveal the neural basis of the encoding and the retrieval of episodic memory in human normal volunteers. Four repeated H{sub 2}{sup 1}5O PET scans with two reference and two activation tasks were performed on 6 normal volunteers to activate brain areas engaged in encoding and retrieval with verbal materials. Images from the same subject were spatially registered and normalized using linear and nonlinear transformation. Using the means and variances for every condition which were adjusted with analysis of covariance, t-statistic analysis were performed voxel-wise. Encoding of episodic memory activated the opercular and triangular parts of left inferior frontal gyrus, right prefrontal cortex, medial frontal area, cingulate gyrus, posterior middle and inferior temporal gyri, and cerebellum, and both primary visual and visual association areas. Retrieval of episodic memory activated the triangular part of left inferior frontal gyrus and inferior temporal gyrus, right prefrontal cortex and medial temporal ares, and both cerebellum and primary visual and visual association areas. The activations in the opercular part of left inferior frontal gyrus and the right prefrontal cortex meant the essential role of these areas in the encoding and retrieval of episodic memeory. We could localize the neural basis of the encoding and retrieval of episodic memory using H{sub 2}{sup 1}5O PET, which was partly consistent with the hypothesis of hemispheric encoding/retrieval asymmetry.

  6. Subtypes of depressive episodes according to ICD-10

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2003-01-01

    a period from 1994 to 1999 were identified. The risk of relapse leading to readmission and the risk of committing suicide were compared for patients discharged with an ICD-10 diagnosis of a single depressive episode with and without melancholic syndrome and for patients with and without psychotic symptoms......BACKGROUND: The long-term predictive ability of the ICD-10 subtypes of depression with melancholic syndrome and depression with psychosis has not been investigated. SAMPLING AND METHODS: All patients in Denmark who had a diagnosis of a single depressive episode at their first ever discharge during......, respectively. RESULTS: In all, 1,639 patients had a diagnosis of depressive episode without psychotic symptoms, 1,275 patients a diagnosis with psychotic symptoms, 293 a diagnosis without melancholic syndrome, and 248 a diagnosis with melancholic symptoms at first discharge. The risk of relapse leading...

  7. The characteristics of Beijing aerosol during two distinct episodes: Impacts of biomass burning and fireworks

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Yuan [State Key Joint Laboratory of Environment Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing (China); Engling, Guenter [Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan (China); He, Ke-bin [State Key Joint Laboratory of Environment Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing (China); State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, Beijing (China); Duan, Feng-kui; Du, Zhen-yu; Ma, Yong-liang; Liang, Lin-lin; Lu, Zi-feng [State Key Joint Laboratory of Environment Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing (China); Liu, Jiu-meng [School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA (United States); Zheng, Mei [College of Environmental Sciences and Engineering, Peking University, Beijing (China); Weber, Rodney J. [School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA (United States)

    2014-02-15

    The chemical composition of Beijing aerosol was measured during summer and winter. Two distinct episodes were identified. Water-soluble potassium (K{sup +}) increased significantly during the firework episode in winter with an episode to non-episode ratio of 4.97, whereas the biomass burning (BB) episode in summer was characterized by high episode to non-episode ratios of levoglucosan (6.38) and K{sup +} (6.90). The BB and firework episodes had only a minor influence on the water-soluble OC (organic carbon) to OC ratio. Based on separate investigations of episode and non-episode periods, it was found that: (i) sulfate correlated strongly with both relative humidity and nitrate during the typical winter period presumably indicating the importance of the aqueous-phase oxidation of sulfur dioxide by nitrogen dioxide, (ii) oxalate and WSOC during both winter and summer in Beijing were mainly due to secondary formation, and (iii) high humidity can significantly enhance the formation potential of WSOC in winter. -- Highlights: • Two episodes were identified based on the chemical composition of Beijing aerosol. • Levoglucosan and K{sup +} increased significantly during the biomass burning episode. • The firework episode was characterized by high concentrations of K{sup +}. • WSOC and oxalate exhibited secondary nature during both summer and winter. • High humidity can significantly enhance the formation of WSOC in winter. -- This study suggests the benefits of investigating aerosol composition separately during episode and non-episode periods, and introducing organic tracers to the speciation measurements of PM{sub 2.5}.

  8. Episodic memory in detoxified alcoholics: contribution of grey matter microstructure alteration.

    Directory of Open Access Journals (Sweden)

    Sandra Chanraud

    Full Text Available Even though uncomplicated alcoholics may likely have episodic memory deficits, discrepancies exist regarding to the integrity of brain regions that underlie this function in healthy subjects. Possible relationships between episodic memory and 1 brain microstructure assessed by magnetic resonance diffusion tensor imaging (DTI, 2 brain volumes assessed by voxel-based morphometry (VBM were investigated in uncomplicated, detoxified alcoholics.Diffusion and morphometric analyses were performed in 24 alcohol dependent men without neurological or somatic complications and in 24 healthy men. The mean apparent coefficient of diffusion (ADC and grey matter volumes were measured in the whole brain. Episodic memory performance was assessed using a French version of the Free and Cued Selective Reminding Test (FCSRT. Correlation analyses between verbal episodic memory, brain microstructure, and brain volumes were carried out using SPM2 software.In those with alcohol dependence, higher ADC was detected mainly in frontal, temporal and parahippocampal regions, and in the cerebellum. In alcoholics, regions with higher ADC typically also had lower grey matter volume. Low verbal episodic memory performance in alcoholism was associated with higher mean ADC in parahippocampal areas, in frontal cortex and in the left temporal cortex; no correlation was found between regional volumes and episodic memory scores. Regression analyses for the control group were not significant.These findings support the hypothesis that regional microstructural but no macrostructural alteration of the brain might be responsible, at least in part, for episodic memory deficits in alcohol dependence.

  9. Episodic and Semantic Autobiographical Memory and Everyday Memory during Late Childhood and Early Adolescence.

    Science.gov (United States)

    Willoughby, Karen A; Desrocher, Mary; Levine, Brian; Rovet, Joanne F

    2012-01-01

    Few studies have examined both episodic and semantic autobiographical memory (AM) performance during late childhood and early adolescence. Using the newly developed Children's Autobiographical Interview (CAI), the present study examined the effects of age and sex on episodic and semantic AM and everyday memory in 182 children and adolescents. Results indicated that episodic and semantic AM both improved between 8 and 16 years of age; however, age-related changes were larger for episodic AM than for semantic AM. In addition, females were found to recall more episodic AM details, but not more semantic AM details, than males. Importantly, this sex difference in episodic AM recall was attenuated under conditions of high retrieval support (i.e., the use of probing questions). The ability to clearly visualize past events at the time of recollection was related to children's episodic AM recall performance, particularly the retrieval of perceptual details. Finally, similar age and sex effects were found between episodic AM and everyday memory ability (e.g., memory for everyday activities). More specifically, older participants and females exhibited better episodic AM and everyday memory performance than younger participants and males. Overall, the present study provides important new insight into both episodic and semantic AM performance, as well as the relation between episodic AM and everyday memory, during late childhood and adolescence.

  10. Episodic and Semantic Autobiographical Memory and Everyday Memory during Late Childhood and Early Adolescence

    Science.gov (United States)

    Willoughby, Karen A.; Desrocher, Mary; Levine, Brian; Rovet, Joanne F.

    2012-01-01

    Few studies have examined both episodic and semantic autobiographical memory (AM) performance during late childhood and early adolescence. Using the newly developed Children’s Autobiographical Interview (CAI), the present study examined the effects of age and sex on episodic and semantic AM and everyday memory in 182 children and adolescents. Results indicated that episodic and semantic AM both improved between 8 and 16 years of age; however, age-related changes were larger for episodic AM than for semantic AM. In addition, females were found to recall more episodic AM details, but not more semantic AM details, than males. Importantly, this sex difference in episodic AM recall was attenuated under conditions of high retrieval support (i.e., the use of probing questions). The ability to clearly visualize past events at the time of recollection was related to children’s episodic AM recall performance, particularly the retrieval of perceptual details. Finally, similar age and sex effects were found between episodic AM and everyday memory ability (e.g., memory for everyday activities). More specifically, older participants and females exhibited better episodic AM and everyday memory performance than younger participants and males. Overall, the present study provides important new insight into both episodic and semantic AM performance, as well as the relation between episodic AM and everyday memory, during late childhood and adolescence. PMID:22403560

  11. [Possibilities of preventive therapy in frequent episodic tension-type headache].

    Science.gov (United States)

    Tabeeva, G R; Fokina, N M

    2016-01-01

    To study the efficacy and safety of tenoten in the preventive treatment of frequent episodic tension-type headache (FETHA) compared to patients treated with pain relievers. A study included 60 patients with FETHA. Patients of the main group (n=30) received tenoten in addition to standard treatment. The study comprised 3 visits: beginning of treatment, after one month and after three months. All patients underwent physical and clinical/neurological examinations. In each visit, treatment efficacy was assessed according the following parameters: VAS scores (0-10) for assessment of pain and tension in pericranial muscles in 6 standard points, mean frequency and duration of the headache episode, quality of life indices, Beck depression scores, Spilberger trait and state anxiety, autonomic symptom severity, parameters of sleep disorders, frequency of adverse effects, CGI scores (0-7). Tenoten as a preventive medication reduced the frequency of headache episodes that allowed to diagnose patients with rare episodic tension-type headache in the end of treatment. At the same time, there was a significant reduction in headache intensity during the episode and decrease in amount of analgesics used by the patients.

  12. Visual Hallucinations in First-Episode Psychosis: Association with Childhood Trauma.

    Science.gov (United States)

    Solesvik, Martine; Joa, Inge; Larsen, Tor Ketil; Langeveld, Johannes; Johannessen, Jan Olav; Bjørnestad, Jone; Anda, Liss Gøril; Gisselgård, Jens; Hegelstad, Wenche Ten Velden; Brønnick, Kolbjørn

    2016-01-01

    Hallucinations are a core diagnostic criterion for psychotic disorders and have been investigated with regard to its association with childhood trauma in first-episode psychosis samples. Research has largely focused on auditory hallucinations, while specific investigations of visual hallucinations in first-episode psychosis remain scarce. The aims of this study were to describe the prevalence of visual hallucinations, and to explore the association between visual hallucination and childhood trauma in a first-episode psychosis sample. Subjects were included from TIPS-2, a first episode psychosis study in south Rogaland, Norway. Based on the medical journal descriptions of the Positive and Negative Symptoms Scale (PANSS), a separate score for visual and auditory hallucinations was created (N = 204). Patients were grouped according to hallucination severity (none, mild, and psychotic hallucinations) and multinomial logistic regression was performed to identify factors associated with visual hallucination group. Visual hallucinations of a psychotic nature were reported by 26.5% of patients. The experience of childhood interpersonal trauma increased the likelihood of having psychotic visual hallucinations. Visual hallucinations are common in first-episode psychosis, and are related to childhood interpersonal trauma.

  13. Remembering in Contradictory Minds: Disjunction Fallacies in Episodic Memory

    Science.gov (United States)

    Brainerd, C. J.; Reyna, V. F.; Aydin, C.

    2010-01-01

    Disjunction fallacies have been extensively studied in probability judgment. They should also occur in episodic memory, if remembering a cue's episodic state depends on how its state is described on a memory test (e.g., being described as a target vs. as a distractor). If memory is description-dependent, cues will be remembered as occupying…

  14. REDEFINING ENSO EPISODES BASED ON CHANGED CLIMATE REFERENCES

    Institute of Scientific and Technical Information of China (English)

    LI Xiao-yan; ZHAI Pan-mao; REN Fu-min

    2005-01-01

    Through studying changes in ENSO indices relative to change of climate reference from 1961~1990 to 1971~2000, the study generated new standards to define ENSO episodes and their intensities. Then according to the new climate references and new index standards, ENSO episodes and their intensities for the period 1951 -2003 have been classified. Finally, an analysis has been performed comparing the new characteristics with the old ones for ENSO period, peak values and intensities.

  15. Diatom diversity in chronically versus episodically acidified adirondack streams

    Science.gov (United States)

    Passy, S.I.; Ciugulea, I.; Lawrence, G.B.

    2006-01-01

    The relationship between algal species richness and diversity, and pH is controversial. Furthermore, it is still unknown how episodic stream acidification following atmospheric deposition affects species richness and diversity. Here we analyzed water chemistry and diatom epiphyton dynamics and showed their contrasting behavior in chronically vs. episodically acidic streams in the Adirondack region. Species richness and diversity were significantly higher in the chronically acidic brown water stream, where organic acidity was significantly higher and the ratio of inorganic to organic monomeric aluminum significantly lower. Conversely, in the episodically acidic clear water stream, the inorganic acidity and pH were significantly higher and the diatom communities were very species-poor. This suggests that episodic acidification in the Adirondacks may be more stressful for stream biota than chronic acidity. Strong negative linear relationships between species diversity, Eunotia exigua, and dissolved organic carbon against pH were revealed after the influence of non-linear temporal trends was partialled out using a novel way of temporal modeling. ?? 2006 WILEY-VCH Verlag GmbH & Co. KGaA.

  16. Intermittent hypoxic episodes in preterm infants: do they matter?

    Science.gov (United States)

    Martin, Richard J; Wang, Katherine; Köroğlu, Ozge; Di Fiore, Juliann; Kc, Prabha

    2011-01-01

    Intermittent hypoxic episodes are typically a consequence of immature respiratory control and remain a troublesome challenge for the neonatologist. Furthermore, their frequency and magnitude are underestimated by clinically employed pulse oximeter settings. In extremely low birth weight infants the incidence of intermittent hypoxia progressively increases over the first 4 weeks of postnatal life, with a subsequent plateau followed by a slow decline beginning at weeks 6-8. Such episodic hypoxia/reoxygenation has the potential to sustain a proinflammatory cascade with resultant multisystem morbidity. This morbidity includes retinopathy of prematurity and impaired growth, as well as possible longer-term cardiorespiratory instability and poor neurodevelopmental outcome. Therapeutic approaches for intermittent hypoxic episodes comprise determination of optimal baseline saturation and careful titration of supplemental inspired oxygen, as well as xanthine therapy to prevent apnea of prematurity. In conclusion, characterization of the pathophysiologic basis for such intermittent hypoxic episodes and their consequences during early life is necessary to provide an evidence-based approach to their management. Copyright © 2011 S. Karger AG, Basel.

  17. Episodic Future Thinking in Semantic Dementia: A Cognitive and fMRI Study

    Science.gov (United States)

    Viard, Armelle; Piolino, Pascale; Belliard, Serge; de La Sayette, Vincent; Desgranges, Béatrice; Eustache, Francis

    2014-01-01

    Semantic dementia (SD) is characterized by gradual loss of semantic memory. While episodic autobiographical memory seems relatively preserved, behavioral studies suggest that episodic future thinking is impaired. We used fMRI to measure brain activity in four SD patients (JPL, EP, LL, EG) while they envisioned future events and remembered personal past events. Twelve healthy elders served as controls. Episodic quality, emotion, mental imagery and level of consciousness (via remember/know judgements) were checked at debriefing. We analyzed the future compared to the past for each patient. All patients presented lateral temporal atrophy, but varied in terms of frontal and anterior hippocampal atrophy. Patient JPL presented atrophy in bilateral superior medial frontal gyri and left anterior hippocampus and was unable to engage in episodic future thinking, despite hyperactivations in frontal and occipital regions. Patient EP presented no atrophy in the anterior hippocampus, but atrophy in bilateral superior medial frontal gyrus and had difficulties to engage in episodic future thinking. Patient LL presented atrophy in left anterior hippocampus, but hyperactivated its right counterpart for future compared to past thinking, permitting her to project efficiently in the future in an episodic way. Patient EG presented no atrophy in the superior medial frontal gyri or anterior hippocampi and was able to engage in episodic future thinking. Altogether, patients' future projections differed depending on the severity and localization of their atrophy. The functional integrity of bilateral superior medial frontal gyri and anterior hippocampus appear crucial for episodic future thinking: atrophy of both structures strongly impairs future projection, while integrity of these structures or hyperactivation of residual tissue normalizes episodic future projection. PMID:25333997

  18. Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals.

    Science.gov (United States)

    Le Monnier, A; Duburcq, A; Zahar, J-R; Corvec, S; Guillard, T; Cattoir, V; Woerther, P-L; Fihman, V; Lalande, V; Jacquier, H; Mizrahi, A; Farfour, E; Morand, P; Marcadé, G; Coulomb, S; Torreton, E; Fagnani, F; Barbut, F

    2015-10-01

    The impact of Clostridium difficile infection (CDI) on healthcare costs is significant due to the extra costs of associated inpatient care. However, the specific contribution of recurrences has rarely been studied. The aim of this study was to estimate the hospital costs of CDI and the fraction attributable to recurrences in French acute-care hospitals. A retrospective study was performed for 2011 on a sample of 12 large acute-care hospitals. CDI costs were estimated from both hospital and public insurance perspectives. For each stay, CDI additional costs were estimated by comparison to controls without CDI extracted from the national DRG (diagnosis-related group) database and matched on DRG, age and sex. When CDI was the primary diagnosis, the full cost of stay was used. A total of 1067 bacteriological cases of CDI were identified corresponding to 979 stays involving 906 different patients. Recurrence(s) were identified in 118 (12%) of these stays with 51.7% of them having occurred within the same stay as the index episode. Their mean length of stay was 63.8 days compared to 25.1 days for stays with an index case only. The mean extra cost per stay with CDI was estimated at €9,575 (median: €7,514). The extra cost of CDI in public acute-care hospitals was extrapolated to €163.1 million at the national level, of which 12.5% was attributable to recurrences. The economic burden of CDI is substantial and directly impacts healthcare systems in France. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  19. Interdependence of episodic and semantic memory: evidence from neuropsychology.

    Science.gov (United States)

    Greenberg, Daniel L; Verfaellie, Mieke

    2010-09-01

    Tulving's (1972) theory of memory draws a distinction between general knowledge (semantic memory) and memory for events (episodic memory). Neuropsychological studies have generally examined each type of memory in isolation, but theorists have long argued that these two forms of memory are interdependent. Here we review several lines of neuropsychological research that have explored the interdependence of episodic and semantic memory. The studies show that these forms of memory can affect each other both at encoding and at retrieval. We suggest that theories of memory should be revised to account for all of the interdependencies between episodic and semantic memory; they should also incorporate forms of memory that do not fit neatly into either category.

  20. Pattern of cognitive impairment after giving total intravenous anaesthesia vs general anesthesia for electroconvulsive therapy in patients with depressive episode severe

    International Nuclear Information System (INIS)

    Malik, U.E.; Ahmed, N.; Hyder, R.R.

    2017-01-01

    To study the pattern of cognitive impairment after giving total intravenous anesthesia Vs general anesthesia for ECT for patients of Depressive Episode Severe. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Skardu, from 15 Jul 2015 till 15 Jan 2016. Material and Methods: Hundred patients fulfilling the inclusion criteria were included by consecutive sampling technique for this study and divided in to two groups of 50 each. Patients of group A were given TIVA (propofol + succinylcholine). Patients in group B received GA (propofol + succinylcholine + isoflurane). Cognitive functions of patient were assessed by psychiatrist via mini mental state examination (MMSE) test before ECT and two weeks after ECT respectively. Results: Both the groups were assessed for cognitive impairment after TIVA Vs GA. In group A the MMSE showed less cognitive impairment as compared to group B (p<0.05). Conclusion: Cognitive impairment is less in total intravenous anesthesia as compared to general anesthesia for ECT in patients of depressive episode severe. (author)