Turner, Stephanie B; Stanton, Marietta P
The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. While there are not a large number of studies available on this topic
Pompili, Enrico; Silvestrini, Cristiana; Nicolò, Giuseppe; Pitino, Annalisa; Bernabei, Laura
Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.
M. Grypdonck; prof Berno van Meijel; M. de Leeuw
The concept of a working alliance is rooted in psychotherapy and has been studied extensively in that field. Much less research has been conducted into working alliances between chronic psychiatric patients and their case managers. The aim of this review was to identify what is known about the
Carbonnel, François; David, Michel; Norton, Joanna; Bourrel, Gérard; Boulenger, Jean-Philippe; Capdevielle, Delphine
Objective: Describe and analyse the experience of family physicians in managing current psychiatric disorders to obtain a better understanding of the underlying reasons of under-detection and inadequate prescribing identified in studies. Methods: A qualitative study using in-depth interviews. Sample of 15 practicing family physicians, recruited by telephone from a precedent cohort (Sesame1) with a maximum variation: sex, age, single or group practice, urban or rural. Qualitative method is inspired by the completed grounded theory of a verbatim semiopragmatic analysis from 2 experts in this approach. Results: Family physicians found that current psychiatric disorders were related to psychological symptoms in reaction to life events. Their role was to make patients aware of a psychiatric symptom rather than establish a diagnosis. Their management responsibility was considered in contrasting ways: it was claimed or endured. They defined their position as facilitating compliance to psychiatrist consultations, while assuring a complementary psychotherapeutic approach. Prescribing medication was not a priority for them. Conclusions: The identified under-detection is essentially due to inherent frontline conditions and complexity of clinical forms. The family physician role, facilitating compliance to psychiatrist consultations while assuring a support psychotherapy is the main result of this study. More studies should be conducted to define more accurately the clinical reality, management and course of current psychiatric disorders in primary care.
Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital. NSZ Tema, ABR Janse van Rensburg. Abstract. Background. Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or ...
Liu, Wen-I; Rong, Jiin-Ru; Liu, Chieh-Yu
E-learning is a flexible strategy to improve nurses' knowledge of case management, but there are methodological limitations in previous research into the effectiveness of such programs. To describe the development and effectiveness of an evidence-integrated e-learning program in case management continuing education for Taiwanese psychiatric nurses. Multiple methods were adopted to develop the program and a randomised controlled trial with repeated measures was employed to evaluate it. The e-learning program was developed in four stages: (1) systematic review of literature; (2) needs assessment through a national survey and focus group; (3) development of learning materials; and (4) pilot test. Following program development, psychiatric nurses were recruited and randomly allocated into an experimental or comparison group. The experimental group participated in an e-learning continuing education program. The case management knowledge index with sufficient reliability and validity and a satisfaction survey were used to determine the outcomes. A generalised estimating equation was used to assess the difference between the 2 groups before, after, and at 3 months follow-up. The learning material comprised 5 simulated learning modules, self-assessment questions, learning cases, sharing experiences, and learning resources. A total of 200 participants completed the 3 measurements. Knowledge scores in the experimental group significantly exceeded those in the comparison group after the program and at the 3-month follow-up. Participants reported positive learning perceptions. The program provides an evidence-based educational resource for nursing continuing education in case management. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available Scientific bacground: It has been reported that; Multiple Sclerosis (MS may be presented with many psychiatric symptoms such as anxiety, depression, mania and psychosis. MS cases, presented with psychiatric symptoms were also reported. Cases: Two MS cases, diagnosed as psychotic and bipolar disorder respectively, were reported in this paper. Both of the cases were responded to the steroid treatment, and neurological and psychiatric examinations were found to be normal after one month. CONCLUSION: MS cases might be presented with psychiatric complaints and symptoms except neurological ones. We conclude that; psychiatric evaluation as well as the neurological evaluation is important in the MS cases presented with psychiatric symptoms
Woodward, Judy; Rice, Eve
Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. Copyright © 2015 Elsevier Inc. All rights reserved.
Alejandro Jiménez Genchi
Full Text Available It has been estimated that 5% of suicides occur inside of the psychiatric institutions. This report describes two cases of suicide inside of a psychiatric hospital which illustrate, on one hand, the characteristics of suicidal risk among psychiatric inpatients, and on the other hand, the limitations, we may have, to prevent suicide. The rate of suicides inside psychiatric hospitals are explained by the very low presentation of this behavior, among patients and the poor specificity for suicidal risk, that may provide the clinical evaluation with standard clinical criteria . Nevertheless, hospitalization in psychiatric institutions avoids more suicide attempts and suicides than those are committed inside of them.
Lindor, Rachel A; Campbell, Ronna L; Pines, Jesse M; Melin, Gabrielle J; Schipper, Agnes M; Goyal, Deepi G; Sadosty, Annie T
Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Full Text Available Taryn Heck,1 Monica Zolezzi21Pharmacy Department, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada; 2Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, QatarAbstract: Psychiatric disorders and obstructive sleep apnea (OSA are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms.Keywords: obstructive sleep apnea, psychiatric disorders, comorbidity, psychotropic medications
Veretilo, Pavel; Billick, Stephen Bates
There is relatively little content available addressing the use of social media, such as Facebook in psychiatric populations. There has been significant growth of various social media websites in the last 10 years, such as Facebook, and yet little is written about their overall impact on this population. There are articles in the scientific literature about the use of social media in adolescents and young adults and also about its use among physicians and medical students. This article reviews the literature addressing social media and describes a therapeutic interaction with a patient with significant psychiatric comorbities and his use of social media. Furthermore, this is a unique example in current literature of an overall positive interaction and social improvement of this patient in large degree due to his use of Facebook. Physicians themselves must be very cautious in their interaction with patients online and especially via social media, while acknowledging that social media can serve as a spring board for more reclusive patients into greater societal integration.
Lazignac, Coralie; Ricou, Bara; Dan, Liviu; Virgillito, Salvatore; Adam, Eric; Seyedi, Majid; Cicotti, Andrei; Azi, Amine; Damsa, Cristian
This paper discusses the importance of psychiatric guidelines and the position of the psychiatrist in the management of agitation in the intensive care unit. The use of psychiatric validated scales to assess agitation seems to ameliorate the quality of care in psychiatry, but also in intensive care. Psychiatric experts' recommendations for managing agitation are given, which is useful to create an open discussion with the intensivists. The use of sedative medication to protect the patient, staff and to prevent an escalation of violence remains a personal choice for each practitioner, depending on individual patient needs and context. In the treatment of agitated patients, an equilibrium needs to be found between the subjective dimension and the available data from evidence based medicine.
Full Text Available Background. Huntington disease occurrs rarely, it can be encountered not only by neurologists and psychiatrists but also by other medical practitioners. Its characteristic features are involuntary movements, cognitive disorders and gradual development of dementia. Diagnosis is given on the basis of these clinical features, positive familial anamnesis, with the laboratory exclusion of other neuropsychiatric diseases and with the help of neuroimaging methods (in particular NMR. The disease can be only confirmed by means of genetic analysis.Patients and methods. In this article, four cases of patients with Huntington disease and diverse psychiatric disorders that were hospitalised at the psychiatric department of the Maribor General Hospital between October 2002 and March 2003 are described. All the patients fulfilled the valid criteria for the diagnosis of Huntington disease. However, they differed according to their accompanying psychiatric psychopathology, age and social problems.Conclusions. The purpose of this article is to draw attention to different psychiatric symptoms and clinical manifestations of Huntington disease that are often misleading in the diagnostic process. In addition, exigency of early diagnostics, guidelines for referrals to genetic testing and psychiatric monitoring of these patients are emphasised.
Full Text Available Background: Autism Spectrum Disorder (ASD is an early neurodevelopmental disorder that accompanies the individual throughout life. There is a significant clinical overlap of ASD with other psychiatric disorders including personality disorders, psychotic disorders, obsessive-compulsive disorder and depression. Additionally, the presence of high rates of psychiatric comorbidity, often with atypical presentations, delays the ASD diagnosis and makes it more difficult to manage. Aims: To illustrate the complexity of ASD diagnosis and approach in adults. Methods: Report of a clinical case and review of the literature. Results and Conclusion: This paper presents the case of a 46-year-old patient, with ASD, with a long history of interpersonal difficulties and psychiatric symptomatology. Over the years, different diagnoses have been made, particularly schizoid and schizotypal personality disorders, psychosis not otherwise specified and paranoid schizophrenia, which led to poor adherence to treatment, and prevented a full understanding of the patient’s clinical presentation and lifelong struggles.
Jacques, Denis; Dubois, Thomas; Zdanowicz, Nicolas; Gilain, Chantal; Garin, Pierre
It is important to perform psychiatric assessments of adult patients who are candidates for cochlear implants both to screen them for psychiatric disorders and to assess their understanding and compliance with the procedure. Deafness is a factor of difficulty for conducting in-depth psychiatric interviews, but concomitant blindness may make it impossible. After a description of Norrie disease, a rare disease in which blindness and deafness may occur together, we propose a case report of a patient suffering from the disease and who consulted in view of a cochlear implant. Early information on cochlear implants appears to be necessary before total deafness occurs in patients suffering from Norrie disease. An inventory of digital communication tools that can be used by the patient is also highly valuable. Research should be supported for a more systematic use of psychiatric assessments prior to cochlear implants. In the special case of Norrie disease, we recommend early screening for mental retardation and related psychotic disorders and, depending on the patient's level of understanding, preventive information on the benefits and limits of cochlear implants before total deafness occurs.
Full Text Available BACKGROUND: There is poor knowledge about the epidemiology of toxocariasis in psychiatric patients. AIMS: Determine the seroepidemiology of Toxocara infection in psychiatric patients. METHODS: Through a case-control seroprevalence study, 128 psychiatric inpatients and 276 control subjects were compared for the presence of anti-Toxocara IgG antibodies in Durango, Mexico. Socio-demographic, clinical, and behavioral characteristics of inpatients associated with toxocariasis were also investigated. RESULTS: Six of the 128 (4.7% psychiatric inpatients, and 3 (1.1% of the 276 controls were positive for anti-Toxocara IgG antibodies (P = 0.03. Stratification by age showed that Toxocara seroprevalence was significantly (P = 0.02 higher in patients aged ≤50 years old (6/90∶6.7% than controls of the same age (2/163∶1.2%. While Toxocara seroprevalence was similar in patients and controls aged >50 years old. Stratification by gender showed that Toxocara seroprevalence was significantly (P = 0.03 higher in female patients (2/37∶5.4% than in female controls (0/166∶0%. No statistically significant associations between Toxocara seropositivity and clinical characteristics were found. In contrast, Toxocara seropositivity was associated with consumption of goat meat and raw sea snail. CONCLUSIONS: This is the first report of toxocariasis in psychiatric inpatients in Mexico. Further studies with larger sample sizes are needed to elucidate the association of toxocariasis with psychiatric diseases. The role of the consumption of goat meat and raw sea snail in the transmission of Toxocara deserve further investigation.
of medicine: 'the psychosomatic unity of the body and ... ¹ Department of Psychiatry, Faculty of Health Sciences, University of the ... assessment, and was more likely to be managed in the medical wards for delirium, ... and ongoing interaction between mental disorders and general ..... such as hallucinations and delusions.
Talih, Farid; Ajaltouni, Jean
The misuse of nootropics—any substance that may alter, improve, or augment cognitive performance, mainly through the stimulation or inhibition of certain neurotransmitters—may potentially be dangerous and deleterious to the human brain, and certain individuals with a history of mental or substance use disorders might be particularly vulnerable to their adverse effects. We describe four cases of probable nootropic-induced psychiatric adverse effects to illustrate this theory. To the best of ou...
Sabry, Walaa M; Vohra, Adarsh
With the significant growth of the Muslim population all over the world, there exists a corresponding increase in the need for mental health services that suit this group of patients. Research demonstrates the effectiveness of the integration of spirituality and religiosity into psychotherapy and how religious beliefs could affect the management plans. This article discusses the impact of various beliefs in the Islamic faith on the bio-psychosocial model for the management of different psychiatric disorders including focusing on the modification of psychotherapeutic techniques as cognitive restructuring. It also shows other types of therapies such as music therapy, meditation therapy, and aromatherapy. The main emphasis remains to ensure that Muslim psychiatric patients get ethical, acceptable, and effective treatment.
Uchiyama, Makoto; Suzuki, Masahiro; Konno, Chisato; Furihata, Ryuji; Osaki, Koichi; Konno, Michiko; Takahashi, Sakae
Most psychiatric disorders, such as schizophrenia, mood disorders, or neurotic disorders are associated with sleep disorders of various kinds, among which insomnia is most prevalent and important in psychiatric practice. Almost all patients suffering from major depression complain of insomnia. Pharmacological treatment of insomnia associated with major depression shortens the duration to achieve remission of depression. Insomnia has been recently reported to be a risk factor for depression. Hypersomnia is also a major sleep problem in patient suffering from depression. There have been no clinical guide to treat the symptoms of hypersomnia in depression, but some clinical trials treating them with NDRI or adjunctive administration of psychostimulants. In patients with schizophrenia, insomnia is often an early indicator of the aggravation of psychotic symptoms. Electroencephalographic sleep studies have also revealed sleep abnormalities characteristic to mood disorders, schizophrenia and anxiety disorders. A shortened REM sleep latency has been regarded as a biological marker of depression. Reduced amount of deep Non-REM sleep has been reported to be correlated with negative symptoms of schizophrenia. Recently, REM sleep abnormalities were found in teenagers having post-traumatic stress disorder after a boat accident. Although these facts indicate that insomnia plays an important role in the development of psychiatric disorders, there are few hypotheses explaining the cause and effect of insomnia in these disorders. Here, we reviewed recent articles on insomnia and hypersomnia associated with psychiatric disorders together with their clinical managements.
Ezura, Michinori; Kakisaka, Yosuke; Jin, Kazutaka; Kato, Kazuhiro; Iwasaki, Masaki; Fujikawa, Mayu; Aoki, Masashi; Nakasato, Nobukazu
We present a case of epilepsy with multiple types of focal seizures that were misdiagnosed as psychiatric disorders. A 20-year-old female patient presented with a variety of episodes, including loss of consciousness, deja vu, fear, delusion of possession, violent movements, and generalized convulsions. Each of these symptoms appeared in a stereotypic manner. She was initially diagnosed with a psychiatric disorder and treated with psychoactive medications, which had no effect. Long-term video electroencephalography revealed that her episodes of violent movement with impaired consciousness and secondarily generalized seizure were epileptic events originating in the right hemisphere. High-field brain magnetic resonance imaging for detecting subtle lesions revealed bilateral lesions from periventricular nodular heterotopia. Her final diagnosis was right hemispheric focal epilepsy. Carbamazepine administration was started, which successfully controlled all seizures. The present case demonstrates the pitfall of diagnosing focal epilepsy when it presents with multiple types of psychiatric aura. Epilepsy should thus be included in differential diagnoses, considering the stereotypic nature of symptoms, to avoid misdiagnosis.
Journal of the American Academy of Child & Adolescent Psychiatry, 2009
An introduction for any medical health clinician on the knowledge and skills that are needed for the psychiatric assessment and management of physically ill children and adolescents is presented. These parameters are presented to assist clinicians in psychiatric decision making.
Portzky, Gwendolyn; Audenaert, Kurt; van Heeringen, Kees
This study aimed at the investigation of psychosocial and psychiatric risk factors of adolescent suicide by means of a case-control psychological autopsy study. Relatives and other informants of 19 suicide victims and 19 matched psychiatric controls were interviewed by means of a semi-structured interview schedule. Psychiatric controls included…
Full Text Available Hashimoto's encephalopathy (HE may often present initially with psychiatric symptoms. These presentations are often variable in clinical aspects, and there has been no systematic analysis of the numerous psychiatric presentations heralding an eventual diagnosis of HE which will guide clinicians to make a correct diagnosis of HE. This systematic review was done to analyze the demographic characteristics, symptom typology, and clinical and treatment variables associated with such forerunner presentations. Electronic databases such as PubMed, ScienceDirect, and Google Scholar databases were searched to identify potential case reports that described initial psychiatric presentations of HE in English language peer-reviewed journals. The generated articles were evaluated and relevant data were extracted using a structured tool. We identified a total of forty articles that described 46 cases. More than half of the total samples (54.4% were above the age of 50 years at presentation. The most common psychiatric diagnosis heralding HE was acute psychosis (26.1% followed by depressive disorders (23.9%. Dementia (10.9% and schizophrenia (2.2% were uncommon presentations. Antithyroid peroxidase antibodies were elevated in all patients but not antithyroglobulin antibodies. Preexisting hypothyroidism was absent in majority of cases (60.9%. Steroid doses initiated were 500–1000 mg of intravenous methylprednisolone for majority (52.1% of patients while oral steroid maintenance was required for a significant minority (39.1%. Psychiatric manifestations of HE may be heterogeneous and require a high index of clinical suspicion, especially in older adults. A range of clinical and treatment variables may assist clinicians in making a faster diagnosis and instituting prompt and effective management.
Rasmussen, Sean A; Rosebush, Patricia I; Smyth, Harley S; Mazurek, Michael F
We report the case of a woman with long-standing refractory depression and psychotic features who was eventually diagnosed with Cushing disease. After surgical treatment of a pituitary adenoma, she experienced gradual psychiatric recovery and was eventually able to discontinue all psychotropic medication. We review the psychiatric components of Cushing disease, implications of psychiatric illnesses for the treatment and prognosis of Cushing disease, and potential pathophysiological mechanisms linking glucocorticoid excess to psychiatric illness.
Bui, Quan M.
Full Text Available We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. [West J Emerg Med. 2015;16(3:414–417.
Fennig, S; Fennig, S
The aim of this work is to present the role of a medical-psychiatric unit in the treatment of chronic resistant encopresis in adolescence as an effective alternative to the standard approach. Four case reports are presented. The integrative program is based on full patient cooperation and involves separating the patient from the family environment and the use of medical intervention combined with modified behavioral therapy and parental education and guidance. The patient is given full responsibility for the cure. The median full hospital stay for our patients was 2 weeks, and outcome in all cases was complete remission. This experience suggests that chronic resistant encopresis in adolescents requires a different approach from the standard because of the patient's developmental stage and the often hostile family dynamics. A medical-psychiatric setting provides an excellent management milieu and can lead to a dramatic improvement in this chronic disabling condition.
Full Text Available Objective: Psoriasis is a chronic, relapsing and disfiguring dermatological disorder with a significant effect on occupational, social, and other areas of functioning. Psychological stress has been known to have a significant role in the onset and exacerbation of this illness. To study the prevalence of psychiatric morbidity in psoriasis and the influence of specified demographic, psychological, social and illness-related variables. Methods: The study was carried out at a tertiary care hospital in a large urban setup. In this case–control study, 100 cases of psoriasis were studied in comparison with healthy controls who were matched for sociodemographic profile. The participants were given a sociodemographic questionnaire, clinical profile sheet, and psoriasis area and severity index (PASI. General Health Questionnaire-12 (GHQ-12 was used to screen for psychological distress, and subsequently, Hospital Anxiety and Depression Scale for screening for depression and anxiety and World Health Organization Quality of Life-BREF scale for assessing the quality of life (QOL were administered. The results obtained were analyzed for evaluating the psychiatric morbidity and its various correlates. Appropriate statistical analysis was done using SPSS 21. Results: Using GHQ-12 cutoff score (≥3 for psychological distress, the overall prevalence of psychological distress was significantly more in cases of in comparison to healthy controls with an odds ratio of 8.54 (95% confidence interval 3.16–23.07, P < 0.0001. Statistical analysis showed a statistically significant correlation of educational status with QOL and severity of skin lesions (PASI with anxiety level. Severe skin lesions, more so on visible body parts were associated more commonly with psychological distress. Conclusions: All patients of psoriasis should be educated about the nature of the illness and screened for psychological distress. Dermatologists and family members should be educated to
Mufaddel, Amir; Alsabousi, Mouza; Salih, Badr; Alhassani, Ghanem; Osman, Ossama T
We report a case of a 34-year-old male who presented with an acute onset of pleomorphic psychiatric features. Upon examination we later diagnosed him with Gorlin-Goltz syndrome based on clinical and radiological findings that are characteristic for this rare autosomal dominant syndrome. His psychiatric manifestations included irritability, aggressive behavior, labile mood, hallucinations, paranoid delusions, and transient cognitive impairment. His past history indicated surgical excision of pigmented lesion in the left lower eyelid which turned out to be a basal cell carcinoma. His past visits to dermatology clinics indicated pitted keratosis involving hands, callosities, and seborrheic dermatitis. There were numerous palmar pits, and Brain CT Head scan revealed extensive calcification along falx cerebri and around the cerebellar vermis. He had low (20 ng/L) vitamin D level and high parathyroid hormone level. The patient improved using antipsychotic medications and vitamin D supplementations for symptomatic management and was discharged with a plan for multispecialty outpatient follow-up. This case highlights the importance of considering rare organic etiologies in the differential diagnosis of patients presenting with psychiatric symptoms. This is of vital importance for early intervention to prevent complications and for better outcomes of the coexistent diseases.
Full Text Available We report a case of a 34-year-old male who presented with an acute onset of pleomorphic psychiatric features. Upon examination we later diagnosed him with Gorlin-Goltz syndrome based on clinical and radiological findings that are characteristic for this rare autosomal dominant syndrome. His psychiatric manifestations included irritability, aggressive behavior, labile mood, hallucinations, paranoid delusions, and transient cognitive impairment. His past history indicated surgical excision of pigmented lesion in the left lower eyelid which turned out to be a basal cell carcinoma. His past visits to dermatology clinics indicated pitted keratosis involving hands, callosities, and seborrheic dermatitis. There were numerous palmar pits, and Brain CT Head scan revealed extensive calcification along falx cerebri and around the cerebellar vermis. He had low (20 ng/L vitamin D level and high parathyroid hormone level. The patient improved using antipsychotic medications and vitamin D supplementations for symptomatic management and was discharged with a plan for multispecialty outpatient follow-up. This case highlights the importance of considering rare organic etiologies in the differential diagnosis of patients presenting with psychiatric symptoms. This is of vital importance for early intervention to prevent complications and for better outcomes of the coexistent diseases.
Huang, Hui-Man; Sun, Fan-Ko
Psychiatric nurses have a special obligation and legal duty as guarantor against criminal negligence. The guarantor role and medical negligence in psychiatric nursing are topics that have been neglected in Taiwan. (1) Identify the status of psychiatric nurses as guarantors; (2) Understand the causal relationship in a legal context between this status and Non-Genuine Omission in the current case; (3) Understand the facts and the dispute in the current case. (4) Explore the reasons why the psychiatric nurse was convicted for criminal negligence in the current case. A literature review and case study were used to analyze the high court criminal judgment and sentence reconsideration of the first instance No. 122 (2005). (1) Psychiatric nurses hold two guarantor roles in Taiwan. One role is as legally protected interest guarantor and the other is as supervisors' dangerous source guarantor. (2) The three sources of guarantor status relevant to the current case are: nurses' voluntary commitments; medical contract; duty of care of supervisors. (3) In this case, the psychiatric nurse did not discharge her obligations as guarantor and failed to prevent the patient from committing suicide. Negligence resulted in patient death and the psychiatric nurse was found guilty. In order to prevent criminal acts, psychiatric nurses should gain a better understanding of their status as guarantor and the obligations entailed in this status. This article is intended to assist psychiatric nurses understand their responsibilities under current laws.
Vieta, Eduard; Garriga, Marina; Cardete, Laura; Bernardo, Miquel; Lombraña, María; Blanch, Jordi; Catalán, Rosa; Vázquez, Mireia; Soler, Victòria; Ortuño, Noélia; Martínez-Arán, Anabel
Psychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode. Spanish experts in PMA from different disciplines (psychiatrists, psychologists and nurses) convened in Barcelona for a meeting in April 2016. Based on recently issued international consensus guidelines on the standard of care for psychiatric patients with PMA, the meeting provided the opportunity to address the complexities in the assessment and management of PMA from different perspectives. The attendees worked towards producing a consensus for a unified approach to PMA according to the local standards of care and current local legislations. The draft protocol developed was reviewed and ratified by all members of the panel prior to its presentation to the Catalan Society of Psychiatry and Mental Health, the Spanish Society of Biological Psychiatry (SEPB) and the Spanish Network Centre for Research in Mental Health (CIBERSAM) for input. The final protocol and algorithms were then submitted to these organizations for endorsement. The protocol presented here provides guidance on the appropriate selection and use of pharmacological agents (inhaled/oral/IM), seclusion, and physical restraint for psychiatric patients suspected of or presenting with PMA. The protocol is applicable within the Spanish healthcare system. Implementation of the protocol and the constituent algorithms described here should ensure the best standard of care of patients at risk of PMA. Episodes of PMA could be identified earlier in their clinical course and patients could be managed in
Kerzner, Harold R
A new edition of the most popular book of project management case studies, expanded to include more than 100 cases plus a ""super case"" on the Iridium Project Case studies are an important part of project management education and training. This Fourth Edition of Harold Kerzner''s Project Management Case Studies features a number of new cases covering value measurement in project management. Also included is the well-received ""super case,"" which covers all aspects of project management and may be used as a capstone for a course. This new edition:Contains 100-plus case studies drawn from re
Full Text Available Shizhen Zhang,* Peng Li,* Zhujun Zhang, Wei WangDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China *These authors contributed equally to this workAbstract: Stuttering is characterized by disrupted fluency of verbal expression, and occurs mostly in children. Persistent developmental stuttering (PDS may occur in adults. Reports of the surgical management of PDS are limited. Here we present the case of a 28-year-old man who had had PDS since the age of 7 years, was diagnosed with depression and anxiety disorder at the age of 24 years, and had physical concomitants. He underwent a bilateral anterior capsulotomy 4 years after the diagnosis. Over one year of follow-up, his physical concomitants resolved, and significant improvements in his psychiatric disorders and PDS were observed. To the best of our knowledge, this is the first report of simultaneous improvement in a patient's PDS and psychiatric disorder after a bilateral anterior capsulotomy.Keywords: persistent developmental stuttering, psychiatric disorders, anterior capsulotomy
Zografos George C
Full Text Available Abstract Introduction Vacuum-assisted breast biopsy is a minimally invasive technique that has been used increasingly in the treatment of mammographically detected, non-palpable breast lesions. Clip placement at the biopsy site is standard practice after vacuum-assisted breast biopsy. Case presentation We present the case of a 62-year-old woman with suspicious microcalcifications in her left breast. The patient was informed about vacuum-assisted breast biopsy, including clip placement. During the course of taking the patient's history, she communicated excellently, her demeanor was normal, she disclosed no intake of psychiatric medication and had not been diagnosed with any psychiatric disorders. Subsequently, the patient underwent vacuum-assisted breast biopsy (11 G under local anesthesia. A clip was placed at the biopsy site. The pathological diagnosis was of sclerosing adenosis. At the 6-month mammographic follow-up, the radiologist mentioned the existence of the metallic clip in her breast. Subsequently, the woman presented complaining about "being spied [upon] by an implanted clip in [her] breast" and repeatedly requested the removal of the clip. The patient was referred to the specialized psychiatrist of our breast unit for evaluation. The Mental State Examination found that systematized paranoid ideas of persecutory type dominated her daily routines. At the time, she believed that the implanted clip was one of several pieces of equipment being used to keep her under surveillance, the other equipment being her telephone, cameras and television. Quite surprisingly, she had never had a consultation with a mental health professional. The patient appeared depressed and her insight into her condition was impaired. The prevalent diagnosis was schizotypal disorder, whereas the differential diagnosis comprised delusional disorder of persecutory type, affective disorder with psychotic features or comorbid delusional disorder with major depression
Unal, Fatih; Pehlivantürk, Berna
Although encopresis is a common and complex disorder, relatively few studies have evaluated the comorbid psychiatric disorders in this condition. This study was performed to investigate the comorbid psychiatric disorders in encopresis. One hundred and sixty boys (79.6%) and 41 girls (20.4%) fulfilled the diagnostic criteria for encopresis according to DSM-IV. There was at least one comorbid diagnosis in 149 (74.1%) patients. The most frequent comorbid diagnosis was enuresis (55.2%). Clinical and demographical data were compared between patients with comorbid disorders and others. Primary encopresis was significantly more frequent in patients with comorbid disorders, and the mean age at admission was lower in these patients. The mean interval between the onset of symptoms and the diagnosis was significantly shorter in secondary encopretic patients with comorbid disorders. Furthermore, there were significantly more psychiatric disorders in the first-degree relatives of patients with comorbid disorders. Encopresis is frequently accompanied with a psychiatric disorder. Clinicians need to inquire about symptoms of other psychiatric disorders in patients who present with encopresis and vice versa.
Dierickx, Sigrid; Deliens, Luc; Cohen, Joachim; Chambaere, Kenneth
Euthanasia for people who are not terminally ill, such as those suffering from psychiatric disorders or dementia, is legal in Belgium under strict conditions but remains a controversial practice. As yet, the prevalence of euthanasia for people with psychiatric disorders or dementia has not been studied and little is known about the characteristics of the practice. This study aims to report on the trends in prevalence and number of euthanasia cases with a psychiatric disorder or dementia diagnosis in Belgium and demographic, clinical and decision-making characteristics of these cases. We analysed the anonymous databases of euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia from the implementation of the euthanasia law in Belgium in 2002 until the end of 2013. The databases we received provided the information on all euthanasia cases as registered by the Committee from the official registration forms. Only those with one or more psychiatric disorders or dementia and no physical disease were included in the analysis. We identified 179 reported euthanasia cases with a psychiatric disorder or dementia as the sole diagnosis. These consisted of mood disorders (N = 83), dementia (N = 62), other psychiatric disorders (N = 22) and mood disorders accompanied by another psychiatric disorder (N = 12). The proportion of euthanasia cases with a psychiatric disorder or dementia diagnosis was 0.5% of all cases reported in the period 2002-2007, increasing from 2008 onwards to 3.0% of all cases reported in 2013. The increase in the absolute number of cases is particularly evident in cases with a mood disorder diagnosis. The majority of cases concerned women (58.1% in dementia to 77.1% in mood disorders). All cases were judged to have met the legal requirements by the Committee. While euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder or dementia remains a comparatively limited practice in Belgium, its
De la Rey, Mark Edward
The aim of the research was to explore the subjective experience of patients admitted to a psychiatric hospital. Sub-aims were to explore how these experiences relate to self management, stress and psychological well-being. This study was motivated by research literature that documents a wide variety of negative experiences by patients. A recent psychiatric patient survey conducted in England and Wales (Mind, 2004) found that more than 50% of respondents indicated that hospital...
Background: Psychiatric emergencies are commonly encountered by the emergency room team where non-mental health specialists are often the first care providers. Materials and Methods: The study took place at the University of Ibadan Health Service, it was a descriptive cross-sectional study and participants were ...
Full Text Available Adult onset urea cycle disorders (UCD may present with psychiatric symptoms, occasionally as the initial presentation. We aimed to describe the characteristics of patients presenting with a psychiatric adult-onset of UCDs, to discuss which signs could suggest this diagnosis in such a situation, and to determine which tests should be conducted. A survey of psychiatric symptoms occurring in teenagers or adults with UCD was conducted in 2010 among clinicians involved in the French society for the study of inborn errors of metabolism (SFEIM. Fourteen patients from 14 to 57 years old were reported. Agitation was reported in 10 cases, perseveration in 5, delirium in 4, and disinhibition in 3 cases. Three patients had pre-existing psychiatric symptoms. All patients had neurological symptoms associated with psychiatric symptoms, such as ataxia or dysmetria, psychomotor slowing, seizures, or hallucinations. Fluctuations of consciousness and coma were reported in 9 cases. Digestive symptoms were reported in 7 cases. 9 patients had a personal history suggestive of UCD. The differential diagnoses most frequently considered were exogenous intoxication, non-convulsive status epilepticus, and meningoencephalitis. Hyperammonemia (180–600 μmol/L was found in all patients. The outcome was severe: mechanical ventilation was required in 10 patients, 5 patients died, and only 4 patients survived without sequelae. Adult onset UCDs can present with predominant psychiatric symptoms, associated with neurological involvement. These patients, as well as patients presenting with a suspicion of intoxication, must have UCD considered and ammonia measured without delay.
Knebel, Elisa; Kolodner, Jennifer
The need to isolated health providers with critical knowledge in tuberculosis (TB) case management prompted the development of "Tuberculosis Case Management" CD-ROM. Features include "Learning Center,""Examination Room," and "Library." The combination of audio, video, and graphics allows participants to…
Bankston White, Cheri; Birmingham, Jackie
Purpose and Objectives: Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the “moving parts” of such a complex role. This is Part 2 of a two-part article written for case management directors, particularly new ones. Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes. This article attempts to answer the following questions: Are case management directors prepared for an expanded role that affects departments and organizations outside of their own?How does a case management director manage the transition of care of patients while managing required relationships outside the department?How does the director manage program outcomes in such a complex department? Primary Practice Setting: The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Findings/Conclusions: Part 1 found that case management directors would benefit from further research and documentation of “best practices” related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations
Terranova, Claudio; Rocca, Gabriele
Interest in psychiatrists' professional liability in Italy has increased in recent years because of the number of medical malpractice claims. Professional liability for failure to prevent violent behaviour by psychiatric patients is particularly debated. This study describes three Italian cases in which health professionals - physicians and nurses - were found guilty of manslaughter for murders committed by psychiatric patients. Examination of the cases focuses on claims of malpractice, patients' characteristics, the circumstances of the homicide and the reasons for the court's judgment. In particular, the predictability of violent behaviour and the concept of causal links are examined in detail. The cases provide an opportunity for a study of comparative jurisprudence. The topics discussed are relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of criminal acts committed by psychiatric patients. © The Author(s) 2015.
Paccione-Dyszlewski, Margaret R; Conelea, Christine A; Heisler, Walter C; Vilardi, Jodie C; Sachs, Henry T
Behavioral crisis management, including the use of seclusion and restraint, is the most high risk process in the psychiatric care of children and adolescents. The authors describe hospital-wide programmatic changes implemented at a children's psychiatric hospital that aimed to improve the quality of crisis management services. Pre/post quantitative and qualitative data suggest reduced restraint and seclusion use, reduced patient and staff injury related to crisis management, and increased patient satisfaction during the post-program period. Factors deemed beneficial in program implementation are discussed.
, current episode manic without psychotic symptoms constituted 17.2% of the cases, while 9.4% were cases of Mental and Behavioural Disorder due to Psychoactive Substance Use. Other cases included depressive illness, mania and delirium.
Patry, L; Guillem, E; Pontonnier, F; Ferreri, M
We report on the case of a 20 year old woman with no previous psychiatric history, who displayed a first episode of catatonia with acute onset. Symptoms started plainly with sudden general impairment, intense asthenia, headache, abdominal pain and confusion. After 48 hours, the patient was first admitted to an emergency unit and transferred to an internal medicine ward afterwards. She kept confused. Her behaviour was bizarre with permanent swinging of pelvis, mannerism, answers off the point and increasingly poor. The general clinical examination was normal, except for the presence of a regular tachycardia (120 bpm). The paraclinical investigations also showed normal: biology, EEG, CT Scan, lumbar puncture. Confusion persisted. The patient remained stuporous, with fixed gazing and listening-like attitudes. She managed to eat and move with the help of nurses but remained bedridden. The neurological examination showed hypokinaesia, extended hypotonia, sweating, urinary incontinence, bilateral sharp reflexes with no Babinski's sign and an inexhaustible nasoorbicular reflex. The patient was mute and contrary, actively closed her eyes, but responded occasionally to simple instructions. For short moments, she suddenly engaged in inappropriate behaviors (wandering around) while connecting back to her environment answering the telephone and talking to her parents. The patient's temperature rose twice in the first days but with no specific etiology found. During the first 8 days of hospitalization, an antipsychotic treatment was administered: haloperidol 10 mg per os daily and cyamemazine 37.5 mg i.m. daily. Despite these medications, the patient worsened and was transferred to our psychiatric unit in order to manage this catatonic picture with rapid onset for which no organic etiology was found. On admission, the patient was stuporous, immobile, unresponsive to any instruction, with catalepsy, maintenance of postures, severe negativism and refusal to eat. A first treatment
Bentholm, Anette Lisbeth
A case study: Inclusion for children with psychiatric diagnosis in physical education (PE) at primary school.Research bagground and aim:A large majority in the Danish parliament decided in 2012 that more children with special needs for example children with psychiatric diagnosis as autism spectrum...... activities at least 45 minutes each school day (Bekendtgørelse af lov om folkeskolen, 2014). ASD and ADHD are disabling conditions that emerge in childhood and affects social communication and interaction, and often also their motor skill performance and cognition fx. academic skills (Harvey & Reid, 2003...... framework:My overall research design is a Case study, because the research question requires an “in-depth” description and valuable insights to the complexities of the social phenomenon of inclusion and exclusions processes (Flyvbjerg, 2006; Yin, 2014). The research focus on 11 children with psychiatric...
Krumm, Silvia; Kilian, Reinhold; Becker, Thomas
There is an increasing awareness of gender-related issues in psychiatry. However, empirical findings on attitudes of psychiatric staff towards patient gender are limited. Gender-related issues are particularly relevant in the debate about mixed versus segregated sex wards, yet while the appropriateness of mixed-sex wards is questioned in Great Britain this is not the case in Germany. To investigate attitudes of psychiatric staff towards both patient gender and mixed versus segregated sex wards, we conducted a case study using focus groups with members of professional teams. We evaluated the transition process from two single-sex wards to two mixed-sex wards in a 330-bed psychiatric hospital in a rural area in south Germany. Staff described female patients as more externally oriented, motivating of others, demanding, and even sexually aggressive. Male patients, on the other hand, were described as more quiet, modest, or lazy. Furthermore, participants described the mixing process as a positive development whereas they did not see a need for gender-separated wards in order to protect vulnerable female patients. Some gender descriptions by professionals are "reversed" in comparison with gender stereotypes supposed to be present in wider society. The perception of crossed gender norms may affect staff attitudes towards the vulnerability of female patients in psychiatric settings and the provision of single-sex wards in in-patient psychiatric care. Practical implications are discussed against the background of a high rate of female patients with sexual abuse histories.
Full Text Available Suicidal behaviour remains challenging for clinicians to predict, with few established risk factors and warning signs among psychiatric patients.We aimed to describe characteristics and identify risk factors for suicide attempts among patients with psychiatric disorders.Multivariable logistic regression analysis, adjusted for clinically important confounders, was employed to determine risk factors for suicide attempts within a psychiatric patient population.The case (n = 146 and control groups (n = 104 did not differ significantly with regards to sociodemographic characteristics. The majority of the participants who had attempted suicide did so with high intent to die, and expected to die without medical intervention. The primary method of attempt was pharmaceutical overdose among the case participants (73.3%. Results showed impulsivity (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.03-1.30 and borderline personality symptoms (OR = 1.07, 95% CI = 1.01-1.13 were significantly associated with attempted suicide.Our findings indicate that known sociodemographic risk factors for suicide may not apply within psychiatric populations. Prevention strategies for suicidal behaviour in psychiatric patients may be effective, including limited access to means for suicide attempts (i.e. excess pharmaceutical drugs and target screening for high-risk personality and impulsivity traits.
Barker, Lucy Church; Kurdyak, Paul; Fung, Kinwah; Matheson, Flora I; Vigod, Simone
Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006-2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n = 8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12-1.50; 1.17, 95 % CI 1.01-1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38-1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01-1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.
Vasfiye Burcu Dogan
Full Text Available Peduncular hallucinosis usually occurs due to vascular or infectious midbrain lesions or brain stem compression by tumors. We present a peduncular hallucinosis case in a 63-year-old female with brain stem infarction, which can easily be misdiagnosed as a psychiatric disorder.
Nkokone S Z Tema
Full Text Available Background. Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or initial presenting symptoms. There are often grey areas with regard to neuropsychiatric disorders in which psychiatrists and specialists from other clinical disciplines would need to co-manage or share ideas on the comprehensive treatment of a presenting patient. Objectives. This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP service at the Helen Joseph Hospital (HJH in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a comorbid medical condition, including delirium, dementia and a mood or psychotic disorder due to a general medical condition. Methods. A retrospective record review of all patients referred to the HJH CLP team over a 6-month period. Results. A total of 884 routine and emergency consultations were done for 662 patients (males n=305; females n=357 between the ages of 13 and 90 years who were referred from various other clinical departments. The most common documented reason for referral was a request for assessment (n=182; 27.5%, which consisted of mental state assessment, reconsultation and assessing capacity. A total of 63 patients (10.0% of cases consulted were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, dementia and/or a mood or psychotic disorder due to a general medical condition (although admission wards were identified in 55 files only. The medical wards admitted the majority (n=37; 67.3% mostly for delirium (n=28; 50.9%. HIV was identified as the most common systemic aetiological factor (n=23; 67.7%. Conclusion. In this study, a female patient between 31 and 45 years of age was slightly more likely to be referred to the HJH CLP service for assessment, and
Dean, Angela J.; Duke, Suzanne G.; George, Michelle; Scott, James
Objective: Aggression is common in children and adolescents admitted to psychiatric inpatient units. Few interventions for reducing aggressive behaviors have been identified. This study aimed to evaluate the impact of a milieu-based behavioral management program on the frequency of aggressive behaviors in a child and adolescent mental health…
Rao, Mukund G; Varambally, Shivarama; Venkatasubramanian, Ganesan; Gangadhar, Bangalore N
Excessive use of over-the-counter (OTC) medications has been a growing public health problem. We present the case of a patient with avoidant personality disorder, social phobia, and dull normal intelligence, with dependence to pheniramine maleate. His anxiety symptoms, initially unresponsive to conventional treatment, reduced only after stopping pheniramine during inpatient care. This case emphasizes the need for awareness and regular monitoring of the use of OTC medications in vulnerable patient populations.
Full Text Available Syphilis is a disease caused by the spirochetal bacterium Treponema Pallidum subspecies pallidum. The route of transmission of syphilis is almost always through sexual contact. The incidence of syphilis decreased significantly with the introduction of penicilin in the 1940s but rose sharply again with the advent of HIV infection in the 1980s. Tertiary or late syphilis develops years after the initial infection and can involve any organ system. Neurologic involvement occurs in up to 10 percent of patients with untreated syphilis. General paresis, the clinical form of neurosyphilis most associated with psychiatric symptoms, occurs with parenchymatous disease and involves neuronal loss as opposed to the vascular lesions or inflammatory changes characteristic of most other forms of neurosyphilis. In the classic description, after early psychiatric manifestations such as mood changes, psychosis, or cognitive changes, demantia becomes prominent. Penicillin is the only drug that has proved effective in the treatment of neurosyphilis. Ceftriaxone is used as an alternative treatment in patients with penicilin allergy. This article reports two cases of neurosyphilis one of whom is presented with dementia and the other with psychiatric symptoms. Both of them are treated with ceftriaxone. Our purpose is to reveal the fact that ceftriaxone is a succesful alternative treatment for the cases with penicilin allergy and to emphasize the importance of neurosyphilis in the differential diagnosis for the psychiatric cases that are resistant to treatment
R. M. Lawrence
Full Text Available We describe two cases of Binswanger's disease of pre-senile onset which presented with affective and psychotic symptoms well before the appearance of cognitive deterioration and neurological signs, initially evading an accurate diagnosis. Psychiatrists should be aware of white matter disease and its role in the pathogenesis of psychiatric illness. Particular attention should be given to a history of hypertension as a risk factor in the early identification of these cases.
Mountain Debbie A
Full Text Available Abstract Background At any time, about 1% of people with severe and enduring mental illness such as schizophrenia require in-patient psychiatric rehabilitation. In-patient rehabilitation enables individuals with the most challenging difficulties to be discharged to successful and stable community living. However, the length of rehabilitation admission that is required is highly variable and the reasons for this are poorly understood. There are very few case-control studies of predictors of outcome following hospitalisation. None have been carried out for in-patient rehabilitation. We aimed to identify the factors that are associated with achieving discharge from in-patient rehabilitation by carrying out a case-control study. Methods We compared two groups: 34 people who were admitted to the Rehabilitation Service at the Royal Edinburgh Hospital and discharged within a six year study period, and 31 people who were admitted in the same period, but not discharged. We compared the groups on demographic, illness, treatment and risk variables that were present at the point of their admission to rehabilitation. We used independent t tests and Pearson Chi-Square tests to compare the two groups. Results We found that serious self harm and suicide attempts, treatment with high dose antipsychotics, antipsychotic polypharmacy and previous care in forensic psychiatric services were all significantly associated with non-discharge. The non-discharged group were admitted significantly later in the six year study period and had already spent significantly longer in hospital. People who were admitted to rehabilitation within the first ten years of developing psychosis were more likely to have achieved discharge. Conclusions People admitted later in the study period required longer rehabilitation admissions and had higher rates of serious self harm and treatment resistant illness. They were also more likely to have had previous contact with forensic services. This
Persons with psychiatric disorders (PD) commonly have their money officially or unofficially managed by others, with money managers most commonly being family members. (i) Identify characteristics of persons with PD, adult family members, and interactions with each other significantly associated with family money management (FMM). (ii) Identify significant differences in aforementioned characteristics between official versus unofficial FMM. Five hundred and seventy-three adults residing in USA with an adult relative with PD completed a survey. Among persons with PD, FMM was positively associated with lower income, diagnosis of schizophrenia/schizoaffective or bipolar disorder, psychiatric hospitalization, and arrest history. FMM was negatively associated with family members having a mental health diagnosis. FMM was positively associated with interaction characteristics of co-residence, financial assistance, caregiving, and use of limit-setting practices. Compared to official FMM, when unofficial FMM was present, persons with PD were less likely to have been psychiatrically hospitalized or to have regularly attended mental health treatment. When unofficial FMM was present, adult family members were less likely to be a parent of the person with PD. Practitioners should assess the level of burden experienced by family money managers and assess and address with family money managers the use of limit-setting practices.
Agerbo, Esben; Qin, Ping; Mortensen, Preben Bo
of these factors. DESIGN: Nested case-control study. Information on causes of death, psychiatric admission, marital status, children, and socioeconomic factors was obtained from routine registers. SETTING: Denmark. PARTICIPANTS: 985 suicide cases, 1104 sex-age (+/-3 years) matched siblings, and 16 619 controls......STUDY OBJECTIVE: Suicides cluster in both families and persons with psychiatric disorders and socioeconomic disadvantages. This study compares these factors between suicide cases, their siblings, and population based controls in an attempt to evaluate both the familial and the individual element...... and controls in exposure to hospitalised psychiatric disorders and socioeconomic disadvantages, although these factors contribute to the familial aggregation of suicides....
Morant, Nicola; Kaminskiy, Emma; Ramon, Shulamit
Mental health care has lagged behind other health-care domains in developing and applying shared decision making (SDM) for treatment decisions. This is despite compatibilities with ideals of modern mental health care such as self-management and recovery-oriented practice, and growing policy-level interest. Psychiatric medication is a mainstay of mental health treatment, but there are known problems with prescribing practices, and service users report feeling uninvolved in medication decisions and concerned about adverse effects. SDM has potential to produce better tailoring of psychiatric medication to individuals' needs. This conceptual review argues that several aspects of mental health care that differ from other health-care contexts (e.g. forms of coercion, questions about service users' insight and disempowerment) may impact on processes and possibilities for SDM. It is therefore problematic to uncritically import models of SDM developed in other health-care contexts. We argue that decision making for psychiatric medication is better understood in a broader way that moves beyond the micro-social focus of a medical consultation. Contextualizing specific medication-related consultations within longer term relationships, and broader service systems enables recognition of the multiple processes, actors and agendas that shape how psychiatric medication is prescribed, managed and used, and which may facilitate or impede SDM. A broad conceptualization of decision making for psychiatric medication that moves beyond the micro-social can account for why SDM in this domain remains a rarity. It has both conceptual and practical utility for evaluating research evidence, identifying future research priorities and highlighting fruitful ways of developing and implementing SDM in mental health care. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.
James M Badger
Full Text Available Background: Suicide by means of self-inflicted stab wounds is relatively uncommon and little is known about this population and their management. Materials and Methods: Retrospective review of adult trauma patients admitted to our Level-1 trauma center between January 2005 and October 2009 for management of non-fatal, self-inflicted stab wounds. Results: Fifty-eight patients were evaluated with self-inflicted stab wounds. Four patients died due to their injuries (mortality, 7%. Of the non-fatal stab wounds, 78% were male ranging in age from 19-82 (mean: 45 years. The most common injury sites were the abdomen (46%, neck (33%, and chest (20%. In terms of operative interventions, 56% of abdominal operations were therapeutic, whereas 100% of neck and chest operations were therapeutic. When assessing for suicidal ideation, 44 patients (81% admitted to suicidal intentions whereas 10 patients (19% described "accidental" circumstances. Following psychiatric evaluation, 8 of the 10 patients with "accidental injuries" were found to be suicidal. Overall, 54 patients (98% met criteria for a formal psychiatric diagnosis with 48 patients (89% necessitating inpatient or outpatient psychiatric assistance at discharge. Conclusions: Compared to previous reports of stab wounds among trauma patients, patients with self- inflicted stab wounds may have a higher incidence of operative interventions and significant injuries depending on the stab location. When circumstances surrounding a self-inflicted stabbing are suspicious, additional interviews by psychiatric care providers may uncover a suicidal basis to the event. Given the increased incidence of psychiatric illness in this population, it is imperative to approach the suicidal patient in a multidisciplinary fashion.
Full Text Available Abstract Background The PERSEO study (psychiatric emergency study and epidemiology is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management. The aims of this paper are: (i to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii to assess the clinical management, subjective wellbeing and attitudes toward medications. Methods A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. Results Almost half of patients (46% showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%, than in aggression toward other people (20%. A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%, followed by depression (16% and personality disorders (14%, and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge, while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge and depression (41 vs 32% during stay and 44 vs 25% at discharge. Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%. Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self
Slemon, Allie; Jenkins, Emily; Bungay, Vicky
The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.
McMain, Shelley F; Links, Paul S; Gnam, William H; Guimond, Tim; Cardish, Robert J; Korman, Lorne; Streiner, David L
The authors sought to evaluate the clinical efficacy of dialectical behavior therapy compared with general psychiatric management, including a combination of psychodynamically informed therapy and symptom-targeted medication management derived from specific recommendations in APA guidelines for borderline personality disorder. This was a single-blind trial in which 180 patients diagnosed with borderline personality disorder who had at least two suicidal or nonsuicidal self-injurious episodes in the past 5 years were randomly assigned to receive 1 year of dialectical behavior therapy or general psychiatric management. The primary outcome measures, assessed at baseline and every 4 months over the treatment period, were frequency and severity of suicidal and nonsuicidal self-harm episodes. Both groups showed improvement on the majority of clinical outcome measures after 1 year of treatment, including significant reductions in the frequency and severity of suicidal and nonsuicidal self-injurious episodes and significant improvements in most secondary clinical outcomes. Both groups had a reduction in general health care utilization, including emergency visits and psychiatric hospital days, as well as significant improvements in borderline personality disorder symptoms, symptom distress, depression, anger, and interpersonal functioning. No significant differences across any outcomes were found between groups. These results suggest that individuals with borderline personality disorder benefited equally from dialectical behavior therapy and a well-specified treatment delivered by psychiatrists with expertise in the treatment of borderline personality disorder.
Biała, Maja; Kiejna, Andrzej
The World Health Organization's estimations indicate that about 50% of patients in well-developed countries may not adhere to long-term therapies. In the field of psychiatry, drop-outs from psychiatric treatment are particularly important. Personality disorders are a significant part of this sphere. The aim of this research was to empirically verify the hypothesis regarding the relation between comorbid personality disorders and drop-outs from treatment among patients of psychiatric wards. This study was a prospective cohort study. 110 patients, hospitalized in 3 different psychiatric wards, were included. Personality disorders were assessed with the Structured Clinical Interview For DSM-IV Personality Disorders (SCID-II). The research was financed by the Polish National Science Center (DEC-2011/01/N/NZ5/05364). The response rate was 89.1%. 72.56% of patients suffered from personality disorders (SCID-II) (among them the most prevalent were: personality disorder - not otherwise specified - 40.7% and borderline personality disorder - 12.38%; 22.95% of patients dropped out from treatment). However, occurrence of personality disorders was not relevant for those drop-outs. On the other hand, relationships at the level of certain criteria of borderline personality disorders and passive-aggressive personality have been revealed. These relationships became stronger when considered from the perspective of differences in the organization of treatment at individual wards. Some personality disorders may play an important role in drop-outs from psychiatric treatment. Presented results require further research.
Full Text Available Introduction. Pulmonary thromboembolism occurs usually by running a thrombus from the deep veins of the legs rarely periprostatic or periuteric veins. Virchow's triad of necessary conditions for the occurrence of thrombosis involves disruption of blood flow, disruption of blood chemistry and damage to the vessel wall. Venous thrombosis is often associated with the implementation of antipsychotic therapy. Case report. We reported two cases of sudden death of psychiatric patients who were in both cases fixed during hospitalization. The first case was a 26-year-old woman treated a year with the diagnose of postpartum reactive psychosis. She was hospitalized because of mental state worsening with a dominant depressed mood, visual and auditory hallucinations. Her therapy was determined by diazepam, clozapine, haloperidol and lamotrigine. Suddenly, the patient died on the fifth day of hospitalization. The autopsy showed massive thromboembolism of the pulmonary artery branches. Toxicological analysis revealed the presence of therapeutic doses of antipsychotics. The second case was a-45-yearold men, a long-time alcoholic. On admission, the diagnosis of delirium tremens was established, and diazepam and haloperidol were administered. On the fifth day of hospitalization, he suddenly died. The autopsy showed thromboembolism of the branch of the pulmonary artery. Toxicological analysis established the presence of nordiazepam in urine (0.06 mg/L. Both patients were fixed during hospitalization. Conclusion. Both presented psychiatric patients were younger than 50 years, were not overweight, did not have changes of the venous blood vessels. Nowadays, when the issue of medical responsibility often arises in these and similar cases of sudden death in patients treated in psychiatric clinics, the questions on medical malpractice could be expected.
Razali, S; Salleh, R M; Yahya, B; Ahmad, S H
To examine the characteristics of maternal filicide and describe the adverse life events experienced by women who have committed filicide and been hospitalised in forensic psychiatric institutions in Malaysia. Registration records from 2000 through 2012 of female patients from 2 main forensic psychiatric institutions in Malaysia were reviewed. The medical records of patients who had committed maternal filicide were selected and descriptively evaluated. A total of 18 cases of maternal filicide were identified. Family dysfunction that presented with marital discord, domestic violence, or husband with substance abuse was the main stress experienced by the women. Three social circumstances, including an adolescent who became a victim of date rape; immigrants who experienced sexual abuse; and filicide-suicide precipitated by financial difficulties were highlighted. Women who committed filicide had experienced various difficulties in their life. The presence of such life events might alert mental health professionals to investigate the possibility of filicide among their patients.
Full Text Available Abstract Introduction Reflex sympathetic dystrophy can result in severe disability with only one in five patients able to fully resume prior activities. Therefore, it is important to diagnose this condition early and begin appropriate treatment. Factitious lymphoedema can mimic reflex sympathetic dystrophy and is caused by self-inflicted tourniquets, blows to the arm or repeated skin irritation. Patients with factitious lymphoedema have an underlying psychiatric disorder but usually present to emergency or orthopaedics departments. Factitious lymphoedema can then be misdiagnosed as reflex sympathetic dystrophy. The treatment for factitious lymphoedema is dealing with the underlying psychiatric condition. Case presentation We share our experience of treating a 33-year-old man, who presented with factitious lymphoedema, initially diagnosed as reflex sympathetic dystrophy. Conclusion Awareness of this very similar differential diagnosis allows early appropriate treatment to be administered.
Maria Carolina Santos Scozzafave
Full Text Available Objective: To analyze the presence of violence as psychosocial risk from the perception of nurses in a psychiatric hospital, as well as the management strategies implemented to address this risk. Methods: Qualitative study with 25 nurses working in a psychiatric hospital. Data collection was carried out from November 2014 to January 2015 through semi-structured interviews. The data were analyzed and organized into thematic categories following three stages: pre-analysis, exploration of the material and treatment of the results obtained. Participants were identified by the letter "E" and received sequential Arabic numeral numbers, thus guaranteeing the anonymity of the speeches. Thus, they were referenced from E1 to E25. The study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing, Brazil. Results: Violence exists in the everyday routine of psychiatric nurses, with the presence of scratches, pinches, kicks, pushes, squeezes against the wall, biting, aggression with the use of objects, among others, and the management strategies consist in appeals to the family, the cinema, music, reading, exercise, therapy, religion. Conclusion: It is important that preventive measures be adopted aimed at promoting safety in the workplace. The discussion on actions to improve the training and practices of nurses working in the mental health area are also important. Keywords: Violence; psychotherapy; emotion; occupational psychiatry; others psychosocial techniques/treatments
Gandubert, Catherine; Carrière, Isabelle; Escot, Chantal; Soulier, Maryvonne; Hermès, Aziz; Boulet, Patrick; Ritchie, Karen; Chaudieu, Isabelle
Our objective is to evaluate the mental status of primary early breast cancer survivors according to DSM-IV criteria, distinguishing new psychiatric diagnosis, which started after the cancer diagnosis from relapse. A comparative study of 144 breast cancer survivors and 125 women without previous history of cancer was carried out. Neuropsychiatric symptomatology was assessed retrospectively using standardized psychiatric examinations (Mini International Neuropsychiatric Interview, Watson's Post-Traumatic Stress Disorder Inventory) over three successive periods, 'before cancer' (from childhood to 3 years before the interview), 'around the cancer event' (the last 3 years including the time of diagnosis and treatment), and 'currently' (the last 2 weeks). Increased rates of anxiety and mood disorders were observed following a diagnosis of breast cancer compared with controls (generalized anxiety disorder (GAD) and major depressive disorder (MDD); 10.4 vs 1.6% and 19.4 vs 8.8%, respectively). The cancer disease promoted the development of dysthymia (n=4 new cases/6 two-year prevalent cases) and PTSD (7/7) and the re-emergence of MDD (n=21 relapses/28 three-year prevalent cases) and GAD (10/15). No improvement in serious mood disorders such as MDD (16.0 vs 7.2%) and dysthymia (4.2 vs 0%) was reported at the time of interview, more than 1.75 years (median time) after the cancer surgery, the prevalence being 2-4 times greater in breast cancer survivors than in controls. Despite significant advances in treatment, a diagnosis of breast cancer is highly associated with various forms of psychopathology, regardless of psychiatric history, with symptoms persisting after treatment. These results may assist clinicians in planning mental healthcare for women with breast cancer.
We are pleased to announce the recent launch of a new workshop on Project Management. This is designed for People with budgetary, scheduling and/or organizational responsibilities in a project or a sub-project. The objectives through a management case study specially suited to CERN are: to become familiar with modern management techniques in use for structuring, planning, scheduling, costing and progress monitoring of a project or a sub-project. to understand in-depth issues associated with Deliverable-oriented Project Management, Earned Value Management, Advanced Project Cost Engineering and Project Risk Management. The full description of this workshop can be found here. The next session will be held on 8 October 2004. If you are interested in this workshop, please contact Nathalie Dumeaux, email or 78144. Programme of Seminars October to December 2004 Situation : 21.09.2004 Séminaires bilingues Dates Jours Places disponibles Project Management Case study 8 October 1 oui Intr...
Gürlek Yüksel, Ebru; Taşkin, E Oryal; Yilmaz Ovali, Gülgün; Karaçam, Melek; Esen Danaci, Ayşen
Carbon monoxide (CO) intoxication is usually a serious condition, which can result in neurological disturbances or death. In some patients with CO intoxication, but not usually, a biphasic pattern can be seen. In this condition, after antitoxic treatment, patients may completely recover and after a short recovery period, neurological and/or psychiatric symptoms appear again. This condition is known as delayed encephalopathy and its occurrence rate is between 0.06% and 11.8%. Herein, we report a case with delayed encephalopathy after CO intoxication, which began with neurological symptoms and continued with obsessive-compulsive disorder, depression, kleptomania, and psychotic disorder. The 41-year-old female patient had no psychiatric or neurological symptoms or disorders prior to CO intoxication. Increased signal intensity changes in the basal region of the left temporal lobe (including the cortex and subcortical white matter), globus pallidus (bilateral), and cerebellar cortical and subcortical white matter (bilaterally symmetrical) was detected on axial T2-weighted magnetic resonance imaging (MRI). In addition, there were atrophic changes in both cerebellar hemispheres. To the best of our knowledge, this is the first case of kleptomania described after CO intoxication in the literature. We discuss the organic etiology of kleptomania and the other psychiatric symptoms of this patient in the light of recent research. We concluded that the kleptomania seen in this patient was related to concurrent lesions in the temporal lobe and globus pallidus; in other words, her kleptomania may have been related to dysfunction simultaneously seen in both the temporolimbic and frontal-subcortical circuits.
Tangu, KeumbÔh; Ifeanyi, Adaora; Velusamy, Mayurapriya; Dar, Sara; Shah, Nurun; Ezeobele, Ifeoma E; Okusaga, Olaoluwa O
The authors compared the current knowledge and attitude of psychiatrists, psychiatry residents, and psychiatric nurses towards the pharmacological management of acute agitation. Questionnaires were electronically distributed to all attending psychiatrists, psychiatry residents, and psychiatric nurses who were either employed by the University Department of Psychiatry and Behavioral Sciences or were staff at a 250-bed affiliated Psychiatric Hospital. Where possible, Fisher's exact test was used to compare responses to questions based on designation. Of the 250 questionnaires distributed, 112 were returned (response rate of 44.8%), of which 64 (57.1%) were psychiatric nurses, 27 (24.1%) were attending psychiatrists, and 21 (18.8%) were psychiatry residents. A significantly higher percentage of attending psychiatrists and psychiatric nurses compared to psychiatry residents thought that newer second- generation antipsychotics (SGAs) are not as effective as older first-generation antipsychotics (FGAs) for managing acute agitation (55.6, 48.4, and 9.5% respectively, p = 0.008). The combination of intramuscular haloperidol, lorazepam, and diphenhydramine was the most preferred option chosen by all designations for the psychopharmacological management of severe agitation. Furthermore, a larger percentage of the psychiatric nurses, in comparison to attending psychiatrists, also chose the combination of intramuscular chlorpromazine, lorazepam, and diphenhydramine as an option for managing severe agitation; no psychiatry resident chose this option. Knowledge of evidence-based psychopharmacological management of agitation differs among attending psychiatrists, psychiatry residents and psychiatric nurses. Although the management of agitation should be individualized and context specific, monotherapy should be considered first where applicable.
Full Text Available Background: Psychiatric Nurses and nurses’ assistants working in an inpatient unit experience a significant number of critical cases. A small number of studies have explored which patients’ problems nurses perceive as ‘critical case or incident’ and particularly which interventions they choose. Aim: The aim of the research was 1. To identify the clinical problems that mental health nurses and assistant nurses characterize as critical 2. To report the main nursing interventions 3. To investigate the main person involved in the critical incident. Material-Method: Critical incident technique was used as a method of data collection. Content analysis was carried out in order nurses’ information to be categorized into subcategories. The sample consisted of 35 mental health nurses and nurses’ assistants who work in psychiatric acute inpatient wards.Results: Nurses identified ten types of critical incidents. They noted violence (verbal, physical by patients and psychotic symptoms to be the most critical situations. Nurses were the main person involved in these incidents. The study also described eight nursing interventions used by nurses when faced with critical events. Conclusions: The findings indicated that mental health nurses and assistant nurses working in acute inpatient wards are called to confront a variety of critical incidents in their every day practice. Further research is necessary to identify in-depth nursing interventions and decision-making used in these situations.
Park, Sung-Jin; Yi, Kikyoung; Lee, Joon Deuk; Hong, Jin Pyo
The goal of this study was to examine the association between IQ and suicide in psychiatric patients. We conducted a nested case-control study using data obtained from psychiatric patients affiliated with a general hospital in Seoul, Korea. In a one-to-two ratio the psychiatric patients who died of suicide (Suicide Group; n=35) were matched to those who didn't (Non-suicide Group; n=70) by age, gender, psychiatric diagnosis and approximate time of first treatment. IQ was measured using the Korean version of the Wechsler Adult Intelligence Scale-Revised. There were no significant differences in any type of IQ between suicide patients and non-suicide patients. Logistic regression showed no evidence of an association between IQ and suicide. These results do not support the existence of an association between IQ and suicide.
Full Text Available Despite the advances in the understanding of neural and genetic foundations of violence, the investigation of the biological bases of a mental disorder is rarely included in psychiatric evaluation of mental insanity. Here we report on a case in which cognitive neuroscience and behavioral genetics methods were applied to a psychiatric forensic evaluation conducted on a young woman, J.F., tried for a violent and impulsive murder. The defendant had a history of multidrug and alcohol abuse and non-forensic clinical evaluation concluded for a diagnosis of borderline personality disorder. We analyzed the defendant’s brain structure in order to underlie possible brain structural abnormalities associated with pathological impulsivity. Voxel-Based Morphometry indexed a reduced gray matter volume in the left prefrontal cortex, in a region specifically associated with response inhibition. Furthermore, J.F.’s DNA was genotyped in order to identify genetic polymorphisms associated with various forms of violence and impulsive behaviour. Five polymorphisms that are known to be associated with impulsivity, violence, and other severe psychiatric illnesses were identified in J.F.’s DNA. Taken together, these data provided evidence for the biological correlates of a mental disorder characterized by high impulsivity and aggressive tendencies. Our claim is that the use of neuroscience and behavioral genetics do not change the rationale underlying the determination of criminal liability, which must be based on a causal link between the mental disorder and the crime. Rather, their use is crucial in providing objective data on the biological bases of a defendant’s mental disorder.
Inceboz, Tonay; Yalçin, Gülter; Aksoy, Umit
The most frequent symptom of taeniasis is the discharge of proglottids (93.7%). Gravid proglottids which do not have uterine pores are damaged when they exit the anus by their movement. Because of this damage most of the eggs contaminate the perianal tract. The cellophane tape technique that is used for getting perineum material is also a convenient technique for diagnosis of taeniasis. A 36 year-old woman was admitted to our parasitology clinic complaining of a watering mouth for one year, of abdominal pain, and of loss of appetite for 6 months, and who had discharged proglottids from time to time. She had been eating raw meat since her childhood and had had treatment for taeniasis fifteen years ago. She has also been under treatment for obsessive and compulsive neurosis and depression for two years and complained of constipation that was the side effect of the drug clomipramine HCL. She was given treatment with niclosamide and purgative treatment. The result of the treatment was incomplete because the patient refused to use the purgative. She was called for follow up controls two weeks and six months after treatment and after six months did not have any evidence of infection in her stools. When she was asked, the patient said that she did not need to use the drugs for the treatment of obsessive and compulsive neurosis and depression any more since her symptoms had decreased. According to various authorities, taeniasis is thought to be the cause of psychiatric symptoms due to its neural and psychological effects. These claims have been confirmed in our case because of her psychiatric symptoms decreased after the taeniasis treatment. Thus, the view that there is a relationship between intestinal parasites and psychiatric disease has been strengthened.
Mouridsen, Svend Erik; Rich, Bente; Isager, Torben
The rates and types of psychiatric disorders were studied in the parents of individuals with infantile autism (IA).......The rates and types of psychiatric disorders were studied in the parents of individuals with infantile autism (IA)....
Page, Andrew; Morrell, Stephen; Hobbs, Coletta; Carter, Greg; Dudley, Michael; Duflou, Johan; Taylor, Richard
Suicide in young adults remains an important public health issue in Australia. The attributable risks associated with broader socioeconomic factors, compared to more proximal psychiatric disorders, have not been considered previously in individual-level studies of young adults. This study compared the relative contributions of psychiatric disorder and socio-economic disadvantage associated with suicide in terms of relative and attributable risk in young adults. A population-based case-control study of young adults (18-34 years) compared cases of suicide (n = 84) with randomly selected controls (n = 250) from population catchments in New South Wales (Australia), with exposure information collected from key informant interviews (for both cases and controls). The relative and attributable risk of suicide associated with ICD-10 defined substance use, affective, and anxiety disorder was compared with educational achievement and household income, adjusting for key confounders. Prevalence of exposures from the control group was used to estimate population attributable fractions (PAF). Strong associations were evident between mental disorders and suicide for both males and females (ORs 3.1 to 18.7). The strongest association was for anxiety disorders (both males and females), followed by affective disorders and substance use disorders. Associations for socio-economic status were smaller in magnitude than for mental disorders for both males and females (ORs 1.1 to 4.8 for lower compared to high SES groups). The combined PAF% for all mental disorders (48% for males and 52% for females) was similar in magnitude to socio-economic status (46% for males and 58% for females). Socio-economic status had a similar magnitude of population attributable risk for suicide as mental disorders. Public health interventions to reduce suicide should incorporate socio-economic disadvantage in addition to mental illness as a potential target for intervention.
KIELING, CHRISTIAN; HERRMAN, HELEN; PATEL, VIKRAM; MARI, JAIR DE JESUS
There is a marked underepresentation of low- and middle-income countries (LAMIC) in the psychiatric literature, which may reflect an overall low representation of LAMIC publications in databases of indexed journals. This paper investigates the worldwide distribution of indexed psychiatric journals. A survey in both Medline and ISI Web of Science was performed in order to identify journals in the field of psychiatry according to their country of origin. Two hundred and twenty-two indexed psychiatric journals were found. Of these, 213 originated from high-income countries and only nine (4.1%) from middle-income countries. None were found in low-income countries. We also present the experience of a LAMIC psychiatric journal, the Revista Brasileira de Psiquiatria, in its recent indexation process. This case study may serve as an example for other LAMIC journals to pursue indexation in major databases as a strategy to widen the international foundation of psychiatric research. There is an important need for the inclusion of LAMIC psychiatric publications in the major indexation databases. This process will require multiple agents to partner with journals from LAMIC to improve their quality and strengthen their chances of being indexed. PMID:19293959
Bernanke, Joel; McCommon, Benjamin
Given many competing demands, psychotherapy training to competency is difficult during psychiatric residency. Good Psychiatric Management for borderline personality disorder (GPM) offers an evidence-based, simplified, psychodynamically informed framework for the outpatient management of patients with borderline personality disorder, one of the most challenging disorders psychiatric residents must learn to treat. In this article, we provide an overview of GPM, and show that training in GPM meets a requirement for training in supportive psychotherapy; builds on psychodynamic psychotherapy training; and applies to other severe personality disorders, especially narcissistic personality disorder. We describe the interpersonal hypersensitivity model used in GPM as a straightforward way for clinicians to collaborate with patients in organizing approaches to psychoeducation, treatment goals, case management, use of multiple treatment modalities, and safety. A modification of the interpersonal hypersensitivity model that includes intra-personal hypersensitivity can be used to address narcissistic problems often present in borderline personality disorder. We argue that these features make GPM ideally suited for psychiatry residents in treating their most challenging patients, provide clinical examples to illustrate these points, and report the key lessons learned by a psychiatry resident after a year of GPM supervision.
Cindy A. McGeary
Full Text Available Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD, especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS pain rating, disability (Oswestry Disability Index; Million Visual Analog Scale, and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed.
Liang, Chen; Sun, Jingchun; Tao, Cui
There remain significant difficulties selecting probable candidate drugs from existing databases. We describe an ontology-oriented approach to represent the nexus between genes, drugs, phenotypes, symptoms, and diseases from multiple information sources. We also report a case study in which we attempted to explore candidate drugs effective for bipolar disorder and epilepsy. We constructed an ontology incorporating knowledge between the two diseases and performed semantic reasoning tasks with the ontology. The results suggested 48 candidate drugs that hold promise for further breakthrough. The evaluation demonstrated the validity our approach. Our approach prioritizes the candidate drugs that have potential associations among genes, phenotypes and symptoms, and thus facilitates the data integration and drug repurposing in psychiatric disorders.
Sahib S Khalsa
Full Text Available We report here, for the first time, two cases demonstrating a synergistic application of bilateral cardiac sympathetic decentralization and multimodal psychiatric treatment for the assessment and management of anxiety following recurrent Implantable Cardioverter Defibrillator (ICD shocks. In a first case the combination of bilateral cardiac sympathetic decentralization (BCSD, cognitive behavioral psychotherapy and anxiolytic medication was sufficient to attenuate the patient’s symptoms and maladaptive behaviors, with a maintained benefit at 1 year. Among the more prominent subjective changes, we observed a decrease in aversive interoceptive sensations, particularly of the heartbeat following BCSD. The patient continued to experience cognitive threat appraisals on a frequent basis, although these were no longer incapacitating. In a second case, we report the effect of BCSD on autonomic tone and subjective state. In the post-lesion state we observed attenuated sympathetic responses to the valsalva maneuver, isometric handgrip and mental arithmetic stressor, including decreased systolic and diastolic blood pressure and decreased skin conductance. Collectively, these preliminary findings suggest that an integrative, multidisciplinary approach to treating anxiety disorders in the setting of ventricular arrhythmias and recurrent ICD shocks can result in sustained improvements in physical, psychological and functional status. These findings raise the possibility of a potential role for the stellate ganglion in the modulation of emotional experience and afferent transmission of interoceptive information to the central nervous system.
Faizi, Fakhrudin; Tavallaee, Abbas; Rahimi, Abolfazl; Saghafinia, Masoud
Background Lifestyle modification has a significant role in chronic daily headache (CDH) management. Participatory action research (PAR) can play an important role in managing chronic medical conditions. However, it has been scarcely used in CDH management. Objectives This study aimed to empower patients with CDH to modify their lifestyle in order to reduce both their headache and related psychiatric co-morbidities in a multidisciplinary headache clinic at Baqiyatallah hospital, Tehran, IR Ir...
Walby, Fredrik A; Odegaard, Erik; Mehlum, Lars
To investigate the differential impact of DSM-IV axis-I and axis-II disorders on completed suicide and to study if psychiatric comorbidity increases the risk of suicide in currently and previously hospitalized psychiatric patients. A nested case-control design based on case notes from 136 suicides and 166 matched controls. All cases and controls were rediagnosed using the SCID-CV for axis-I and the DSM-IV criteria for axis-II disorders and the inter-rater reliability was satisfactory. Raters were blind to the case and control status and the original hospital diagnoses. Depressive disorders and bipolar disorders were associated with an increased risk of suicide. No such effect was found for comorbidity between axis-I disorders and for comorbidity between axis-I and axis-II disorders. Psychiatric diagnoses, although made using a structured and criteria-based approach, was based on information recorded in case notes. Axis-II comorbidity could only be investigated at an aggregated level. Psychiatric comorbidity did not predict suicide in this sample. Mood disorders did, however, increase the risk significantly independent of history of previous suicide attempts. Both findings can inform identification and treatment of patients at high risk for completed suicide.
Martin, T; Daffern, M
Inpatient mental health clinicians need to feel safe in the workplace. They also require confidence in their ability to work with aggressive patients, allowing the provision of therapeutic care while protecting themselves and other patients from psychological and physical harm. The authors initiated this study with the predetermined belief that a comprehensive and integrated organizational approach to inpatient aggression was required to support clinicians and that this approach increased confidence and staff perceptions of personal safety. To assess perceptions of personal safety and confidence, clinicians in a forensic psychiatric hospital were surveyed using an adapted version of the Confidence in Coping With Patient Aggression Instrument. In this study clinicians reported the hospital as safe. They reported confidence in their work with aggressive patients. The factors that most impacted on clinicians' confidence to manage aggression were colleagues' knowledge, experience and skill, management of aggression training, use of prevention and intervention strategies, teamwork and the staff profile. These results are considered with reference to an expanding literature on inpatient aggression. It is concluded that organizational resources, policies and frameworks support clinician perceptions of safety and confidence to manage inpatient aggression. However, how these are valued by clinicians and translated into practice at unit level needs ongoing attention.
Full Text Available Regular physical exercise has been shown to favorably influence mood and anxiety; however, there are few studies regarding psychiatric aspects of physically active patients with coronary artery disease (CAD. The objective of the present study was to compare the prevalence of psychiatric disorders and cardiac anxiety in sedentary and exercising CAD patients. A total sample of 119 CAD patients (74 men were enrolled in a case-control study. The subjects were interviewed to identify psychiatric disorders and responded to the Cardiac Anxiety Questionnaire. In the exercise group (N = 60, there was a lower prevalence (45 vs 81%; P < 0.001 of at least one psychiatric diagnosis, as well as multiple comorbidities, when compared to the sedentary group (N = 59. Considering the Cardiac Anxiety Questionnaire, sedentary patients presented higher scores compared to exercisers (mean ± SEM = 55.8 ± 1.9 vs 37.3 ± 1.6; P < 0.001. In a regression model, to be attending a medically supervised exercise program presented a relevant potential for a 35% reduction in cardiac anxiety. CAD patients regularly attending an exercise program presented less current psychiatric diagnoses and multiple mental-related comorbidities and lower scores of cardiac anxiety. These salutary mental effects add to the already known health benefits of exercise for CAD patients.
Rait, Douglas; Glick, Ira
Objective: Given the marginalization of couples and family therapy in psychiatric residency programs over the past two decades, the authors propose a rationale for the reintegration of these important psychosocial treatments into the mainstream of general psychiatric residency education. Methods: After reviewing recent trends in the field that…
Mouridsen, S.E.; Rich, B.; Isager, T.
The objective of this study was to compare the prevalence and types of psychiatric disorders in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with psychiatric disorders in 336 matched controls from the general population using data from the nationwide Danish...
Mouridsen, S.E.; Rich, B.; Isager, T.
The prevalence and types of psychiatric disorders were studied in a clinical sample of 89 individuals with atypical autism (AA) first seen as children, and 258 matched controls from the general population using data from the nationwide Danish Psychiatric Central Register. The average observation...
Park, Eun-Jun; Kim, Chunmi
The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea. A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory. Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources. This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.
Florkowski, Antoni; Zboralski, Krzysztof; Macander, Marian; Flinik-Jankowska, Magdalena; Wierzbiński, Piotr
In this study we attempted to visualize certain irregularities that took place in the evaluation of a patient with personality disorders performed by psychiatrist expert witness, which resulted in an incorrect diagnosis, leading to wrong ruling of the court and a referral of the patient to clinical therapy lasting six years. The psychiatric and psychological expert opinions submitted to the court and first-hand psychiatric and psychological examination of the patient were analyzed. Efforts were made to show that the failure to comply with the diagnostic criteria in the process of diagnosis and not taking into account the previously issued five forensic psychiatric opinions issued by independent and experienced teams of psychiatrist expert witnesses, as well as not taking into account the nature of the offense committed have led to a number of irregularities in the assessment of the mental state of the patient. Above mentioned shortcomings have caused unjustified legal classification of the offense and six years long detention of the patient in closed psychiatric institutions, in our regard unnecessary. The described case could be regarded as an abuse of psychiatry for the non-medical purposes and thus should have be punish. Based on the presented case it has been demonstrated that insufficient experience in forensic psychiatry and failure to comply with diagnostic criteria of psychiatrists and psychologists expert witnesses had led to a series of blatant offense of civil rights and liberties, and thus unnecessary detention of the patient for six years. © 2015 MEDPRESS.
Glangeaud-Freudenthal, Nine M-C; Sutter-Dallay, Anne-Laure; Thieulin, Anne-Claire; Dagens, Véronique; Zimmermann, Marie-Agathe; Debourg, Alain; Amzallag, Corinne; Cazas, Odile; Cammas, Rafaële; Klopfert, Marie-Emmanuelle; Rainelli, Christine; Tielemans, Pascale; Mertens, Claudine; Maron, Michel; Nezelof, Sylvie; Poinso, François
Our aim was to investigate the factors associated with mother-child separation at discharge, after joint hospitalization in psychiatric mother-baby units (MBUs) in France and Belgium. Because parents with postpartum psychiatric disorders are at risk of disturbed parent-infant interactions, their infants have an increased risk of an unstable early foundation. They may be particularly vulnerable to environmental stress and have a higher risk of developing some psychiatric disorders in adulthood. This prospective longitudinal study of 1,018 women with postpartum psychiatric disorders, jointly admitted with their infant to 16 French and Belgian psychiatric mother-baby units (MBUs), used multifactorial logistic regression models to assess the risk factors for mother-child separation at discharge from MBUs. Those factors include some infant characteristics associated with personal vulnerability, parents' pathology and psychosocial context. Most children were discharged with their mothers, but 151 (15 %) were separated from their mothers at discharge. Risk factors independently associated with separation were: (1) neonatal or infant medical problems or complications; (2) maternal psychiatric disorder; (3) paternal psychiatric disorder; (4) maternal lack of good relationship with others; (5) mother receipt of disability benefits; (6) low social class. This study highlights the existence of factors other than maternal pathology that lead to decisions to separate mother and child for the child's protection in a population of mentally ill mothers jointly hospitalized with the baby in the postpartum period.
Glangeaud-Freudenthal, Nine M.-C.; Sutter-Dallay, Anne-Laure; Thieulin, Anne-Claire; Dagens, Véronique; Zimmermann, Marie-Agathe; Debourg, Alain; Amzallag, Corinne; Cazas, Odile; Cammas, Rafaële; Klopfert, Marie-Emmanuelle; Rainelli, Christine; Tielemans, Pascale; Mertens, Claudine; Maron, Michel; Nezelof, Sylvie; Poinso, François
Purpose Our aim was to investigate the factors associated with mother-child separation at discharge, after joint hospitalization in psychiatric mother-baby units (MBUs) in France and Belgium. Because parents with postpartum psychiatric disorders are at risk of disturbed parent-infant interactions, their infants have an increased risk of an unstable early foundation. They may be particularly vulnerable to environmental stress and have a higher risk of developing some psychiatric disorders in adulthood. Methods: This prospective longitudinal study of 1018 women with postpartum psychiatric disorders, jointly admitted with their infant, to 16 French and Belgian psychiatric mother-baby units (MBUs), used multifactorial logistic regression models to assess the risk factors for mother-child separation at discharge from MBUs. Those factors include some infant characteristics associated with personal vulnerability, parents’ pathology and psychosocial context. Results Most children were discharged with their mothers, but 151 (15%) were separated from their mothers at discharge. Risk factors independently associated with separation were: i) neonatal or infant medical problems or complications; ii) maternal psychiatric disorder; iii) paternal psychiatric disorder; iv) maternal lack of good relationships with others; v) mother receipt of disability benefits; vi) low social class. Conclusions This study highlights the existence of factors other than maternal pathology that lead to decisions to separate mother and child for the child’s protection in a population of mentally ill mothers jointly hospitalized with the baby in the postpartum period. PMID:22706788
Palijan, Tija Zarković; Muzinić, Lana; Radeljak, Sanja
For the past several years a numerous studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse. The comorbid substance abuse in violent offenders was usually unrecognized and misdiagnosed. Furthermore, comorbidity in forensic psychiatry describes the co-occurrence of two or more conditions or psychiatric disorder known in the literature as dual diagnosis and defined by World Health Organization (WHO). In fact, many violent offenders have multiple psychiatric diagnoses. Recent studies have confirmed causal relationship between major psychiatric disorders and concomitant substance abuse (comorbidity) in 50-80% of forensic cases. In general, there is a high level of psychiatric comorbidity in forensic patients with prevalence of personality disorders (50-90%), mood disorders (20-60%) and psychotic disorders (15-20%) coupled with substance abuse disorders. Moreover, the high prevalence of psychiatric comorbidities could be found in mentally retarded individuals, as well as, in epileptic patients. Drugs and alcohol abuse can produce serious psychotoxic effects that may lead to extreme violent behavior and consequently to serious criminal offence such as physical assault, rape, armed robbery, attempted murder and homicide, all due to an altered brain function and generating psychotic-like symptoms. Studies have confirmed a significant statistical relevance in causal relationship between substance abuse and violent offences. In terms of forensic psychiatry, the comorbidity strongly contributes in the process of establishing psychiatric diagnosis of diminished mental capacity or insanity at the time of the offence in the course of clinical assessment and evaluation of violent offenders. Today, the primary focus of forensic psychiatry treatment services (in-patient or community) is management of the violent offenders with psychiatric comorbidity which requires a multilevel, evidence based approach to
Full Text Available The importance of waste management in hospitals is indisputable in preserving the environment and protecting public health, but management models are rarely discussed. This study presents the legal and conceptual frameworks of good waste management practices applicable to hospitals and associated indicators. As a case study, the overall performance of Hospital Centre of São João, in Porto, was analysed based on published reports. Data on the production of waste in their different typologies were collected from 2010 to 2016, enabling a correlation of the waste production with the kg/bed/day indicator. The aim of this study was to gather data and discuss trends in a real scenario of evolution over a six-year period in order to contribute to a future research proposal on indicators that can be used as reference for benchmarking the construction of methodological guides for hospital waste management.
Benrimoh, David; Perreault, Antoine; Van Den Eynde, Frederique
Euthanasia was decriminalized in Quebec in December 2015, and Canada-wide in June 2016. Both the Provincial and Federal legislation have limited the right to medical assistance in dying (MAID) to end-of-life cases; which makes MAID inaccessible to most patients solely suffering from psychiatric illness. While some end-stage anorexia nervosa or elderly patients may meet the end-of-life criterion because of their medical comorbidities or their age (Kelly et al., 2003), repeated suicide attempts or psychotic disorganization would not qualify since they would not be seen as elements of an illness leading to a foreseeable "natural death" (Canada, 2016). This is in contradiction to other jurisdictions, such as Belgium and the Netherlands as well as the eligibility criteria stated in the Supreme Court of Canada's decision in Carter v. Canada (Supreme Court of Canada, 2015). Here we analyze three cases of patients who presented to a psychiatric emergency department and requested MAID for psychiatric reasons. While none of the patients were eligible for MAID under Canadian law, we find that their demographics match closely that of patients granted MAID for psychiatric reasons in jurisdictions where that practice is allowed. Based on these cases, we comment on potentially negative consequences that may come from decriminalizing MAID for psychiatric reasons (such as an increased assessment burden on ED staff) and potentially positive consequences (such as encouraging suffering patients who had not consulted to seek care). While it is by no means our intention to take a political or moral stand on this important issue, or to conclusively weigh the negatives and positives of allowing MAID for psychiatric reasons, we do stress the importance of an active voice for psychiatry in this ongoing public debate. Copyright © 2017 Elsevier Ltd. All rights reserved.
Mancke, Falk; Kaklauskait?, Gintar?; Kollmer, Jennifer; Weiler, Markus
Falk Mancke,1,2,* Gintare Kaklauskaite,1,* Jennifer Kollmer,3 Markus Weiler1 1Department of Neurology, 2Department of General Psychiatry, Center for Psychosocial Medicine, 3Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany *These authors contributed equally to this work Abstract: Nitrous oxide (N2O), a long-standing anesthetic, is known for its recreational use, and its consumption is on the rise. Several case studies have reported neurological and psychiatric ...
Sada, Andrea; Robles-García, Rebeca; Martínez-López, Nicolás; Hernández-Ramírez, Rafael; Tovilla-Zarate, Carlos-Alfonso; López-Munguía, Fernando; Suárez-Alvarez, Enrique; Ayala, Xochitl; Fresán, Ana
Assessing dangerousness to gauge the likelihood of future violent behaviour has become an integral part of clinical mental health practice in forensic and non-forensic psychiatric settings, one of the most effective instruments for this being the Historical, Clinical and Risk Management-20 (HCR-20). To examine the HCR-20 factor structure in Mexican psychiatric inpatients and to obtain its predictive validity and reliability for use in this population. In total, 225 patients diagnosed with psychotic, affective or personality disorders were included. The HCR-20 was applied at hospital admission and violent behaviours were assessed during psychiatric hospitalization using the Overt Aggression Scale (OAS). Construct validity, predictive validity and internal consistency were determined. Violent behaviour remains more severe in patients classified in the high-risk group during hospitalization. Fifteen items displayed adequate communalities in the original designated domains of the HCR-20 and internal consistency of the instruments was high. The HCR-20 is a suitable instrument for predicting violence risk in Mexican psychiatric inpatients.
Guydish, Joseph; Chan, Monica; Bostrom, Alan; Jessup, Martha A.; Davis, Thomas B.; Marsh, Cheryl
This article reports findings from a clinical trial of a probation case management (PCM) intervention for drug-involved women offenders. Participants were randomly assigned to PCM (n = 92) or standard probation (n = 91) and followed for 12 months using measures of substance abuse, psychiatric symptoms, social support, and service utilization.…
Oudin, Anna; Åström, Daniel Oudin; Asplund, Peter; Steingrimsson, Steinn; Szabo, Zoltan; Carlsen, Hanne Krage
Air pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. Our aim was to investigate associations between daily fluctuations in air pollution concentrations and the daily number of visits to a psychiatric emergency unit. Data from Sahlgrenska University Hospital, Gothenburg, Sweden, on the daily number of visits to the Psychiatric emergency unit were combined with daily data on monitored concentrations of respirable particulate matter(PM 10 ), ozone(O 3 ), nitrogen dioxides(NO 2 ) and temperature between 1st July 2012 and 31st December 2016. We used a case-crossover design to analyze data with conditional Poisson regression models allowing for over-dispersion. We stratified data on season. Visits increased with increasing PM 10 levels during the warmer season (April to September) in both single-pollutant and two-pollutant models. For example, an increase of 3.6% (95% Confidence Interval, CI, 0.4-7.0%) was observed with a 10 μg/m3 increase in PM 10 adjusted for NO 2 . In the three-pollutant models (adjusting for NO 2 and O 3 simultaneously) the increase was 3.3% (95% CI, -0.2-6.9). There were no clear associations between the outcome and NO 2 , O 3 , or PM 10 during the colder season (October to March). Ambient air particle concentrations were associated with the number of visits to the Psychiatric emergency unit in the warm season. The results were only borderline statistically significant in the fully adjusted (three-pollutant) models in this small study. The observation could be interpreted as indicative of air pollution as either exacerbating an underlying psychiatric disorder, or increasing mental distress, even in areas with comparatively low levels of
Czech, O M; Podoll, K; Schneider, F
Communication by means of social networks and messenger programs as well as the use of smartphones have rapidly increased during recent years and are constantly present in everyday life. We report about a 25-year-old patient with a diagnosis of borderline personality disorder who posted photographs of acute self-injuries to a group of fellow patients by means of a messenger app while on weekend leave during psychiatric hospital treatment. The implications about possible effects of the use of social media by psychiatric in-patients on treatment and group dynamics are discussed. Furthermore, social media communication by patients is focused on in general and potential consequences for psychiatric, psychotherapeutic and psychosomatic treatment are discussed.
Hogan, Tierney D
A positive relationship between staff RN case managers and their case management supervisor significantly impacts job satisfaction and retention in case managers. Literature review supports the premise that staff need to trust their supervisor and that there is a connection between this trust and job satisfaction. Staff case managers need to have a voice at work and feel empowered, and a supervisor's leadership style can influence job satisfaction and retention in their staff.
paranoid behavior. Notable in his evaluation were a blood alcohol level (BAL) of 0.203% and a positive urine screen for marijuana . The EP and social worker...1994; 24(4):672–677. 7. Dubin WR, Weiss KJ, Zeccardi JA. Organic brain syndrome: The psychiatric imposter. JAMA. 1993;249(1):60–62. 8. Tintinalli JE
for instigating MR is dangerous patient behavior and research has suggested that many MR episodes result from experienced violence or threat of violence by staff these aspects attract special attention. This study analyzes the role of threat, violence, and contextual characteristics in MR lawsuits. Methodology......: In Denmark a Psychiatric Complaint Board considers patients’ complaints about compliance with law. The Board annually makes public a selection of case decisions. A case law review was carried out on all publicly available lawsuits concerning MR completed by the Board during the years 2007-2014 with focus.......g. psychological) or aggressive behavior was described (e.g. humiliating remarks). In 52 cases (32%) there was information that belt fixation had been supplemented with arm or leg fixation. MR was concluded illegal in 124 (76%) of cases and in 33 cases (20%) the duration of MR use was concluded illegal. Among...
Gómez-Durán, Esperanza L; Forti-Buratti, M Azul; Gutiérrez-López, Beatriz; Belmonte-Ibáñez, Anna; Martin-Fumadó, Carles
Suicide is an important Public Health problem. One of the most relevant known risk factors for suicide is suffering from a mental health disorder, identified in up to 90-95% of completed suicides, with this risk being increased if comorbidity is present. Findings from international research on the most common psychiatric disorders are dichotomous, divided into mood disorders and psychotic disorders. In Spain, data of this kind are scarce. This study describes the psychiatric and forensic characteristics of completed suicide cases (n=79) ocurred in a psychiatric hospital healthcare area (in Spain), between 2007 and 2010. The forensic data were obtained from the Institute of Legal Medicine of Catalonia and the clinical data by reviewing the clinical records. Most of the subjects in this sample were males (78.5%, 95% CI; 68.4%-87.3%). Almost half of the sample (45.4%, 95% CI; 33.8%-57.1%, 35/77) had records in the Mental Health Services Network (including substance misuse services). Two of the 79 were under 18, so we were not able to access the records. More than half (54.3%, 95% CI; 37.1%-71.4%) of those with psychiatric history suffered from a mood disorder; 37.1% (95% CI; 22.9%-51.4% from a depressive disorder; 14.3% (95% CI; 2.9%-25.7%) from a bipolar disorder, and 17.1% (95% CI; 5.7%-31.4%) suffered from a psychotic disorder. With regard to substance misuse, 42.9% (95% CI; 25.7%-60.0%) presented substance misuse, and 48.6% did not. Psychiatric and forensic characteristics of completed suicide in this Spanish sample confirm previous findings from international studies: there is a high rate of psychiatric disorders in those who complete suicide, and there is a specific pattern as regards the method used to complete it. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.
Gowda, Guru S; Telang, Ashay; Sharath, Chandra Reddy; Issac, Thomas Gregor; Haripriya, Chintala; Ramu, Praveen Shivalli; Math, Suresh Bada
Homeless Mentally Ill (HMI) patients pose a challenge in treatment, management and rehabilitation services. HMI patients are often difficult to engage in treatment, and associated with relapse and rehospitalization, even after recovery. Family plays an important role in treatment engagement and care of the mentally ill person in India. Here, we report two unknown psychiatric patients who were reintegrated to their families using newer technologies with existing service. Newer technologies have helped in early identification of HMI families and reintegration into them. The early reintegration reduced the unnecessary detention of HMI patients inside the hospital after recovery. Copyright © 2017 Elsevier B.V. All rights reserved.
Sherman, Mark; And Others
The ability of 24 Veterans Administration Day Treatment Center psychiatric outpatients to vary intentionally their degree of apparent psychopathology during structured interviews was studied. Patients defined as sick presenters behaved in a significantly more pathological manner during an interview preceded by "fake sick" instructions than they…
Full Text Available Abstract The creation of the Rorschach Performance Assessment System (R-PAS requires research that allows its use in the Brazilian population. The Formal Quality (FQ category is essential both for clinic and research. The aim of this study was to compare form quality variables in Rorschach protocols from psychiatric patients and ratings coded in the Comprehensive System (CS and R-PAS. The sample comprised 206 Rorschach protocols from adult patients in psychiatric treatment, who were also assessed by SCID-I and SCID-II. Most protocols were administered in the CS and recoded according to the R-PAS. The kappa coefficient was calculated, and we compared the means of these variables in both systems. The kappa results varied from almost perfect to substantial consistency for all variables, however, the descriptive statistics confirmed that the R-PAS elicits more FQ Ordinary coding while the CS elicits more FQ minus coding.
Chiu, Yu-Chuan; Bai, Ya-Mei; Su, Tung-Ping; Chen, Tzeng-Ji; Chen, Mu-Hong
Previous studies showed that psychiatric disorders such as major depression, bipolar disorders, and alcohol misuse are associated with an increased risk of ischemic stroke. However, the link between psychiatric disorders and stroke in the young population is rarely investigated. Using the Taiwan National Health Insurance Research Database, 2063 young adults aged between 18 and 45 years with ischemic stroke and 8252 age- and sex-matched controls were enrolled in our study between 1998 and 2011. Participants who had preexisting psychiatric disorders were identified. After adjusting for preexisting physical disorders and demographic data, patients with ischemic stroke had an increased risk of having preexisting psychiatric disorders, including bipolar disorder (odds ratio [OR]: 2.23, 95% confidence interval [CI]: 1.06∼4.67), unipolar depression (OR: 2.15, 95% CI: 1.62∼2.86), anxiety disorders (OR: 2.63, 95% CI: 1.87∼3.69), and alcohol use disorders (OR: 2.86, 95% CI: 1.79∼4.57). Young ischemic stroke (age ≥30 years) was related to the risk of preexisting unipolar depression (OR: 1.49, 95% CI: 1.05∼2.11), anxiety disorders (OR: 1.99, 95% CI: 1.33∼2.97), and alcohol use disorders (OR: 2.54, 95% CI: 1.55∼4.14); very young stroke (age ischemic stroke at age younger than 45 years had a higher risk of having pre-existing bipolar disorder, unipolar depression, anxiety disorders, and alcohol use disorders than those who did not after adjusting for demographic data and stroke-related medical comorbidities.
Cester-Martínez, Armando; Cortés-Ramas, José Antonio; Borraz-Clares, Diego; Pellicer-Gayarre, Marta
This case series explored the usefulness of an inhaled dose of 9.1 mg of loxapine administered outside the hospital to treat psychomotor agitation related to schizophrenia, bipolar disorder, or schizoaffective disorder. The Clinical Global Impression Scale and the Positive and Negative Syndrome Scale (excitement component) were used to assess the effects of treatment in 14 patients. The treatment was useful in 12 patients, who showed significant improvement (Pagitation related to a psychiatric disorder. Mechanical restraint and parenteral medication can be avoided after use of this drug. Loxapine treatment shortens the agitation episode and attenuates the impact on the patient, facilitating ambulance transfer.
Sheridan, Ann J
Using psychiatric nursing education and practice as a case study, this paper examines how the achievement of independence by a nation impacts significantly on the organisations, structures and service provision within that country. Furthermore, it sheds light on how an emerging nation is required to engage in a series of 'trade-offs' between priorities in an attempt to ensure progress towards the greater visioning goals such as the (re)establishing of a national cultural identity, freedom to practice religious beliefs and enhanced economic and practical benefits for all citizens. In the case of Irish psychiatric nursing, the achievement of independence resulted in a diminishing of earlier initiatives related to training and ultimately in a prolonged period of retrenchment, due primarily to competitive pressures and to imposed cultural influences and belief systems. The lesson from this Irish case study indicates that the initial phase of national autonomy can, of necessity, lead to a number of sacrifices as part of the realisation of self-governance and determination; and that this is a necessary prerequisite to gaining the strength to enable a much more confident progression into the future.
Full Text Available Advances made in genetic testing and tools applied to pharmacogenetics are increasingly being used to inform clinicians in fields such as oncology, hematology, diabetes (endocrinology, cardiology and expanding into psychiatry by examining the influences of genetics on drug efficacy and metabolism. We present a clinical case example of an adolescent male with anxiety, attention deficit hyperactivity disorder (ADHD and autism spectrum disorder who did not tolerate numerous medications and dosages over several years in attempts to manage his symptoms. Pharmacogenetics testing was performed and DNA results on this individual elucidated the potential pitfalls in medication use because of specific pharmacodynamic and pharmacokinetic differences specifically involving polymorphisms of genes in the cytochrome p450 enzyme system. Future studies and reports are needed to further illustrate and determine the type of individualized medicine approach required to treat individuals based on their specific gene patterns. Growing evidence supports this biological approach for standard of care in psychiatry.
Niimura, Junko; Nakanishi, Miharu; Yamasaki, Syudo; Nishida, Atsushi
Several clinical trials have demonstrated that linkage to an outreach service can prevent prolonged length of stay of patients at psychiatric hospitals. However, there has been no investigation of the association between length of stay in psychiatric hospital and regional supply of outreach services using national case mix data. The aim of this study was to clarify the relationship between length of stay in psychiatric hospital and regional supply of outreach services. We used data from the National Patient Survey in Japan, a nationally representative cross-sectional survey of inpatient care conducted every three years from 1996 to 2014. Data from 42,268 patients with schizophrenia who had been admitted to psychiatric hospitals were analyzed. After controlling for patient and regional characteristics, patients in regions with fewer number of visits for psychiatric nursing care at home had significantly longer length of stay in psychiatric hospitals. This finding implies that enhancement of the regional supply of outreach services would prevent prolonged length of stay in psychiatric hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.
Mancke, Falk; Kaklauskaitė, Gintarė; Kollmer, Jennifer; Weiler, Markus
Nitrous oxide (N 2 O), a long-standing anesthetic, is known for its recreational use, and its consumption is on the rise. Several case studies have reported neurological and psychiatric complications of N 2 O use. To date, however, there has not been a study using standardized diagnostic procedures to assess psychiatric comorbidities in a patient consuming N 2 O. Here, we report about a 35-year-old male with magnetic resonance imaging confirmed subacute myelopathy induced by N 2 O consumption, who suffered from comorbid cannabinoid and nicotine dependence as well as abuse of amphetamines, cocaine, lysergic acid diethylamide, and ketamine. Additionally, there was evidence of a preceding transient psychotic and depressive episode induced by synthetic cannabinoid abuse. In summary, this case raises awareness of an important mechanism of neural toxicity, with which physicians working in the field of substance-related disorders should be familiar. In fact, excluding N 2 O toxicity in patients with recognized substance-related disorders and new neurological deficits is compulsory, as untreated for months the damage to the nervous system is at risk of becoming irreversible.
Full Text Available Falk Mancke,1,2,* Gintare Kaklauskaite,1,* Jennifer Kollmer,3 Markus Weiler1 1Department of Neurology, 2Department of General Psychiatry, Center for Psychosocial Medicine, 3Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany *These authors contributed equally to this work Abstract: Nitrous oxide (N2O, a long-standing anesthetic, is known for its recreational use, and its consumption is on the rise. Several case studies have reported neurological and psychiatric complications of N2O use. To date, however, there has not been a study using standardized diagnostic procedures to assess psychiatric comorbidities in a patient consuming N2O. Here, we report about a 35-year-old male with magnetic resonance imaging confirmed subacute myelopathy induced by N2O consumption, who suffered from comorbid cannabinoid and nicotine dependence as well as abuse of amphetamines, cocaine, lysergic acid diethylamide, and ketamine. Additionally, there was evidence of a preceding transient psychotic and depressive episode induced by synthetic cannabinoid abuse. In summary, this case raises awareness of an important mechanism of neural toxicity, with which physicians working in the field of substance-related disorders should be familiar. In fact, excluding N2O toxicity in patients with recognized substance-related disorders and new neurological deficits is compulsory, as untreated for months the damage to the nervous system is at risk of becoming irreversible. Keywords: addictive disorders, laughing gas, subacute combined degeneration, substance use disorder, vitamin B12 deficiency
Che, Zhenghong; Che, Zhengmei
Case teaching is an efficient teaching method of management. It plays an important role to enhance the students' ability to practice the theory. However, case teaching of financial management has not achieved the expected results. The paper aims to study the importance, characteristics and corresponding methods of case teaching method of financial…
Fernandez, Fabrice; Lézé, Samuel
Mental health evaluation within a legal setting is widely seen as a power to judge. The aim of this paper is to challenge this current thesis, which was popularised by Michel Foucault, who encapsulated the notion in a brief sentence: "The sordid business of punishing is thus converted into the fine profession of curing" (Foucault, 2003: 23). On the basis of an ethnography of a French district court (between September 2008 and May 2009, n = 60 trials) including interviews with judges (n = 10) and psychiatrists (n = 10), we study the everyday penal treatment of sexual offenders using psychiatric reports. Our findings show how (i.) the expectations of the judges select the psychiatrists' skills (based on the following criteria for their reports: accessibility of knowledge, singularization and individualization of content) and (ii.) reframe the psychiatric report as a moral tool. The clinical reasoning of forensic psychiatrists in their reports offer moral affordances due to their clinical caution regarding the risk of recidivism (therapeutic and criminological reversal, moral prevention). Both the judges' evaluation and the psychiatrists' clinical authority are shaped by a moral economy of dangerousness, which eclipses the idea of lack of criminal responsibility. In conclusion, we show that these unintended effects are necessarily of interest to most clinical practitioners engaged in work as expert witnesses. Copyright © 2014 Elsevier Ltd. All rights reserved.
Kamışlı, Songül; Dil, Satı; Daştan, Leyla; Eni, Nurhayat
In this study, we investigated whether liberty-restricting and other factors can predict internalized stigma among psychiatric inpatients and outpatients. The study sample comprised of 129 inpatients, admitted at least once to psychiatry ward, and 100 outpatients who have never been hospitalized, receiving psychiatric treatment. In addition to demographic and clinical features, patients were evaluated for perceived deprivation of liberty and internalized stigma levels. Patients stated that their liberty was restrained mostly due to involuntary treatment, communication problems, side effects of medical treatment and inability to choose their treatment team. Regression analysis showed that internalized stigma was predicted by perceived deprivation of liberty, marital status and number of admissions to ward. Stigma was related to marital status and admissions to the psychiatry ward. Perceived deprivation of liberty predicts stigma regardless of the disease severity CONCLUSION: Perception of stigma leads to self-isolation, behavioral avoidance and refusal of aid-seeking. Our study indicated that perceived deprivation of liberty is one of the most important factors that lead to increased stigma. Based on our findings, we can say that as patients experience less perceived deprivation of liberty, they would have less stigma and thus, their compliance would increase.
Triplett, Patrick; Dearholt, Sandra; Cooper, Mary; Herzke, John; Johnson, Erin; Parks, Joyce; Sullivan, Patricia; Taylor, Karin F; Rohde, Judith
Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.
Aberg-Wistedt, A; Cressell, T; Lidberg, Y; Liljenberg, B; Osby, U
Two-year outcomes of patients with schizophrenic disorders who were assigned to an intensive, team-based case management program and patients who received standard psychiatric services were assessed. The case management model featured increased staff contact time with patients, rehabilitation plans based on patients' expressed needs, and patients' attendance at team meetings where their rehabilitation plan was discussed. Forty patients were randomly assigned to either the case management group or the control group that received standard services. Patients' use of emergency and inpatient services, their quality of life, the size of their social networks, and their relatives' burden of care were assessed at assignment to the study groups and at two-year follow-up. Patients in the case management group had significantly fewer emergency visits compared with the two years before the study, and their relatives reported significantly reduced burden of care associated with relationships with psychiatric services over the two-year period. The size of patients' social networks increased for the case management group and decreased for the control group. A team-based intensive case management model is an effective intervention in the rehabilitation of patients with chronic schizophrenia.
Hammond, Julie; Lipsedge, Maurice
This review aimed to improve infant risk assessments in the context of maternal mental illness by identifying key predictors of poor parenting outcomes. Inadequate parenting as a result of severe and persistent mental illness is a common reason for courts terminating parental rights. However, the current practice of parenting capacity assessments in the setting of perinatal psychiatry is fraught with risks and uncertainty. A well-recognised flaw in the assessment process is the lack of valid and reliable tools that have been specifically validated for assessing parenting capacity in mothers with a history of mental illness and the potential risk of harm to their infant. To date, there is only one instrument available. A systematic search of Medline, PsycInfo and Embase via the Ovid interface was conducted between September and December 2014. Citation snowball sampling was also used to identify further relevant studies. An additional search was performed in Google to access grey literature. A total of 38 citations were identified, of which 8 publications focusing on the populations of England, France and Belgium met the eligibility criteria of this review. Evidence from existing research suggests that poor parenting outcomes in maternal psychiatric illness are strongly associated with correlates of socio-economic inequalities. However, evidence regarding the long-term implications of such factors is weak as only one follow up study and no longitudinal studies were identified in this review. Our review suggests that the use of standardised empirically validated risk assessment tools would benefit the current practice of parenting assessments by improving the process by which collected information is analysed. This would enhance the accuracy of decision-making, and improve the safeguarding of the infant. Further research is needed on medium to long-term parenting outcomes, particularly regarding its relations to: the type of maternal psychiatric disorder; the quality
Fegert, J M; Geiken, G; Lenz, K
The fall of the Berlin wall caused a sudden increase in migration from East-Germany to West-Berlin. In our sample we compared 155 Berlin elementary school children to 17 children from East-Germany now living in Berlin and 25 immigrant children most oft them coming from Turkey and Poland. Although many authors expected short-term disorders of adaptation, we found a constancy of psychiatric diagnosis in the migration group. We noticed important differences particularly in the new psychosocial situation of the former East German mothers, with many single-mother-families, where the mothers now were often unemployed.
Full Text Available The Centers for Disease Control and Prevention (CDC has published significant data and trends related to suicide rates in the United States (U.S.. Suicide is the 10th leading cause of death in U.S. adults, and rates are increasing across all geographic regions. There is a significant increase in the suicide rate among adults in the 35-64 age range. We present findings from the CDC’s Morbidity and Mortality Weekly Report (MMWR with commentary on current resources and barriers to psychiatric care. [West J Emerg Med. 2014;15(1:11–13.
Hakvoort, Laurien; Bogaerts, Stefan; Thaut, Michael H; Spreen, Marinus
The effect of music therapy on anger management and coping skills is an innovative subject in the field of forensic psychiatry. This study explores the following research question: Can music therapy treatment contribute to positive changes in coping skills, anger management, and dysfunctional behavior of forensic psychiatric patients? To investigate this question, first a literature review is offered on music therapy and anger management in forensic psychiatry. Then, an explorative study is presented. In the study, a pre- and post-test design was used with a random assignment of patients to either treatment or control condition. Fourteen participants' complete datasets were collected. All participants received "treatment as usual." Nine of the participants received a standardized, music therapy anger management program; the five controls received, unplanned, an aggression management program. Results suggested that anger management skills improved for all participants. The improvement of positive coping skills and diminishing of avoidance as a coping skill were measured to show greater changes in music therapy participants. When controlling for the exact number of treatment hours, the outcomes suggested that music therapy might accelerate the process of behavioral changes. © The Author(s) 2013.
Sowers, W; Golden, S
Persons presenting with concurrent psychiatric and substance problems present unique challenges for diagnosis and for effective and rational treatment planning. This is especially true for psychiatrists attempting to prescribe pharmacologic interventions which will promote recovery from both disorders and improve function. In order to be effective in this endeavor it is important to have a clear understanding of the dynamics of addiction as well as the particular issues and struggles related to mental illness which will affect an individual's attitude toward and use of medication. This article discusses some of the common problems related to diagnostic decision making and initiation of medication in persons with co-occurring disorders. An algorithm for guiding these decisions is presented. Common misconceptions held by these individuals regarding medication, as distinguished from "drugs," are considered. Unique psychodynamic issues that may lead these persons to actively seek medication as a solution to their problems, or which may, conversely, lead them to an outright rejection of medication as a part of their recovery, are discussed. Countertransferential issues influencing the physician's approach to prescribing for this population are also considered. The article concludes with recommendations for pharmacologic approaches to address specific psychiatric syndromes which may present in this population.
Sortedahl, Charlotte; Mottern, Nina; Campagna, Vivian
The purpose of this article is to examine how case managers are routinely confronted by ethical dilemmas within a fragmented health care system and given the reality of financial pressures that influence life-changing decisions. The Code of Professional Conduct for Case Managers (Code), published by the Commission for Case Manager Certification, acknowledges "case managers may often confront ethical dilemmas" (Code 1996, Rev. 2015). The Code and expectations that professional case managers, particularly those who are board certified, will uphold ethical and legal practice apply to case managers in every practice setting across the full continuum of health care. This discussion acknowledges the ethical dilemmas that case managers routinely confront, which empowers them to seek support, guidance, and resources to support ethical practice. In addition, the article seeks to raise awareness of the effects of burnout and moral distress on case managers and others with whom they work closely on interdisciplinary teams.
Hall, James A.; Vaughan Sarrazin, Mary S.; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin
Objective: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual…
... POSTAL REGULATORY COMMISSION [Docket No. PI2010-3; Order No. 456] Postal Rate Case Management AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is seeking comments relevant to management of an anticipated exigent postal rate case. It has scheduled a technical conference...
Schutt, Russell K; Fawcett, Jacqueline; Gall, Gail B; Harrow, Brooke; Woodford, Mary Lou
The purpose of this study was to examine correlates of case managers' satisfaction with their work, services, and service network and to identify connections to service performance and service costs. A decentralized public health program that exemplifies the trend toward more diverse clients and networked services. A mixed method design with 34 case managers. As hypothesized, the case managers' experiences with clients and the service network, and their service effectiveness, were associated with their satisfaction with their jobs and the services they provide. Satisfaction was also positively associated with more timely service delivery. These associations were explained in part by case managers' education and training. Case managers can achieve high levels of job and service satisfaction in outreach programs serving a diverse client population in a decentralized service network. Case managers' job and service satisfaction improves with reduced service problems and service delays and when case managers can devise work-arounds for persistent service problems. Using advanced practice nurses (APN) and providing more on-the-job training may increase case manager satisfaction with their jobs and the services they provide. Special efforts may be needed to prevent a decline in job satisfaction with years of experience.
Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian
Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…
Within a delegated portfolio management setting, this paper presents a case study of how the manager selection process can be operationalized in practice. Investors have to pursue a thorough screening of potential portfolio managers in order to discover their quality, and this paper discusses how...
Levenson, Steven A; Desai, Abhilash K
Despite much attention including national initiatives, concerns remain about the approaches to managing behavior symptoms and psychiatric conditions across all settings, including in long-term care settings such as nursing homes and assisted living facilities. One key reason why problems persist is because most efforts to "reform" and "correct" the situation have failed to explore or address root causes and instead have promoted inadequate piecemeal "solutions." Further improvement requires jumping off the bandwagon and rethinking the entire issue, including recognizing and applying key concepts of clinical reasoning and the care delivery process to every situation. The huge negative impact of cognitive biases and rote approaches on related clinical problem solving and decision making and patient outcomes also must be addressed. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Keuroghlian, Alex S; Palmer, Brian A; Choi-Kain, Lois W; Borba, Christina P C; Links, Paul S; Gunderson, John G
The effect that attending a 1-day workshop on Good Psychiatric Management (GPM) had on attitudes about borderline personality disorder (BPD) was assessed among 297 clinicians. Change was recorded by comparing before and after scores on a 9-item survey previously developed to assess the effects of workshops on Systems Training for Emotional Predictability and Problem Solving (STEPPS). Participants reported decreased inclination to avoid borderline patients, dislike of borderline patients, and belief that BPD's prognosis is hopeless, as well as increased feeling of competence, belief that borderline patients have low self-esteem, feeling of being able to make a positive difference, and belief that effective psychotherapies exist. Less clinical experience was related to an increased feeling of competence and belief that borderline patients have low self-esteem. These findings were compared to those from the STEPPS workshop. This assessment demonstrates GPM's potential for training clinicians to meet population-wide needs related to borderline personality disorder.
Eduardo L. G. Rios-Neto
The objective of this paper is to present the Brazilian migration experience and its relationship with migration management. The article is divided into three parts. First, it reviews some basic facts regarding Brazilian immigration and emigration processes. Second, it focuses on some policy and legal issues related to migration. Finally, it addresses five issues regarding migration management in Brazil.
In this paper, the requirements management based on use cases is theoretically explored, and a multi-layer use-case model is introduced, which combined with three levels of use cases and a single use-case refinement model. Through the practice in a software project, the multi-layer use-case model provides a good solution on how to control the requirements scope and change, and provides the balance of work assignment between customer departments, information management departments and software development outsourcing team. (authors)
Smith, Annetta; Mackay, Seonaid; McCulloch, Kathleen
This article is a report of an action research study carried out with community nurses to help develop case management within their practice. Using action research principles, nurses reviewed and analysed their current practice and developed recommendations for further embedding case management as a means of supporting patients with complex care needs in their own homes. Findings indicate that a number of factors can influence the community nurse's ability to implement case management. These factors include approaches to case finding, availability of resources and interprofessional working. Important considerations for nurses were the influence of the context of care, the geographical location and the health needs of the local patient population, which meant that case management may need to be adapted to meet local circumstances.
Faizi, Fakhrudin; Tavallaee, Abbas; Rahimi, Abolfazl; Saghafinia, Masoud
Lifestyle modification has a significant role in chronic daily headache (CDH) management. Participatory action research (PAR) can play an important role in managing chronic medical conditions. However, it has been scarcely used in CDH management. This study aimed to empower patients with CDH to modify their lifestyle in order to reduce both their headache and related psychiatric co-morbidities in a multidisciplinary headache clinic at Baqiyatallah hospital, Tehran, IR Iran. In the PAR plan, 37 patients (27 females) diagnosed with CDH were selected using purposeful sampling. Along with face-to-face group sessions, all available communication means such as phone calls, emails, short message system (SMS), and social media (Telegram) were used to facilitate the process. Questionnaires of health promotion lifestyle profile (HPLPІІ), visual analog scale (VAS), and depression-anxiety-stress scale (DASS21) were used to collect data. The data were analyzed using SPSS software. Mean age of the patients was 38.33 (± 9.7) years. Both "general pain" and "the worst imaginable pain" reduced (mean of reduction: 2.56 ± 2.7 and 2.3 ± 2.9, respectively, P 50% of pain reduction occurred in "the worst imaginable pain" category (-1.45 ± 2.02, P communication tools helped the CDH patients better handle their lifestyle, reduce their headache, and lower their symptoms. Further studies with better use of currently available communication tools and social media are recommended for action research to be more applicable.
Jinjoo Oh, Ph.D., RN, GNP; Seieun Oh, Ph.D., RN
Purpose: The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for ...
Lesage, Alain; Groden, David; Goldner, Elliot M; Gelinas, Daniel; Arnold, Leslie M
Psychiatric hospitals remain the main venue for long-term mental health care and, despite widespread closures and downsizing, no country that built asylums in the last century has done away with them entirely--with the recent exception of Italy. Differentiated community-based residential alternatives have been developed over the past decades, with staffing levels that range from full-time professional, to daytime only, to part-time/on-call. This paper reviews the characteristics of community-based psychiatric residential care facilities as an alternative to long-term care in psychiatric hospitals. It describes five factors decision makers should consider: 1. number of residential places needed; 2. staffing levels; 3. physical setting; 4. programming; and 5. governance and financing. In Italy, facilities with full-time professional staff have been developed since the mid-1990s to accommodate the last cohorts of patients discharged from psychiatric hospitals. In the United Kingdom, experiments with hostel wards since the 1980s have shown that home-like, small-scale facilities with intensive treatment and rehabilitation programming can be effective for the most difficult-to-place patients. More recently in Australia, Community Care Units (CCUs) have been applying this concept. In the Canadian province of British Columbia (BC), Tertiary Psychiatric Residential Facilities (TPRFs) have been developed as part of an effort to regionalise health and social services and downsize and ultimately close its only psychiatric hospital. This type of service must be further developed in addition to the need for forensic, acute-care and intermediate-level beds, as well as for community-based care such as assertive community treatment and intensive case management. All these types of services, together with long-term community-based residential care, constitute the elements of a balanced mental health care system. As part of a region's balanced mental health care plan, these Tertiary
Christiansen, Erik; Juul Larsen, Kim
discharge from last contact with a psychiatric department. The risk of suicide attempt is highest for children and adolescents suffering from personality disorders, depression and substance use disorders. Children and adolescents with previous contact with a psychiatric department and parental income......Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk....... Methods: A complete extraction of Danish register data for every individual born in the period 1983-1989 was made. Of these 403,431 individuals, 3,465 had attempted suicide. In order to control for confounder effects from gender, age and calendar-time, a nested case-control study was designed. A total...
Chang, Andy Y.; Koh, Chester J.; Stein, John P.
The management of urethral foreign bodies may require the use of various surgical techniques in a urologist's armamentarium. We report a unique case of a urethral foreign body requiring percutaneous and endoscopic techniques for removal.
Association for Retarded Citizens, Arlington, TX.
A question-and-answer format is used in this fact sheet to provide information on case management for individuals with mental retardation. The fact sheet describes the major components of a case management system, the role of the case manager, the individual's or family's role in case management, providers of case management services and systems…
Haber, S.B.; Barriere, M.T.; Roberts, K.H.
Outage management issues identified from a field study conducted at a two-unit commercial pressurized water reactor (PWR), when one unit was in a refueling outage and the other unit was at full power operation, are the focus of this paper. The study was conduced as part of the US Nuclear Regulatory Commission's (NRC) organizational factors research program, and therefore the issues to be addressed are from an organizational perspective. Topics discussed refer to areas identified by the NRC as critical for safety during shutdown operations, including outage planning and control, personnel stress, and improvements in training and procedures. Specifically, issues in communication, management attention, involvement and oversight, administrative processes, organizational culture, and human resources relevant to each of the areas are highlighted by example from field data collection. Insights regarding future guidance in these areas are presented based upon additional data collection subsequent to the original study
Turvey, Carolyn; Fortney, John
This article discusses recent applications in telemedicine to promote the goals of population health and population management for people suffering psychiatric disorders. The use of telemedicine to promote collaborative care, self-monitoring and chronic disease management, and population screening has demonstrated broad applicability and effectiveness. Collaborative care using videoconferencing to facilitate mental health specialty consults has demonstrated effectiveness in the treatment of depression, PTSD, and also ADHD in pediatric populations. Mobile health is currently being harnessed to monitor patient symptom trajectories with the goal of using machine learning algorithms to predict illness relapse. Patient portals serve as a bridge between patients and providers. They provide an electronically secure shared space for providers and patients to collaborate and optimize care. To date, research has supported the effectiveness of telemedicine in promoting population health. Future endeavors should focus on developing the most effective clinical protocols for using these technologies to ensure long-term use and maximum effectiveness in reducing population burden of mental health.
Full Text Available Contemporary management literature often makes use of strong religious vocabulary. This article will provide a critical analysis of this practice. It especially analyses the usage of three religious terms in management circles: �vision� � a term omnipresent in leadership literature, �metanoic organisations� � a notion found in books about change management, and �evangelists� � a job title mentioned in job advertisements by companies such as Apple and Microsoft. This phenomenon goes hand in hand with the megatrend �workplace spirituality�, which started in the 1990s. In addition, it can be observed that religious vocabulary has found its way into ordinary current management literature, even if this literature does not show any overt link to spirituality. The article lists some negative side effects of this use, such as confusion of terms, manipulation of people and inappropriate pathos.Intradisciplinary and/or interdisciplinary implications: It is important for both Theology and Management Theory to be critical of the use of religious terms in non-religious contexts.
Full Text Available Background: Cotard’s Syndrome (CS is a rare and severe neuropsychiatric condition in which the central feature is the existence of nihilistic delusions. Controversy has ensued about the precise clinical picture Jules Cotard meant to describe and attempts have been made, more recently, not only to clarify the terminology, but also to define different types of this syndrome and explore its biological basis. Aims: We intend to briefly review the terminology, etiology, epidemiology and differential diagnosis of this syndrome, based on two clinical cases. Methods: Bibliographic search conducted through the electronic databases Medline and Gallica (French National Library, consultation of clinical records and direct interviews with the patients. Results and Conclusions: Typically the patients diagnosed with CS manifest the delusional idea that they are dying or already dead. However, it is also possible that they deny the existence of only some parts of their own body, or the functioning of some organs, and they may even sometimes deny the existence of the external world. We illustrate the case of a 66-year-old woman, diagnosed with bipolar affective disorder, admitted in the context of a severe depressive episode with psychotic symptoms, compatible with CS type II and the case of a young male aged 22, admitted due to a first psychotic episode with schizophrenia like characteristics, presenting with nihilistic delusions compatible with CS type I.
Gruber, Ema N; Ivezić-Strkalj, Sladana; Agius, Mark; Martić-Biocina, Sanja
The authors present a case report of a patient who was treated by a case manager, a member of a Croatian Community Mental Health (CMH) Team, following the recommendations of WHO 2004 as well as the IRIS guidelines and the Basic Standards for Management of Patients with Serious Mental Illness in the Community (Agius 2005) and using the elements of Clinical case management (Muser 1998), Assertive community treatment model (Burns 1995, Scott 1995, Wolfsan 1990), the personal strength model (Rapp 1988) and Rehabilitation model (Anthony 1993). In order to emphasize the importance of the therapist-patient relationship in the treatment of chronic schizophrenic patients (Ivezic 2001) and creating the group atmosphere a Croatian model of case management is created where the patient's needs and risks are assessed by a multidisciplinary team which also conducts the recommended psychosocial interventions plan. The majority of interventions are conducted in groups. The case manager develops a confident relationship with a patient, nourishes the positive transference and aids the delivery of the treatment. The main goals of the interventions are empowerment of the patient, improvement of his abilities and decreasing of disabilities. The case manager also carries out a full assessment of the needs of the patient's family so that the family or carers are also included in the treatment or support if necessary (Gruber 2006). A case report of a patient and the work of her case manager as well as the case manager's diary (Gruber 2007) and the Croatian model of case management is presented in this article.
Lucas, B; Audini, B; Chisholm, D; Knapp, M; Lelliott, P
This study examines the effect of managing agency (local authority, private or voluntary) on the use of other health and social care services by residents in mental health hostels and group homes with different levels of staffing in England and Wales. The sample comprised 1323 residents in 275 facilities in eight districts. The measures of service use were number of days in hospital and number of other service contacts. There were highly significant differences between facilities with similar levels of staffing managed by different agencies. Residents in the voluntary sector used fewer community services overall; residents in low-staffed local authority facilities used more services than those in similar facilities managed by other agencies. These differences were not easily explained by differences in the social or clinical characteristics of residents. This suggests that there may be organisational factors, e.g. hostel staff, knowledge of services, which influence access to and use of community services.
Jinjoo Oh, Ph.D., RN, GNP
Full Text Available Purpose: The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management. Methods: Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews. Results: Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected. Conclusion: The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea. Keywords: case management, focus groups, hospitalization, qualitative research, vulnerable populations
Russell, Andrew T.; Hahn, Joan Earle; Hayward, Katharine
The purpose of this study was to describe the medication management and treatment provided in a specialty outpatient psychiatry clinic for 198 community-residing children and adults with intellectual disability and other developmental disabilities (IDD) referred to the clinic and discharged between 1999 and 2008. Using a descriptive design, data…
Clemm von Hohenberg, Christian; Dreßing, Harald
We report the case of a 48-year-old female whom we examined for legal culpability. The proband was taking the dopamine agonist pramipexole as a treatment for Parkinson's disease. In temporal association, she had committed numerous shoplifting offences.While pathological gambling, excessive shopping and hypersexuality have often been described as adverse effects of dopamine agonists, there are only few reports about impulsive stealing in this context.We discuss the synergy of the pharmacological effects with familial, biographic and social factors, suggesting a bio-psycho-social etiology. © Georg Thieme Verlag KG Stuttgart · New York.
Renata Cesar Torres
Full Text Available This study is a teaching case that deals with a managerial problem faced by a medium-size Brazilian company. Amendopar was a family business in the peanut products industry that operated in the Brazilian market for 47 years. The Londrina, Paraná unit was operating close to its maximum production capacity, imposing a limit to the company’s growth. Having an already well established position in its state of origin, the owners were considering expanding into other markets. There was also interest on their part because of the tax benefits they would reap by establishing a new production unit in São Paulo State. However, the challenge at this time was to decide whether it was the right time to make this move and how much investment would be required. These decisions would be made at a meeting to be held and for which the Industrial Director was preparing.
Oh, Jinjoo; Oh, Seieun
The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management. Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews. Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected. The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea. Copyright © 2017. Published by Elsevier B.V.
Vanina Lima Monteiro
Full Text Available Objective: Psychiatric symptoms emerge in the early stages of anti-N-methyl-D-aspartate receptor (anti-NMDAR encephalitis, and patients often seek treatment in psychiatric departments before visiting any other general medical services. Numerous articles about anti-NMDAR encephalitis have been published in the scientific community worldwide, but few emphasize the role of psychiatry in symptom management.Case description: We describe the case of a patient with anti- -NMDAR encephalitis seen in our service and discuss the management of behavioral symptoms based on current scientific literature. High doses of atypical antipsychotics and benzodiazepines were used to control agitation, and trazodone was administered to treat insomnia.Comments: Consultation-liaison psychiatry may help the healthcare team adjust the management of neuropsychiatric complications that might affect inpatients with anti-NMDAR encephalitis.
In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Routine monitoring of caseload, especially by a workplace
Full Text Available A case of dissociative amnesia with regressed behaviour was diagnosed applying the existing criteria for dissociative disorder in the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10. Though there are number of cases of such condition, but when coupled with regressed behaviour it adds to new dimension in the management. An applied strategy in lines with both pharmacological and non pharmacological was used, and we found that it helped our patient to gradually improve her behaviour. This is one of the few cases reported and we hope more such cases should be reported in understanding the psychopathology.
Hauseux, P-A; Cyprien, F; Cif, L; Gonzalez, V; Boulenger, J-P; Coubes, P; Capdevielle, D
Tourette syndrome (TS) is a complex neuropsychiatric disorder associated with comorbid psychiatric disorders. Peak of tic severity typically occurs in early adolescence and impacts quality of life. Since 1999, promising therapeutic effects of Deep Brain Stimulation (DBS) have been reported in tic reduction for adults with refractory TS. The aim of the study was to assess the long-term risk-benefit ratio of pallidal DBS for young patients with refractory TS and severe comorbid psychiatric disorders. We retrospectively assessed the long-term clinical outcomes of three adolescents who underwent pallidal DBS for the treatment of refractory TS. The mean duration of follow-up was 52 months in our case series. We observed that motor tics decreased with posteroventral GPi DBS in all patients, without reaching a continuous significance over the long-term follow-up. Self-reported social inclusion was globally improved, despite lack of efficacy of DBS on comorbid conditions. These findings suggest a long-term therapeutic benefit of early DBS intervention for highly socially impaired young patients suffering from intractable TS with severe comorbid psychiatric conditions. Further studies are needed to determine the most effective targets of DBS on both tics and comorbid psychiatric profile of TS. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
Almaden, Stefany; Freshman, Brenda; Quaye, Beverly
To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.
Kast, Kristopher A; Gershengoren, Liliya
The increasing prevalence of cannabis use in the United States requires awareness of cannabis-related disorders and familiarity with treatment options. We present a case of cannabinoid hyperemesis syndrome that required psychiatric consultation for diagnostic clarification and effective treatment with intravenous haloperidol. Literature from emergency medicine, toxicology, and gastroenterology is reviewed, including proposed diagnostic criteria for cannabinoid hyperemesis syndrome and reported off-label treatment options, with a specific focus on clinical questions facing the practicing psychiatrist regarding this emerging disorder.
Psychiatric disorders and psychiatric consultation in a general hospital: a case- control study Transtornos psiquiátricos e solicitações de interconsulta psiquiátrica em hospital geral: um estudo de caso controle
Sumaia Inaty Smaira
Full Text Available INTRODUCTION: Psychiatric consultation (PC has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence. METHODS: A case-control patient study was conducted (47 cases and 94 controls to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures, and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD-10 criteria. The Self Report Questionnaire (SRQ, the CAGE and Brief Psychiatric Rating Scale (BPRS were used as well as a specifically designed questionnaire to collect clinical and demographic data. RESULTS: Behavioral alterations, either of elation or of depression, were the main for requesting a PC ; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases, while anxiety, depressive and alcohol-related disorders were predominant in group II (controls. Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals. DISCUSSION: The SRQ and CAGE were quite useful in the screening
This report provides an anthology of psychiatric eponyms. Clinically, many of these described syndromes represent valid diagnostic constructs and may accommodate the atypical cases that defy the official diagnostic designation in the current classificatory systems in psychiatry. © Copyright 2018 Physicians Postgraduate Press, Inc.
Nishinaka, Hirofumi; Nakane, Jun; Nagata, Takako; Imai, Atsushi; Kuroki, Noriomi; Sakikawa, Noriko; Omori, Mayu; Kuroda, Osamu; Hirabayashi, Naotsugu; Igarashi, Yoshito; Hashimoto, Kenji
In Japan, the legislation directing treatment of offenders with psychiatric disorders was enacted in 2005. Neuropsychological impairment is highly related to functional outcomes in patients with psychiatric disorders, and several studies have suggested an association between neuropsychological impairment and violent behaviors. However, there have been no studies of neuropsychological impairment in forensic patients covered by the Japanese legislation. This study is designed to examine the neuropsychological characteristics of forensic patients in comparison to healthy controls and to assess the relationship between neuropsychological impairment and violence risk. Seventy-one forensic patients with psychiatric disorders and 54 healthy controls (matched by age, gender, and education) were enrolled. The CogState Battery (CSB) consisting of eight cognitive domains, the Iowa Gambling Task (IGT) to test emotion-based decision making, and psychological measures of violence risk including psychopathy were used. Forensic patients exhibited poorer performances on all CSB subtests and the IGT than controls. For each group, partial correlational analyses indicated that poor IGT performance was related to psychopathy, especially antisocial behavior. In forensic patients, the CSB composite score was associated with risk factors for future violent behavior, including stress and noncompliance with remediation attempts. Forensic patients with psychiatric disorders exhibit a wide range of neuropsychological impairments, and these findings suggest that neuropsychological impairment may increase the risk of violent behavior. Therefore, the treatment of neuropsychological impairment in forensic patients with psychiatric disorders is necessary to improve functional outcomes as well as to prevent violence.
Full Text Available In Japan, the legislation directing treatment of offenders with psychiatric disorders was enacted in 2005. Neuropsychological impairment is highly related to functional outcomes in patients with psychiatric disorders, and several studies have suggested an association between neuropsychological impairment and violent behaviors. However, there have been no studies of neuropsychological impairment in forensic patients covered by the Japanese legislation. This study is designed to examine the neuropsychological characteristics of forensic patients in comparison to healthy controls and to assess the relationship between neuropsychological impairment and violence risk.Seventy-one forensic patients with psychiatric disorders and 54 healthy controls (matched by age, gender, and education were enrolled. The CogState Battery (CSB consisting of eight cognitive domains, the Iowa Gambling Task (IGT to test emotion-based decision making, and psychological measures of violence risk including psychopathy were used.Forensic patients exhibited poorer performances on all CSB subtests and the IGT than controls. For each group, partial correlational analyses indicated that poor IGT performance was related to psychopathy, especially antisocial behavior. In forensic patients, the CSB composite score was associated with risk factors for future violent behavior, including stress and noncompliance with remediation attempts.Forensic patients with psychiatric disorders exhibit a wide range of neuropsychological impairments, and these findings suggest that neuropsychological impairment may increase the risk of violent behavior. Therefore, the treatment of neuropsychological impairment in forensic patients with psychiatric disorders is necessary to improve functional outcomes as well as to prevent violence.
Pratt, Renée M. E.; Smatt, Cindi T.
This is an example of a real-world applicable case study, which includes background information on a small local business (i.e., TCS), description of functional business requirements, and sample data. Students are asked to design and develop a database to improve the management of the company's customers, products, and purchases by emphasizing…
Wijnveld, Anne-Marie; Crowe, Marie
The aim of this study was to use a phenomenological methodology to examine mental health nurses' experiences of administering medications to patients who were non-adherent in an acute inpatient service. There is a large body of literature focused on exploring the issue of non-adherence to prescribed medication, but there is very little examining this from mental health nurses' perspectives. Many of the medications prescribed for patients diagnosed with a psychiatric disorder have serious side effects and limited efficacy. Mental health nurses in acute inpatient environments are regularly confronted with the difficulties inherent in the conflicting roles associated with the need to maintain therapeutic relationships and the expectation that they ensure patients take their medications. This is a qualitative study exploring mental health nurses' descriptions of managing medication adherence in an acute inpatient unit. The interpretive phenomenological methodology of Van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990) was used in this study to capture the experiences of a group of nurses. This research process involves a dynamic interplay between the following six research activities: (1) turning to the nature of the lived experience; (2) investigating the experience as we live it; (3) reflecting on essential themes; (4) a description of the phenomenon through the art of writing and rewriting; (5) maintaining a strong and oriented pedagogical relation to the phenomenon; and (6) balancing the research context by considering parts and whole. Four themes emerged from the existential analysis that described the mental health nurses' experiences: doing the job for doctors (relationality); stopping and listening (temporality); stepping in (corporeality); and walking a fine line (spatiality). It is proposed that models of therapeutic interventions offering alternative or conjunctive treatment to medications could be incorporated into
Full Text Available The graduate advanced psychiatric nursing (psychiatric nursing specialist from master degree in Indonesia are about 70 nurses, 67 nurses were graduated from University of Indonesia. They are working at mental health services and educational setting around Indonesia and yet seem not ready to perform some specific advanced competencies in clinical area. The mastery on mental health assessment, neurochemical perspectives, medical management and psychotherapy have not yet performed by the psychiatric nurse specialist in the clinical area or community.To have those competencies and its performances, therefore the curriculum in a psychiatric nursing graduate program must include advanced courses in physiopsychology, psychopathology, advanced psychopharmacology, neurobehavioral science, advanced mental health assessment, and advanced treatment interventions such as psychotherapy and prescription and management of psychotropic medications as their core and major courses in the curriculum. Those courses should be performed in their clinical practice courses or other related learning experiences. When those qualifications are met, then they are competent to be called advanced psychiatric nurse.As advanced practice registered nurses, the advanced psychiatric nurses should be able to demonstrate their direct expertise and roles in advanced mental health assessment, diagnostic evaluation, psychopharmacology management, psychotherapy with individuals, group and families, case management, millieu management, liason and counselling from prevention, promotion until psychiatric rehabilitation. Meanwhile the skill such as psycho-education, teaching, unit management, research and staff development can be added as their indirect roles.
Habibi, Bouchra; Achachi, Leila; Hayoun, Sohaib; Raoufi, Mohammed; Herrak, Laila; Ftouh, Mustapha El
Pneumothorax is a collection of air in the pleural cavity. We conducted a retrospective study of patients with spontaneous pneumothorax in the Department of Pneumology at the Ibn Sina Hospital in Rabat (2009-2011) with the aim to determine the epidemiological, clinical, radiological, therapeutic and evolutionary manifestation of spontaneous pneumothorax. The study involved 138 patients: 128 men and 10 women (17-83 years), with an average age of 44.5 +/- 17.4 years and sex ratio of 12/8. 81.2% of patients were smokers. Clinical symptomatology was chest pain (92%), dyspnea (60%). Chest radiograph showed total unilateral (110 cases); partial (10 cases); localized (6 cases); bilateral (4 cases); right (51.4%) or left (45.7%) PNO (pneumothorax). During our study period we found that 70% of patients had spontaneous primitive pneumothorax and 30% had PNO secondary to Chronic obstructive pulmonary disease (COPD) (44%) and pulmonary tuberculosis (TB) (39%). Initial management included patients hospitalization, chest drainage (95%), needle exsufflation (1%), rest and O 2 (4%). It enables the lung to stick to the chest wall within 10 days in 63% of patients. Evolution was favorable in 89% of patients. Immediate complications included: subcutaneous emphysema (5 cases); infection (6 cases) and 3 deaths (cardiorespiratory arrest). Late complications included: recurrences in 11.6%; the first recurrence occurred in 13 cases (chest drainage in 11 cases and oxygen therapy in 2 cases) while the second recurrence occurred in 3 cases (surgery). This study shows the role of chest drainage and monitoring in the management of pneumothorax to avoid complications and especially to prevent recurrences, with a possible need to resort to surgery.
Qin, Ping; Nordentoft, Merete; Hansen Høyer, Eyd
longitudinal registers. Data were analyzed using conditional logistic regression. RESULTS: This study shows that the reduction in suicide rate is generally faster among individuals with a history of psychiatric admission than among individuals without such a history. However, this substantial reduction...... at the time of suicide or the index date, the reduction in suicide rate is relatively slower. Such trends hold for all diagnostic groups. Further analyses stratified by age indicate that the faster reduction in suicide rate associated with history of hospitalized psychiatric illness is more pronounced among...
The role of ethnicity, community structure, and folk concepts of mental illness in facilitating the adaptation of long term psychiatric patients to community living has received little attention. This article examines the cultural concepts of mental illness and the community involvement of 30 Puerto Rican psychiatric patients participating in a New York City treatment program. It is shown that many of the attributes usually associated with chronic mental illness do not apply to this population. It is argued that the folk concept of nervios helps to foster the integration of these patients in a wide range of community networks. The impact of gentrification on these patients' community integration is also discussed.
Axelsen, Karina Rahbek; Nafei, Hanne; Jakobsen, Stine Finne; Gandrup, Per; Knudsen, Janne Lehmann
Case managers are increasingly used to optimize trajectories for patients. This study is based on a questionnaire among case managers in cancer care, aiming at the clarification of the function and its impact on especially patient safety, when handing over the responsibility. The results show a major variation in how the function is organized, the level of competence and the task to be handled. The responsibility has in general been narrowed to department level. Overall, the case managers believe that the function has optimized pathways for cancer patients and improved safety, but barriers persist.
Thaís Sumie Nozu Imada
Full Text Available INTRODUCTION: Torus palatinus is a specific name to identify exostoses developed in the hard palate along the median palatine suture. Despite of not being a pathological condition, its presence requires attention and knowledge regarding its management. Surgical removal of exostoses is indicated when the patient frequently traumatizes the area of palatine torus during mastication and speech or when it is necessary for the rehabilitation of the upper arcade with complete dentures. OBJECTIVE: The aim of this article is to present three cases of Torus palatinus and to discuss the management of them. CASE REPORT: In the first case, a 57-year-old Caucasian man sought oral rehabilitation of his edentulous maxilla but presented a hard nodules in the hard palate; in the second case, a 40-year-old Caucasian woman was referred for frequent trauma of palatal mucosa during mastication, aesthetic complaint, and discomfort caused by the trauma of her tongue in this area; and in the third case, a 45-year-old Caucasian woman presented with a lesion on the palate that caused difficulty swallowing. When the Torus palatinus was impairing the basic physiological functions of the patients, all cases were surgically treated, improving the patients' quality of life. FINAL CONSIDERATION: The dentist should be properly prepared to choose the best from among the existing surgical approaches for each individual lesion in order to improve the results and avoid possible complications.
Jacky Siu-Lun Ting
Full Text Available Risk management is a decision-making process involving considerations of political, social, economic and engineering factors with relevant risk assessments relating to a potential hazard. In the last decade, a number of risk management tools are introduced and employed to manage and minimize the uncertainty and threats realization to the organizations. However, the focus of these methodologies are different; in which companies need to adopt various risk management principles to visualize a full picture of the organizational risk level. Regarding to this, this paper presents a new approach of risk management that integrates Hierarchical Holographic Modeling (HHM, Enterprise Risk Management (ERM and Business Recovery Planning (BCP for identifying and assessing risks as well as managing the consequences of realized residual risks. To illustrate the procedures of the proposed methodology, a logistic company ABC Limited is chosen to serve as a case study Through applying HHM and ERM to investigate and assess the risk, ABC Limited can be better evaluated the potential risks and then took the responsive actions (e.g. BCP to handle the risks and crisis in near future.
Weerasundera, Rajiv; Yogaratnam, Jegan
Psychotic illness has a low incidence in the puerperal period. Peripartum cardiomyopathy as a complication of pregnancy is also rare. We report a case where the above two conditions occurred simultaneously in a patient and posed significant difficulties in the clinical management. She was diagnosed as having paranoid schizophrenia and peripartum cardiomyopathy. Many of the antipsychotics were contraindicated, and electroconvulsive therapy could not be administered due to the added risks involved with regard to anesthesia. She was therefore managed with clonazepam and olanzapine. This case highlights the challenges in a patient with a psychiatric illness presenting with comorbid physical illness. Copyright © 2013 Elsevier Inc. All rights reserved.
Lindegaard, Birthe Rosenkrantz; Qvist, Peter
Allocation of a case manager is now mandatory for both in- and outpatients in Denmark. Case manager allocation is reported quarterly to the regions and results are generally satisfying. Knowledge about fulfillment of the case manager role is, however, sparse. This study aims to examine the degree of fulfillment of the case manager role for a sample of inpatients. Two medical and two surgical wards participated. Patients were interviewed in relation to discharge while staff assigned as case managers completed a survey. Both patients and case managers answered questions regarding the defined roles as case managers: Planning/coordination, continuous information and discharge planning. 107 of 125 eligible patients were interviewed. Only 25 declared themselves informed about the allocation of a case manager. The patients' assessment of the service provided by the staff in relation to case manager tasks was generally good, but the services were seldom provided by the named case manager. 22% of patients did not experience continuous information, while only 13% did not experience a generally coherent stay in hospital. 110 case managers completed the survey. Less than half felt themselves well informed about the case manager role. Only a few case managers feel that they succeed in fulfilling the role, particularly regarding the participation in discharge planning. There seems to be a need for a targeted effort to improve the conditions for case managers in Danish hospitals in order to meet the intentions of this initiative.
AFRL-OSR-VA-TR-2014-0337 CASE-BASED INFLUENCE IN CONFLICT MANAGEMENT Robert Axelrod ARTIS RESEARCH & RISK MODELING Final Report 10/31/2014...FA9550-10-1-0373 Dr. Robert Axelrod - PI Dr. Richard Davis- PD ARTIS Research & Risk Modeling ARTIS 5741 Canyon Ridge North Cave Creek, AZ 85331-9318...analysis of the timing of cyber conflict that quickly received attention from over 30 countries. 3 1 Axelrod , Final Report and Publications Final
Ahlem, Harrathi; Soumeyya, Halayem; Nadia, Janhani; Sami, Othman; Ines, Lahmar; Samira, Blouza; Ahlem, Belhadj; Asma, Bouden; Halayem, Mohamed B
Anorexia nervosa is a complex psychiatric illness that can lead to severe physical complications. This work aimed to study the approach taken by the child psychiatry service of Razi hospital in the management of anorexia nervosa and to compare it with international recommendation. We propose to illustrate by a case report and review international recommendations on this topic while undertaking a review of the literature based on a Medline search using the following keywords: anorexia, nervosa adolescence, management, guidelines. Case report: AS, 16 years old, addressed to us by the school doctor for management of anorexia nervosa evolving for two years without improvement through outpatient care. His condition was considered precarious requiring urgent care in a medical hospital. She was then hospitalized at the Institute of Nutrition with a weight contract to achieve, She received a gradual refueling strongly denied. We have provided a psychological support by moving on site three times a week to help establish a good therapeutic alliance. After three weeks, the teenager has reached an acceptable weight for its output to the hospital and additional support at the outpatient child psychiatry with supportive psychotherapy. Two months later, she developed depression because of the weight gain. The appointment at the dietician was continued three months after hospitalization. At 10 months of the hospitalization, the girl had good grades and was not amenorrheic. However, on the psychological level she kept the same traits and intrafamilial relationships were marked by the seal of the manipulation. Subsequently, the teenager has spaced the consultations then lost sight. Currently, at 15 months of the hospitalization, parents describe a relapse, with a dietary restriction without amenorrhea ad a refusal to take weight. In management of this patient, we followed the recommendations of the literature namely those of the High Authority of Health and NICE (National Institute
Tully, Phillip J; Selkow, Terina
Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than patients. Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.
Epaenetus A. Awuzu
Full Text Available Various studies have reported that abuse of cannabis is a risk factor for psychosis. The aims of this study were to determine the prevalence of delta 9-tetrahydrocanabinol (Δ 9 -THC, a major metabolite of cannabis, in psychiatric patients in Uganda, and to assess the diagnostic capacity of two referral mental health hospitals to screen patients for exposure to cannabis in Uganda. Socio-demographic characteristics of the patients were collected through questionnaires and review of medical records. Urine samples were collected from 100 patients and analyzed using Δ 9 -THC immunochromatographic kit (Standard Diagnostics®, South Korea. Seventeen percent of the patients tested positive for Δ 9 -THC residues in their urine. There was strong association ( p < 0.05 between history of previous abuse of cannabis and presence of Δ 9 -THC residues in the urine. Alcohol, cocaine, heroin, pethidine, tobacco, khat and kuber were the other substances abused in various combinations. Both referral hospitals lacked laboratory diagnostic kits for detection of cannabis in psychiatric patients. In conclusion, previous abuse of cannabis is associated with occurrence of the residues in psychiatric patients, yet referral mental health facilities in Uganda do not have the appropriate diagnostic kits for detection of cannabis residues as a basis for evidence-based psychotherapy.
McCormick, Cynthia G; Henningfield, Jack E; Haddox, J David; Varughese, Sajan; Lindholm, Anders; Rosen, Susan; Wissel, Janne; Waxman, Deborah; Carter, Lawrence P; Seeger, Vickie; Johnson, Rolley E
The development and implementation of programs in the U.S. to minimize risks and assess unintended consequences of new medications has been increasingly required by the Food and Drug Administration (FDA) since the mid 1990s. This paper provides four case histories of risk management and post-marketing surveillance programs utilized recently to address problems associated with possible abuse, dependence and diversion. The pharmaceutical sponsors of each of these drugs were invited to present their programs and followed a similar template for their summaries that are included in this article. The drugs and presenting companies were OxyContin, an analgesic marketed by Purdue Pharma L.P., Daytrana and Vyvanse, ADHD medications marketed by Shire Pharmaceuticals, Xyrem for narcolepsy marketed by Jazz Pharmaceuticals, and Subutex and Suboxone for opioid dependence marketed by Reckitt Benckiser Pharmaceuticals Inc. These case histories and subsequent discussions provide invaluable real-world examples and illustrate both the promise of risk management programs in providing a path to market and/or for keeping on the market drugs with serious potential risks. They also illustrate the limitations of such programs in actually controlling unintended consequences, as well as the challenge of finding the right balance of reducing risks without posing undue barriers to patient access. These experiences are highly relevant as the FDA increasingly requires pharmaceutical sponsors to develop and implement the more formalized and enforceable versions of the risk management term Risk Evaluation and Mitigation Strategies (REMS).
Full Text Available This case study serve as exemplar regarding what can go wrong with the implementation of an electronic document management system. Knowledge agility and knowledge as capital, is outlined against the backdrop of the information society and knowledge economy. The importance of electronic document management and control is sketched thereafter. The literature review is concluded with the impact of human resource management on knowledge agility, which includes references to the learning organisation and complexity theory. The intervention methodology, comprising three phases, follows next. The results of the three phases are presented thereafter. Partial success has been achieved with improving the human efficacy of electronic document management, however the client opted to discontinue the system in use. Opsomming Die gevalle studie dien as voorbeeld van wat kan verkeerd loop met die implementering van ’n elektroniese dokumentbestuur sisteem. Teen die agtergrond van die inligtingsgemeenskap en kennishuishouding word kennissoepelheid en kennis as kapitaal bespreek. Die literatuurstudie word afgesluit met die inpak van menslikehulpbronbestuur op kennissoepelheid, wat ook die verwysings na die leerorganisasie en kompleksietydsteorie insluit. Die metodologie van die intervensie, wat uit drie fases bestaan, volg daarna. Die resultate van die drie fases word vervolgens aangebied. Slegs gedeelte welslae is behaal met die verbetering van die menslike doeltreffendheid ten opsigte van elektroniese dokumentbestuur. Die klient besluit egter om nie voort te gaan om die huidige sisteem te gebruik nie.
Biebel, Kathleen; Mizrahi, Raphael; Ringeisen, Heather
Accessing and successfully completing postsecondary educational opportunities may be challenging for those living with psychiatric disabilities. This exploratory study highlights the experiences of individuals with psychiatric disabilities participating in postsecondary educational support initiatives. Investigators conducted case studies with 3 education support initiatives across the United States. Focus groups revealed what concrete supported education services were helpful and key ingredients in delivering education supports. Access to specialists, mindfulness techniques, help with time management and procrastination, and facilitating classroom accommodations were identified as critical. Developing authentic relationships with supported education staff, flexibility in service delivery and access to student peers living with psychiatric disabilities were noted as key ingredients in service delivery. Incorporating the voice of students with psychiatric disabilities into supported education services can increase access, involvement, and retention, therein providing more supports to students with psychiatric disabilities achieving their postsecondary education goals. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Demiroglu, S Y; Skrowny, D; Quade, M; Schwanke, J; Budde, M; Gullatz, V; Reich-Erkelenz, D; Jakob, J J; Falkai, P; Rienhoff, O; Helbing, K; Heilbronner, U; Schulze, T G
Large-scale collaborative research will be a hallmark of future psychiatric genetic research. Ideally, both academic and non-academic institutions should be able to participate in such collaborations to allow for the establishment of very large samples in a straightforward manner. Any such endeavor requires an easy-to-implement information technology (IT) framework. Here we present the requirements for a centralized framework and describe how they can be met through a modular IT toolbox.
Renaud, Johanne; Berlim, Marcelo T; McGirr, Alexander; Tousignant, Michel; Turecki, Gustavo
The present study was designed to evaluate psychiatric risk factors for child and adolescent suicide, and to determine the association between impulsive-aggressive and other personality traits, and suicide completion in this population. Psychiatric diagnoses, impulsive-aggressive and other personality traits were assessed in 55 child and adolescent suicide victims and 55 community controls using semi-structured proxy-based interviews and questionnaires. The most significant psychiatric risk factors associated with child and adolescent suicide were depressive disorders (OR=48.414, 95% CI 6.247-375.185), substance/alcohol abuse disorder (OR=5.365, 95% CI 1.434-20.076), and disruptive disorders (OR=13.643, 95% CI 2.292-23.16). Additionally, suicide victims showed higher scores on lifetime aggression/impulsivity, and harm avoidance. However, after logistic regression, the only independent significant predictors of suicide in this age group were the presence of depressive disorders (Adjusted OR (AOR)=39.652, 95% CI 4.501-349.345), substance/alcohol abuse disorders (AOR=7.325, 95% CI 1.127-47.62), and disruptive disorders (AOR=6.464, 95% CI 1.422-29.38). Relatively small sample size, and cross-sectional design. Our findings confirm the existence of a particular clinical profile of children and adolescents at high risk for suicide. Additionally, our results reinforce the need for improved understanding of the interrelationships between stressors, depression, substance/alcohol abuse disorders, disruptive disorders and personality traits/dimensions in youth suicidal behavior.
McMain, Shelley F; Guimond, Tim; Streiner, David L; Cardish, Robert J; Links, Paul S
The authors conducted a 2-year prospective naturalistic follow-up study to evaluate posttreatment clinical outcomes in outpatients who were randomly selected to receive 1 year of either dialectical behavior therapy or general psychiatric management for borderline personality disorder. Patients were assessed by blind raters 6, 12, 18, and 24 months after treatment. The clinical effectiveness of treatment was assessed on measures of suicidal and nonsuicidal self-injurious behaviors, health care utilization, general symptom distress, depression, anger, quality of life, social adjustment, borderline psychopathology, and diagnostic status. The authors conducted between-group comparisons using generalized estimating equation, mixed-effects models, or chi-square statistics, depending on the distribution and nature of the data. Both treatment groups showed similar and statistically significant improvements on the majority of outcomes 2 years after discharge. The original effects of treatment did not diminish for any outcome domain, including suicidal and nonsuicidal self-injurious behaviors. Further improvements were seen on measures of depression, interpersonal functioning, and anger. However, even though two-thirds of the participants achieved diagnostic remission and significant increases in quality of life, 53% were neither employed nor in school, and 39% were receiving psychiatric disability support after 36 months. One year of either dialectical behavior therapy or general psychiatric management was associated with long-lasting positive effects across a broad range of outcomes. Despite the benefits of these specific treatments, one important finding that replicates previous research is that participants continued to exhibit high levels of functional impairment. The effectiveness of adjunctive rehabilitation strategies to improve general functioning deserves additional study.
Seng, Elizabeth K; Seng, Cynthia D
This article describes recent trends in our understanding of the role of psychiatric disorders in the experience and treatment of migraine, and the role of migraine in the experience and treatment of psychiatric disorders. Although the majority of studies evaluating psychiatric comorbidity in migraine have focused on depression, anxiety, and bipolar disorders are highly associated with migraine and relevant for prognosis and treatment planning. Comorbid psychiatric disorders may be associated with poorer treatment response for some acute pharmacotherapies; however, people with comorbid migraine and mood or anxiety disorders can achieve large responses to preventive pharmacologic and behavioral therapies. Emerging research is developing and evaluating behavioral treatments designed to manage cooccurring migraine and mood or anxiety disorders. Stigma related to psychiatric disorders has been well characterized, and could exacerbate extant migraine-related stigma. Anxiety and mood disorders are prevalent in people with migraine, although not ubiquitous. Psychiatric comorbidity is associated with greater migraine symptoms and disability; however, people with comorbid depression or anxiety are amenable to preventive migraine treatment. Research regarding migraine treatment strategies optimized for people with comorbid psychiatric disorders is critical to advancing care and reducing stigma for this important subpopulation of people with migraine.
Morrison, Gerold; Greening, Holly; Yates, Kimberly K.; Wolanski, Eric; McLusky, Donald S.
Tampa Bay, Florida, USA, is a shallow, subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of seagrasses and other selected habitat types, to support estuarine-dependent faunal guilds. Over the past three decades, nitrogen controls involving sources such as wastewater treatment plants, stormwater conveyance systems, fertilizer manufacturing and shipping operations, and power plants have been undertaken to meet these and other management objectives. Cumulatively, these controls have resulted in a 60% reduction in annual total nitrogen (TN) loads relative to earlier worse-case (latter 1970s) conditions. As a result, annual water-clarity and chlorophyll a targets are currently met in most years, and seagrass cover measured in 2008 was the highest recorded since 1950. Factors that have contributed to the observed improvements in Tampa Bay over the past several decades include the following: (1) Development of numeric, science-based water-quality targets to meet a long-term goal of restoring seagrass acreage to 1950s levels. Empirical and mechanistic models found that annual average chlorophyll a concentrations were a primary manageable factor affecting light attenuation. The models also quantified relationships between TN loads, chlorophyll a concentrations, light attenuation, and fluctuations in seagrass cover. The availability of long-term monitoring data, and a systematic process for using the data to evaluate the effectiveness of management actions, has allowed managers to track progress and
Singh, V. P.; Badiger, N. M.; Managanvi, S. S.; Bhat, H. R.
Removal half-life (RHL) of tritium is one of the best means for optimising medical treatment, reduction of committed effective dose (CED) and quick/easy handling of a large group of workers for medical treatment reference. The removal of tritium from the body depends on age, temperature, relative humidity and daily rainfall; so tritium removal rate, its follow-up and proper data analysis and recording are the best techniques for management of accidental acute tritium exposed cases. The decision of referring for medical treatment or medical intervention (MI) would be based on workers' tritium RHL history taken from their bodies at the facilities. The workers with tritium intake up to 1 ALI shall not be considered for medical treatment as it is a derived limit of annual total effective dose. The short-term MI may be considered for tritium intake of 1-10 ALI; however, if the results show intake ≥100 ALI, extended strong medical/therapeutic intervention may be recommended based on the severity of exposure for maximum CED reduction requirements and annual total effective dose limit. The methodology is very useful for pressurized heavy water reactors (PHWRs) which are mainly operated by Canada and India and future fusion reactor technologies. Proper management will optimise the cases for medical treatment and enhance public acceptance of nuclear fission and fusion reactor technologies. (authors)
Singh, Vishwanath P; Badiger, N M; Managanvi, S S; Bhat, H R
Removal half-life (RHL) of tritium is one of the best means for optimising medical treatment, reduction of committed effective dose (CED) and quick/easy handling of a large group of workers for medical treatment reference. The removal of tritium from the body depends on age, temperature, relative humidity and daily rainfall; so tritium removal rate, its follow-up and proper data analysis and recording are the best techniques for management of accidental acute tritium exposed cases. The decision of referring for medical treatment or medical intervention (MI) would be based on workers' tritium RHL history taken from their bodies at the facilities. The workers with tritium intake up to 1 ALI shall not be considered for medical treatment as it is a derived limit of annual total effective dose. The short-term MI may be considered for tritium intake of 1-10 ALI; however, if the results show intake ≥100 ALI, extended strong medical/therapeutic intervention may be recommended based on the severity of exposure for maximum CED reduction requirements and annual total effective dose limit. The methodology is very useful for pressurized heavy water reactors (PHWRs) which are mainly operated by Canada and India and future fusion reactor technologies. Proper management will optimise the cases for medical treatment and enhance public acceptance of nuclear fission and fusion reactor technologies.
Adams, J M
The healthcare industry is only beginning to understand e-health. E-health can be defined as the use of technology to directly improve healthcare delivery-affording patients the opportunity to participate in their own healthcare management, provider, and institution. The market is changing rapidly, and innovations, partnerships, and mergers are taking place daily. For healthcare institutions, setting a long-term, yet adaptable e-health strategy is of vital importance for the continued success of the organization. For clinicians, an understanding of and familiarity with technologies can significantly improve workflow, organization, and patient interaction. For the patient, technology can be leveraged as a means to take initiative and responsibility for his/her own health. This article defines e-health and explains the implications and benefits of e-health to nurses and their patients. The article also identifies unique opportunities e-health/e-commerce can provide case managers in promoting patient connectivity, care management, and economy in cost of care.
Jacobus N. Cronjé
Full Text Available Background: Since logistics emerged as an applied discipline during the latter part of the 20th century, there has been an increased need for skills development in logistics and supply chain management. However, literature suggests a general shortage of educated and skilled logistics and supply chain managers worldwide. Objectives: The purpose of this article was to benchmark an in-house training programme in logistics management in the beverage industry of Zimbabwe with international best practice. Method: A case study approach was followed focusing on the programme curriculum, content and delivery. The article reports on the nature and effectiveness of the programme. The curriculum was benchmarked with skills requirements identified in literature. Relevance was evaluated based on participant perceptions over a period of 3 years using questionnaires with both closed- and open-ended questions. Results: Findings suggested that the programme offering is in line with international practice whilst it also addresses particular issues in Third World countries. Participants perceived the programme as being practical and valuable for enhancing their job performance and career development. Conclusion: The article provides a framework for evaluating logistics training programmes. Future research could include an evaluation that measures changes in on-the-job behaviour of participants.
... Facts for Families Guide Facts for Families - Vietnamese Comprehensive Psychiatric Evaluation No. 52; Updated October 2017 Evaluation ... with serious emotional and behavioral problems need a comprehensive psychiatric evaluation. Comprehensive psychiatric evaluations usually require a ...
Scarr, Elizabeth; Money, Tammie Terese; Pavey, Geoffrey; Neo, Jaclyn; Dean, Brian
Mu opioid receptors have previously been shown to be altered in people with affective disorders who died as a result of suicide. We wished to determine whether these changes were more widespread and independent of psychiatric diagnoses. Mu receptor levels were determined using [3 H]DAMGO binding in BA24 from 51 control subjects; 38 people with schizophrenia (12 suicides); 20 people with major depressive disorder (15 suicides); 13 people with bipolar disorder (5 suicides) and 9 people who had no history of psychiatric disorders but who died as a result of suicide. Mu receptor levels were further determined in BA9 and caudate-putamen from 38 people with schizophrenia and 20 control subjects using [3 H]DAMGO binding and, in all three regions, using Western blots. Data was analysed using one-way ANOVAs with Bonferroni's Multiple Comparison Test or, where data either didn't approximate to a binomial distribution or the sample size was too small to determine distribution, a Kruskal-Wallis test with Dunn's Multiple Comparison Test. [3 H]DAMGO binding density was lower in people who had died as a result of suicide (pendogenous ligands occupying these receptors.
Stein, Catherine H; Craft, Scott A
This study examines aspects of case managers' perceived personal growth in their work with consumers. Using a sample of 98 case managers, the psychometric properties of a brief self-report measure of personal growth of case managers were examined. The Case Manager Personal Growth Scale (CMPG) showed good reliability and construct validity as evidenced by negative correlations with scores on professional burnout and positive correlations with personal accomplishment and job satisfaction scores. CMPG scores were unrelated to social desirability scores or caseload size and positively related to age and tenure in the mental health system. Results suggest the strong relevance of the construct of personal growth for case managers.
Peterson, G A; Drone, I D; Munetz, M R
Though ubiquitous in community mental health agencies, case management suffers from a lack of consensus regarding its definition, essential components, and appropriate application. Meaningful comparisons of various case management models await such a consensus. Global assessments of case management must be replaced by empirical studies of specific interventions with respect to the needs of specific populations. The authors describe a highly differentiated and prescriptive system of case management involving the application of more than one model of service delivery. Such a diversified and targeted system offers an opportunity to study the technology of case management in a more meaningful manner.
Davies, Deborah J
This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.
Reviewed by Dr. Adnan BOYACI
Full Text Available 161Case Studies in Knowledge ManagementEdited by Murray JennexHersley: PA: Idea Group, 2005, pp. 372, ISBN 1-59140-352-9Reviewed by Dr. Adnan BOYACIAnadolu UniversityEskişehir-TurkeyKnowledge management (KM as a structured system and the way to the effectiveness isrelatively new field for the contemporary organizations functioning in different andcompetitive domain of public and private sectors in terms of getting optimal effectivenessunderlined by the concepts such as quality, productivity…etc. Because of the growingimportance and the popularity of the KM either as a research topic or specialized coursesubject, a crucial need for understanding, conceptualization and implementation of KM asa system has emerged since the mid 1990’s. In this sense, the book contributes criticallyto fill the gap between theory and implementation as a teaching material.This edited book is published by Idea Group Publishing. The book has twenty chaptersdivided into seven sections. In addition to a section of authors’ biography contributing thebook and an index, there is a preface that the basic terms and key concepts underliningthe cases discussed following chapters, which is explained in a schematized way.Besides the editor, total of 47 authors have contributed to the book. These authors arefrom different countries, academic backgrounds, and institutions. Although approximatelyone third of the authors are from USA, the rest of the authors are from Canada, England,Austria, Germany, Australia, New Zealand, Egypt, Bahrain and China. The authorsrepresent a variety of universities, private companies, and military institutions. Most ofthem have strong professional backgrounds, which help them address the issues bothfrom theoretical and practical perspectives. Contributions of authors having differentbackgrounds and institutions enable the book to have very comprehensive spectrum andthis makes the book attractive practically for those working different sectors
Full Text Available Neurological and psychiatric symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case-control study examined changes in substance abuse/dependence and neurological and psychiatric symptoms in substance abusers with (DD group, n=26 and without schizophrenia (SUD group, n=24 and in non-abusing schizophrenia patients (SCZ group, n=23 undergoing 12-week treatment with the atypical antipsychotic, quetiapine. Neurological and psychiatric symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale and the Barnes Akathisia Rating Scale. At endpoint, DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554mg/d and 478mg/d, respectively, relative to SUD patients (mean = 150mg/d. We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher Parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in PANSS positive scores than DD and SCZ patients. Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.
Miodonski, Kathleen; Hines, Patricia
The director of case management is one of health care's leadership positions most frequently in demand. The lack of qualified and effective case management leaders will continue to be an issue for organizations for years to come, influenced by increasing pressures on health care reimbursement and the aging case management workforce. Organizations have an opportunity to create a program to develop future case management leaders from their internal talent. The proposed strategies are designed for the acute care hospital but also have applicability in other health care settings where there are case managers and a need for case management leadership. The business community offers leadership research and leadership development models with relevance to case management. Identifying and developing internal talent for leadership roles has been proven to be effective in preparation for advanced responsibilities, has a positive effect on staff morale, and minimizes the impact of vacant leadership positions during recruitment and onboarding activities. Creating a case management leadership development program for an organization can be an alternative to the process of external recruitment for case management department leaders. Such a program can be undertaken even in today's budget conscious environment by accessing existing resources in an organization in a creative and organized manner. The authors outline an approach for case management leaders to accept responsibility for succession planning and for case managers to accept responsibility for promoting their own career development through creation of a leadership development program.
Ellis, Michael J; Ritchie, Lesley J; Koltek, Mark; Hosain, Shahid; Cordingley, Dean; Chu, Stephanie; Selci, Erin; Leiter, Jeff; Russell, Kelly
. Interventions for patients with postinjury psychiatric outcomes included pharmacological therapy alone in 2 patients (10%), cognitive behavioral therapy alone in 4 (20%), multimodal therapy in 9 (45%), and no treatment in 5 (25%). Overall, 5 (25%) of the patients with postinjury psychiatric disorders were medically cleared to return to full sports participation, whereas 5 (25%) were lost to follow-up and 9 (45%) remained in treatment by the multidisciplinary concussion program at the end of the study period. One patient who was asymptomatic at the time of initial consultation committed suicide. Emotional symptoms were commonly reported among pediatric patients with SRC referred to a multidisciplinary pediatric concussion program. In some cases, these symptoms contributed to the development of an NPD, isolated suicidal ideation, and worsening symptoms of a preexisting psychiatric disorder. Future research is needed to clarify the prevalence, pathophysiology, risk factors, and evidence-based management of postinjury psychiatric outcomes after pediatric SRC. Successful management of these patients requires prompt recognition and multidisciplinary care by experts with clinical training and experience in concussion and psychiatry.
Srivastava, Anil; Grube, Michael
Psychiatric diagnosis is invariably guided by self-report. When such self-report is questioned, reliance on formalized testing predominates. The situation is less certain, however, when such methods and clinical "feel", or intuition, conflict. While many argue for the supremacy of actuarial methods, fields such as Management have increasingly emphasized the importance of intuition; Psychiatry, although with few objective tests and reliance on the clinical encounter, offers surprisingly few answers. We explore here the use of intuition in decision-making through a case example and suggest that it is not inferior to other diagnostic methods: intuition should be used to suggest, guide, and modify psychiatric diagnosis. Mostly, there is a need for greater discussion among Psychiatrists including consideration to the clinical, legal, and ethical implications of the use of intuition in psychiatric decision-making.
Fernanda Lima de Paula
Full Text Available Goal: to analyze the possibilities and limits of multiprofessional care in the attention to psychiatric emergencies. Method: it is an analytical study of the type integrative review of the comprehensive literature. Searches were conducted in the Latin American and Caribbean Literature (LILACS and Nursing Database (BDENF databases and in the ScieLo Virtual Library, with the use of Descriptors in Health Sciences (DECs: “Emergency Services, Psychiatric”, “Forensic Psychiatry”, “Psychiatric Rehabilitation”, in the period from 2007 to 2017. Results: after data analysis, two thematic categories emerged: “Possibilities and limits in multiprofessional care for patients in crisis” and “The continuity of care to the patient in crisis by the multiprofessional team”. The studies point out fragility in the management of the multiprofessional team of care to the patients in psychiatric crisis. Therefore, in the substitutive services to the psychiatric hospital, it is necessary to strengthen the care and bonding tools for continuity of treatment after the cases of psychiatric emergency of these patients. Conclusion: this research provided a deepening of the knowledge regarding the challenges of the multiprofessional team in the care of analytical psychiatric emergencies and in relation to the patient in crisis, considering the main multiprofessional actions, understanding how this approach is done and patient follow-up. Descriptors: Emergency Services, Psychiatric. Forensic Psychiatry. Psychiatric Rehabilitation.
Full Text Available Abstract Background Mu opioid receptors have previously been shown to be altered in people with affective disorders who died as a result of suicide. We wished to determine whether these changes were more widespread and independent of psychiatric diagnoses. Methods Mu receptor levels were determined using [3 H]DAMGO binding in BA24 from 51 control subjects; 38 people with schizophrenia (12 suicides; 20 people with major depressive disorder (15 suicides; 13 people with bipolar disorder (5 suicides and 9 people who had no history of psychiatric disorders but who died as a result of suicide. Mu receptor levels were further determined in BA9 and caudate-putamen from 38 people with schizophrenia and 20 control subjects using [3 H]DAMGO binding and, in all three regions, using Western blots. Data was analysed using one-way ANOVAs with Bonferroni’s Multiple Comparison Test or, where data either didn’t approximate to a binomial distribution or the sample size was too small to determine distribution, a Kruskal-Wallis test with Dunn’s Multiple Comparison Test. Results [3 H]DAMGO binding density was lower in people who had died as a result of suicide (p3 H]DAMGO binding densities, but not mu protein levels, were significantly decreased in BA9 from people with schizophrenia who died as a result of suicide (p Conclusions Overall these data suggest that mu opioid receptor availability is decreased in the brains of people with schizophrenia who died as a result of suicide, which would be consistent with increased levels of endogenous ligands occupying these receptors.
Sarikoc, Gamze; Ozcan, Celale Tangul; Elcin, Melih
The use of standardized patients is not very common in psychiatric nursing education and there has been no study conducted in Turkey. This study evaluated the impact of using standardized patients in psychiatric cases on the levels of motivation and perceived learning of the nursing students. This manuscript addressed the quantitative aspect of a doctoral thesis study in which both quantitative and qualitative methods were used. A pre-test and post-test were employed in the quantitative analysis in a randomized and controlled study design. The motivation scores, and interim and post-test scores for perceived learning were higher in the experimental group compared to pre-test scores and the scores of the control group. The students in the experimental group reported that they felt more competent about practical training in clinical psychiatry, as well as in performing interviews with patients having mental problems, and reported less anxiety about performing an interview when compared to students in the control group. It is considered that the inclusion of standardized patient methodology in the nursing education curriculum in order to improve the knowledge level and skills of students would be beneficial in the training of mental health nurses. Copyright © 2017 Elsevier Ltd. All rights reserved.
Wilmar M Wiersinga
Full Text Available Management of Graves′ ophthalmopathy (GO is based on three pillars: to stop smoking, to restore and maintain euthyroidism, and to treat the eye changes according to severity and activity of GO. Difficulties are frequently encountered in each of these three management issues. The advice to discontinue smoking is straightforward, but just a small minority of smokers is able to quit smoking. Detailed information on how smoking adversely affects the outcome of Graves′ disease may convince patients they have to stop smoking right away. Controversy exists on the most appropriate treatment of Graves′ hyperthyroidism in the presence of GO. 131I therapy is associated with a risk of about 15% for worsening of GO; a preventive course of steroids is indicated in the presence of risk factors (smoking, biochemically severe hyperthyroidism, high level of TSH receptor antibodies, active GO. Alternatives are thyroidectomy or long-term treatment with antithyroid drugs, which apparently are rather neutral with respect to the course of GO. Mild GO is not always perceived as being mild by the patients themselves. Selenium improves mild GO. Moderate-to-severe GO is preferably treated with intravenous methylprednisolone pulses, but serious side effects and relapsing GO do occur. After steroid failure combination therapy with low-dose oral prednisone with either cyclosporine or retrobulbar irradiation can be effective. Dysthyroid optic neuropathy is best treated with IV pulses, followed by orbital decompression if visual functions do not improve. In resistant cases, rituximab might be considered, although failures of this drug are also described.
Common adverse drug reactions with psychiatric medications and an approach to their management: Adverse drug reactions are as important in psychiatric practice as they are in any other branch of medicine.
Strategically conceived case management system implementation makes good patient care and business sense, CIOs agree. Significant financial savings can be achieved from case management IS implementations, if those implementations are executed in the context of partnership between clinical leaders and the CIO's team. CIOs agree that applying the concept of "investment" to the implementation of case management IT can make resource allocation decisions easier.
An attempt is made to identify and document the problems of comparative evaluation of the more recent studies of psychiatric morbidity after abortion and to determine the current consensus so that when the results of the joint RCGP/RCOG study of the sequelae of induced abortion become available they can be viewed in a more informed context. The legalization of abortion has provided more opportunities for studies of subsequent morbidity. New laws have contributed to the changing attitudes of society, and the increasing acceptability of the operation has probably influenced the occurrence of psychiatric sequelae. The complexity of measuring psychiatric sequelae is evident from the many terms used to describe symptomatology and behavioral patterns and from the number of assessment techniques involved. Numerous techniques have been used to quantify psychiatric sequelae. Several authors conclude that few psychiatric problems follow an induced abortion, but many studies were deficient in methodology, material, or length of follow-up. A British study in 1975 reported a favorable outcome for a "representative sample" of 50 National Health Service patients: 68% of these patients had an absence of or only mild feelings of guilt, loss, or self reproach and considered abortion as the best solution to their problem. The 32% who had an adverse outcome reported moderate to severe feelings of guilt, regret, loss, and self reproach, and there was evidence of mental illness. In most of these cases the adverse outcome was related to the patient's environment since the abortion. A follow-up study of 126 women, which compared the overall reaction to therapeutic abortion between women with a history of previous mild psychiatric illness and those without reported that a significantly different emotional reaction could not be demonstrated between the 2 groups. In a survey among women seeking an abortion 271 who were referred for a psychiatric opinion regarding terminations of pregnancy
A case study that focuses on building a website for a woodworking business is discussed. Project management and linear programming techniques can be used to determine the time required to complete the website project discussed in the case. This case can be assigned to students in an undergraduate or graduate decision modeling or management science…
Psychiatric reports in German civil law cases are required if questions are raised of legal capacity, capacity to express a testamentary will, ability to sue or be sued, capacity to marry, ability of mentally disordered patients to consent to treatment, and when custody or hospital orders of these patients is considered or compensation is due for mental disorders resulting from accidents. Many reports must decide whether the ability to decide using sound reason or motives is or was impaired by a mental disorder. This capability is attributed to every adult person; only if incapability is claimed must it be proven by psychiatric assessment. As in most psychiatric court reports, such assessments must be structured in several steps. First a clinical diagnosis has to be established which must then be translated into legal terminology. After this has been accomplished, the psychiatrist must describe the functional impairments caused by the disorder and define the probability with which these impairments might affect the legal act in question. Most reports are prepared in the context of custody law, which centers on helping those patients who, due to a mental disorder, cannot manage their own legal matters.
Dean, C; Gadd, E M
To determine the factors influencing the successful outcome of community treatment for severe acute psychiatric illnesses that are traditionally treated in hospital. All patients from a single electoral ward who were either admitted to hospital or treated at home over a two year period (1 October 1987 to 30 September 1989) were included in the study and their case notes audited. The second year of the study is reported. Electoral ward of Sparkbrook, Birmingham. 99 Patients aged 16-65 with severe acute psychiatric illness. 65 Patients were managed by home treatment alone; 34 required admission to hospital. The location of treatment was significantly (all p less than 0.05) influenced by social characteristics of the patients (marital state, age (in men), ethnicity, and living alone) and by characteristics of the referral (occurring out of hours; assessment taking place at hospital or police station). DSM-III-R diagnosis was more weakly associated with outcome. Violence during the episode was significantly related to admission, although deliberate self harm was not. Home treatment is feasible for most patients with acute psychiatric illness. A 24 hour on call assessment service increases the likelihood of success because admission is determined more strongly by social characteristics of the patient and the referral than by illness factors. Admission will still be required for some patients. A locally based mental health resource centre, a 24 hour on call service, an open referral system, and an active follow up policy increase the effectiveness of a home treatment service.
Ladois-Do Pilar Rei, A; Chraïbi, S
The psychiatric ward is a place where all forms of violence are treated. Occasionally, this violence involves acts of aggression between patients in emergency psychiatric units or hospital wards. Such events can lead to the development or worsening of posttraumatic stress disorder. To establish the context, we first examined the epidemiology data concerning posttraumatic stress disorder in psychiatric patients who were frequently exposed to assaults. Secondly, we examined the issue of sexual and physical assaults between patients receiving treatment in a psychiatric ward. In this context, we studied possible occurrence of posttraumatic stress disorder associated with exposure to assaults of this kind. In certain cases, potentially traumatic exposure to violence was unknown to the medical staff or not taken into consideration. This would induce a risk of later development of posttraumatic stress disorder that would not be treated during the stay in psychiatry. To date, few scientific studies have focused on the proportion of patients assaulted by other patients during treatment in a psychiatric ward and the subsequent development of peritraumatic reactions and/or posttraumatic stress disorder associated with these assaults. We know that an insufficient number of public and private health institutions report the existence of such facts to the competent authorities. Also, a minority of clinicians and caregivers are trained in screening and management of trauma victims. Yet, these issues are particularly relevant in the scope of public health and health promotion. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Roger E. Thomas
Full Text Available Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL case management identified 17 research articles, with content analysis revealing two themes: (a seeking to determine or establish the value of EOL case management and (b identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.
Integrating research with management: The case of Katavi National Park, Tanzania. ... national park: (i) reduced water flow caused by local damming of the Katuma River, ... to both management and policy makers for tackling these problems.
Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.
It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…
The subject diploma paper is „The strengths perspective in client’s social case management.” The aim of the diploma paper is to research the strengths perspective in client’s social case management. Diploma paper consists of five chapters. In the first chapter the case management was theoretically researched. In the second chapter was done description of the strengths perspective in the social work. In the third chapter by describing principles and strategies of strengths perspective, cli...
Malone Robert M
Full Text Available Abstract Background Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. Methods Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI, the Center for Epidemiological Studies-Depression Scale scale (CESD and the Pain Disability Index (PDI. Patients were monitored for substance misuse. Results Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73% completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003. The mean PDI score improved to 39.3 (p Conclusions A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.
Hardy, Lyons T
Encopresis is an elimination disorder that involves symptoms of fecal incontinence in children. It affects an estimated 1.5% to 7.5% of children ages 6 to 12 and accounts for approximately 3% to 6% of psychiatric referrals. The etiology of encopresis is thought to be related to physiologic problems such as constipation; however, it is also a psychiatric diagnosis and anecdotally may have some association with psychiatric problems. Publications on this association and publications directed toward psychiatric nurses are limited. Encopresis is typically treated with nutritional and medical management along with behavioral modification. Psychiatric nurses working with patients who have encopresis in inpatient settings will have unique concerns and challenges. This article gives an overview of published literature from the past 10 years on the etiology and treatment of encopresis. Specific suggestions for inpatient psychiatric nurses based on published literature and the author's professional experience are provided.
Alice Guimarães Bottaro de Oliveira
Full Text Available A reforma psiquiátrica no Brasil articula várias dimensões - conceitual, técnica-assistencial, administrativa, legislativa e cultural - com o objetivo de superar o paradigma psiquiátrico que se estruturou em torno do isolamento e exclusão dos doentes mentais. Articula-se ao SUS e pressupõe hierarquização, municipalização, participação e controle social. Em Mato Grosso, apesar do avanço na dimensão administrativa, observa-se a sua realização em contextos de gestão centralizados, numa aparente contradição às suas raízes críticas. Nosso objetivo é analisar os processos participativos na construção da reforma psiquiátrica em Cuiabá e Mato Grosso, por meio do estudo de documentos dos Conselhos e Conferências de Saúde produzidos no período de 2000 a 2005. A fragilidade dos processos políticos dos Conselhos de Saúde dificulta a sua constituição como espaços articuladores de novas práticas. O processo de mudança rumo à reforma psiquiátrica se conforma como um novo desenho administrativo de gestão, determinado pelos novos modelos de financiamento - redução de internações e desospitalização -, sendo possível sua realização em processos centralizados de gestão, pois não resulta de crítica à lógica manicomial representada nas instâncias do SUS analisadas.The psychiatric reform in Brazil articulates several dimensions - conceptual, technical, administrative, legislative and cultural. It is aimed at overcoming the psychiatric paradigm based on isolation and exclusion of the mentally ill. The Reform makes part of the Brazilian Health System and presupposes a hierarchical system, municipality, participation and social control. Besides the advances made in the administrative dimension, in the state of Mato Grosso the reform takes place in centralized management contexts, revealing an apparent contradiction. Aim: Analyzing the participative processes in the construction of the psychiatric reform in Cuiab
Giceli Carvalho Batista
Full Text Available Este artigo discute o processo de consolidação e institucionalização da reforma psiquiátrica em Aracaju/Sergipe a partir de uma pesquisa realizada entre 2009 e 2010, que teve como objeto as práticas da equipe de gestão Rede de Atenção Psicossocial (REAP. Foram realizadas entrevistas com sujeitos que compunham ou já haviam composto a equipe de gestão e análise documental dos relatórios anuais de gestão, seguindo o método da análise das configurações tomado como estudo de caso social e da análise do discurso de base foucaultiana. Constrói-se uma breve história da reforma psiquiátrica no município, pontuando em que medida a função de gerir articula-se com alguns dispositivos biopolíticos. Evidencia-se que a governamentalidade, inerente ao exercício de poder que caracteriza as funções estatais, efetiva-se através do exercício de gestão configurando práticas normativas a serviço do controle dos corpos, mas não impede a produção de práticas de resistência, como mostra o caso "Estrela" aqui apresentado.This paperwork is a discussion about the process of the Psychiatric Reform in Aracaju, state of Sergipe, were considered, taking into account the practices of the management group of the Psychosocial Attention Network between 2007 and 2009. The investigation adopted the analysis of configuration e analysis of discourse as studied by Michel Foucault. It is done a brief history about the psychiatric reform process, emphasizing the level in which the function of manager is articulated to mechanisms of control was considered, also considering the partisanship in vogue. What becomes clear is that the "governmentalization"- essential when exercising the power in state functions- takes place throughout exercises of management, configuring normative practices, those which are in service of body control, therefore, resistance is in attendance, represented in the "Estrela" case.
Hakvoort, Laurien; Bogaerts, S.; Thaut, Michael H.; Spreen, Marinus
The effect of music therapy on anger management and coping skills is an innovative subject in the field of forensic psychiatry. This study explores the following research question: Can music therapy treatment contribute to positive changes in coping skills, anger management, and dysfunctional
Full Text Available Chloroquine is a prototype antimalarial drug, widely used in several branches of medicine. Antimalarial drugs are used in the treatment of various dermatological, immunological, rheumatological and infectious diseases. Examples of off-labelled indications for chloroquine analogues use include dermatomyositis, sarcoidosis, polymorphous light eruption, disseminated granuloma annulare and porfiria cutanea tarda. There is a relatively small number of adverse effects related to chloroquine analogues used in standard doses, such as gastrointestinal disturbances, headaches, skin reactions, hypotension, convulsions, extrapyramidal symptoms and visual disturbances. Psychiatric side effects of chloroquine seem to be rare, but may manifest in a wide range of symptoms, such as confusion, disorientation, ideas of persecution, agitation, outbursts of violence, loss of interest, feeling sad, suicidal ideas and impaired insight. There is also a report of a manic episode with psychotic features in the course of bipolar disorder, and another case report of persecutory delusions, anxiety, derealisation and visual illusions triggered by chloroquine. The duration of psychiatric symptoms usually ranges from one to two weeks, and symptoms usually disappear within several days following cessation of chloroquine usage and starting psychiatric treatment where indicated. This article reviews the case studies of patients diagnosed with mental disorders resulting from the use of chloroquine, and discusses the management in such cases.
Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia
The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.
This paper investigates the differences in the discursive patterning of cases in Law and Management. It examines a corpus of 271 Law and Management cases and discusses the kind of information that these two disciplines call for and how discourses are constructed in discursive hierarchical patterns. A discursive hierarchical pattern is a model…
Family medicine tools including the Family circle, Family life cycle, Home visits and Family counseling were used in the management of this case. This case emphasizes the need for a thorough contact tracing, family involvement in care, home visits and individualization in the management of pulmonary tuberculosis.
Dr. J. de Lange; E. Deusing; I.F.M. van Asch; J. Peeters; M. Zwaanswijk; A.M. Pot; A.L. Francke
To obtain insight into facilitating factors for case management in dementia care, we conducted a qualitative study with 13 online focus groups (OFGs). Participants were professionals involved in dementia case management (N = 99). We used mind-maps and the method of constant comparison for analysis.
Jensen, Per Anker; Katchamart, Akarapong
on the management model for FM included in the European FM standards, recent theories on added value of FM and real estate and the related concept of Value Management from building projects. The paper outlines a preliminary theoretical based management concept, which is investigated, tested and discussed based...... on a case study of LEGO. Results: The study shows that the management model for FM creates a relevant starting point but also that stakeholder and relationship management is an essential aspect of Value Adding Management. The case study confirms the relevance of the basic concept and provides an important...... example of how Value Adding Management can be implemented and added value measured. Practical Implications: The concept of Value Adding Management is expected to increase the awareness of the impacts and strategic importance of FM for organisations and can be a practical tool for facilities managers...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Medical, psychiatric and psychological... MANAGEMENT MISCELLANEOUS Pretrial Inmates § 551.114 Medical, psychiatric and psychological. (a) Staff shall provide the pretrial inmate with the same level of basic medical (including dental), psychiatric, and...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Involuntary psychiatric treatment and... INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.43 Involuntary psychiatric treatment and medication. Title 18 U.S.C. 4241-4247 and federal court...
Moffat, M; Prociw, M
The Sunnybrook Health Science Centre's matrix organization model includes a traditional departmental structure, a strategic program-based structure and a case management-based structure--the Clinical Unit structure. The Clinical Unit structure allows the centre to give responsibility for the management of case mix and volume to decentralized Clinical Unit teams, each of which manages its own budget. To train physicians and nurses in their respective roles of Medical Unit directors and Nursing Unit directors, Sunnybrook designed unique short courses on financial management and budgeting, and case-costing and case mix management. This paper discusses how these courses were organized, details their contents and explains how they fit into Sunnybrook's program of decentralized management.
Tahan, Hussein A
The use of case management plans has contained cost and improved quality of care successfully. However, the process of developing these plans remains a great challenge for healthcare executives, in this article, the author presents the answer to this challenge by discussing a 10-step formal process that administrators of patient care services and case managers can adapt to their institutions. It also can be used by interdisciplinary team members as a practical guide to develop a specific case management plan. This process is applicable to any care setting (acute, ambulatory, long term, and home care), diagnosis, or procedure. It is particularly important for those organizations that currently do not have a deliberate and systematic process to develop case management plans and are struggling with how to improve the efficiency and productivity of interdisciplinary teams charged with developing case management plans.
This thesis studied hotel security management and examined one case hotel more closely on matters of security management. The case hotel in this research was Original Sokos Hotel Vaakuna Vaasa. The aim of the thesis was to find out how security aspects are managed and how they could be developed in the case hotel. This research was conducted to help the case hotel’s security supervisor to develop and improve security. The thesis consists of a theoretical framework and an empirical study. The ...
Adya Shanker Srivastava
Full Text Available Aims and objectives: Postpartum psychiatric disturbances pose a significant mental health problem in community because of their impact on parent-infant and couple relationship. This study was carried out with the aim to find out psychiatric morbidities in postpartum females during puerperium so that a proper assessment of mental health and comprehensive management can be planned. Methodology: Hundred females who had delivered in maternity ward of obstetrics and gynaecology department of Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi were evaluated for mental status on day one (i.e. day of delivery, and followed-up till four weeks postpartum period. Psychiatric evaluation was done on the basis of structured proforma containing socio-demographic details and the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR diagnostic criteria for diagnosis. Brief Psychiatric Rating Scale (BPRS, Hamilton Anxiety Rating Scale (HARS, and Hamilton Rating Scale for Depression (HDRS were used to assess the severity of the respective conditions. Result: Psychiatric evaluation during postpartum puerperal stage revealed that 16 (16% females had developed psychiatric morbidity. Twelve (12% cases fulfilled the criteria for major depressive disorder and four (four per cent patients had features of anxiety disorder. In 84 (84% cases, postpartum period was uneventful and no psychiatric disturbance was found.Seventy five per cent females had joint family and good family support. Conclusion: Major depressive disorder is the most common psychiatric morbidity observed in postpartum females during puerperium. The careful observation of females during postpartum puerperal stage may help in identification and proper management of mental state of such females, and also proper care of newborn.perspective.
Bauer, Anna E; Maegbaek, Merete L; Liu, Xiaoqin
OBJECTIVE: Postpartum psychiatric disorders are common and morbid complications of pregnancy. The authors sought to evaluate how family history of psychiatric disorders is associated with postpartum psychiatric disorders in proband mothers with and without a prior psychiatric history by assessing...
Wiersinga, Wilmar M.
Management of Graves' ophthalmopathy (GO) is based on three pillars: to stop smoking, to restore and maintain euthyroidism, and to treat the eye changes according to severity and activity of GO. Difficulties are frequently encountered in each of these three management issues. The advice to
Braun, Dietmar; Benninghoff, Martin; Ramuz, Raphaël; Gorga, Adriana
There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually "rules" in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge…
Jensen, Per Anker; Katchamart, Akarapong
be used more directly and proactively by facilities managers to implement adding value strategies and practices. Methodology: The development of the concept of Value Adding Management is based on the management model for FM included in the European FM standards, recent theories on added value of FM...... practice value adding management. It underlines the importance of stakeholder and relationship management as part of adding value. The case study confirms the relevance of the basic concept of Value Adding Management. Practical implications: The concept of Value Adding Management is expected to increase......Purpose: To develop a management concept that can assist facilities managers in implementing value adding strategies and practices. The FM Value Map has been developed to analyse and demonstrate the different ways FM can add value. However, there is a need to develop management tools that can...
Babikian, Sarkis; Emerson, Lyndal; Wynn, Gary H
A 22-year-old active duty E1 Nepalese male who recently emigrated from Nepal suddenly exhibited strange behaviors and mutism during Advanced Individual Training. After receiving care from a hospital near his unit, he was transferred to Walter Reed Army Medical Center Inpatient Psychiatry for further evaluation and treatment. Although he was admitted with a diagnosis of psychosis not otherwise specified (NOS), after consideration of cultural factors and by ruling out concurrent thought disorder, a diagnosis of selective mutism was made. To our knowledge this is the first reported case of selective mutism in a soldier. This case serves as a reminder of the need for cultural awareness during psychological evaluation, diagnosis, and treatment of patients.
National Aeronautics and Space Administration — Software Health Management (SWHM) is a new field that is concerned with the development of tools and technologies to enable automated detection, diagnosis,...
management, addressing treatment, monitoring for parasite drug resistance, and the impact of drug resistance on ... at all levels of healthcare delivery and ... System (DHS) based on primary healthcare .... intramuscular artesunate, artemether,.
Buckland, K.; Hindle, A.
In professional training of librarians, mathematical modeling can be useful in relatively sophisticated library management games if the models simulate the provision and use of library services. (33 references) (MM)
The advances in the managing of nuclear information in Colombia are present, this has allowed recapturing the activities starting from 1999 contributing the INIS the results of the investigations related with the AIEA mission, for benefit of the international scientific community. Thanks to the support of the directive and to my own managing, year after year the efforts are reflected, through a constant increase of the records to the INIS, like in the participation in the RRIAN in Latin America. (author)
We present two females with severe, mainly full thickness burns, who have developed gross deformities due to inadequate treatment of their bums. Early referral to major centres with the technical expertise and material resources to manage such complicated injuries will help to minimise the degree of deformity and ...
U.S. Department of Health & Human Services — This file contains case level data for inpatient psychiatric stays and is derived from 2011 MEDPAR data file and the latest available provider specific file. The...
Sudre, Y; Becq-Giraudon, B; Boutaud, P h
Botulism is relatively common in the Vienne department as we have observed 36 cases over a peroid of 7 years. Other French cases, published over the last 10 years, included 10 to 19 cases in the largest series. In a total of 10 series, there were 105 cases. Botulism is caused, in most cases, by eating ham prepared on the farm. It gives rise to the usual clinical picture including paralysis of accommodation, dysphagia, digestive symptoms with abdominal pain and constipation and finally, bladder paralysis. The mild forms are fairly common. We did not observe any severe cases. Our patients were treated in two homogeneous series of 17 cases each ; two patients were given no treatment. Patients treated by sero-anatoxin therapy according to classical methods, evolved towards a cure within 21 days on average. Patients treated by sulfguanidin were cured within 24 days. This study permitted us to confirm that sero-anatoxin therapy is not essential. The disadvantages are the number of injections, the possibility of sometimes fatal hyper-sensitive reactions which, in the opinion of many authors, justifies routine cover with cortisone. This attitude does not seem to us justified owing to the usually benign nature of the botulism. The treatment with sulfaguanidin is well tolerated and is not of any risk to the patient.
Full Text Available At the International Association for Court Administration (IACA Conference in 2008 in Dublin Barry Mahoney, President Emeritus, Justice Management Institute did an excellent job at presenting some of the major sources of delay in case processing. He identified both case-specific and systemic factors. He also identified the goals of case flow management. I was impressed by the thoroughness and succinctness of what he was presenting. On my way back home I thought about how I might present the same information to my judges and court staff and how the information might be used to make positive changes in one of my courts. The following is a description of what took place at our one-day workshop on felony case management, and the positive results we obtained in working with judges, court staff and our justice partners. The process described below identified specific barriers to case processing and resulted in the development of workable solutions to case delay.
Cozza, Paola; Marino, Alessandra; Lagana, Giuseppina
The aim of the present report is to describe a case of a patient with eruption disturbances of an ankylosed lower primary second molar, delayed development of a maxillary permanent canine associated with an odontoma and a class III dental malocclusion. In such a case the objectives of treatment are: to prevent impaction of the lower second premolar and tipping of the lower first molar; to establish correct anterior overbite and overjet and to control the development of the permanent upper canine.
Kozloduy NPP: Units 5&6, type VVER-1000 - in operation. SE RAW SD “Decommissioning of units 1-4” (type VVER-440); SD “Radioactive Waste – Kozloduy”; SD “National Repository for Radioactive Waste“; SD “Permanent Repository for Radioactive Waste – Novi Han”. Decommissioning Strategy: Strategy Target: “Brown Field”. Initial Version: Safe enclosure – completing by 2050. Updated Version: Continuous dismantling of equipment; Completing the process of Decommissioning of Units 1-4 by 2030. Major Phases: 1.Pre-decommissioning activities; 2.Facility shutdown activities; 3.Procurement of equipment; 4.Dismantling activities; 5.Treatment of RAM and RAW and delivery for disposal; 6.Site management and support; 7.Project management and engineering; 8.Management of SNF and activated materials
Full Text Available A síndrome de burnout, identificada na década de 1970, caracteriza-se por uma tríade de dimensões (exaustão emocional, despersonalização e redução da realização pessoal e é uma condição relacionada à organização do trabalho. Entretanto, não consta nas classificações psiquiátricas. O artigo apresenta o conceito de burnout, estabelece o seu atual status nosológico e introduz uma breve discussão sobre a diferença entre burnout e depressão, a partir do relato de um caso atendido no Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro.The burnout syndrome was first described in the 1970's and is characterized by three dimensions (emotional exhaustion, depersonalization and reduced personal accomplishment. Burnout is a work organization-related health condition. Nevertheless, it is not part of any psychiatric classification. This article presents the concept of burnout, establishes its nosological status and introduces a brief discussion on the difference between burnout and depression, based on the report of a clinical case treated at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro.
Ricardo Abrantes do Amaral
Full Text Available OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência", "álcool", "cocaína", "cannabis", "opioides", "inalantes" e "manejo", tendo o inglês como idioma. RESULTADOS E CONCLUSÃO: O cuidado de pessoas com transtornos por uso de substâncias deve conter: avaliação completa (médica geral e psiquiátrica, tratamento dos quadros diagnosticados (abstinência, intoxicação e quadros clínicos que caracterizem uma emergência, sensibilização do paciente para realizar tratamento, se for necessário, e elaboração de encaminhamento.OBJECTIVE: Substance use disorders are prevalent in emergency departments in medical and psychiatric services, reaching rates of 28% of cases in medical emergency departments. However, professionals in the emergency department identify less than 50% of cases of alcohol-related problems. This article aims to provide evidence-based interventions for the specific treatment to patients who meet diagnostic criteria for substance use disorders and who present to emergency rooms during intoxication or abstinence. METHOD: A literature review was performed on Medline database, using the descriptors "acute intoxication", "withdrawal", "alcohol", "cocaine", "cannabis", "opioid", "inhalant", "management", using English as the language. RESULTS: AND CONCLUSION: The care of persons with
Brett, J L; Bueno, M; Royal, N; Kendall-Sengin, K
Building on redesign efforts that created case management, clinical care technicians, support service hosts, and pharmacy technician roles, this redesign focused on integrating case management, utilization management, and discharge planning functions into a new outcomes manager role. The authors describe the process of developing and implementing the new role and outline specific actions that eliminated redundancy and inefficiency. Results of the evaluation of the project are reviewed, including full-time equivalent and salary savings and employee and physician satisfaction improvements.
Cheng, T C
This paper discusses a study to investigate various operations management problems in a newly opened, modern regional hospital in Hong Kong. The findings of the study reveal that there exist in the hospital a number of current and potential problem areas. Recommendations for solving these problems are suggested with a view to improving the overall operational efficiency and effectiveness of the hospital.
This paper seeks to demonstrate that knowledge management (KM) is a function of sustainable development (SD). The authors define the two concepts and discuss both the factors that make for successful SD process and the challenges that characterize KM. The conclusion reached is hat KM is emerging as a powerful ...
The Electronic Freight Management (EFM) initiative is a USDOT-sponsored project that applies Web technologies that improve data and message transmissions between supply chain partners. The EFM implementation case studies contained in this document ex...
Rice, Elizabeth I
The aim of this study is to understand the experiences of case managers as they delivered care to women who were diagnosed with schizophrenia and live with histories of violence. Interpretive phenomenology. Providers valued their relationships with women, yet felt overwhelmed and frustrated with aspects of the case management role. Case managers at times blamed women for the violence in their lives and lacked clarity with regard to their role assisting women in recovery. The violence and poverty that is common for these women is a key factor that increased providers' alienation and confusion as to their role in the provision of care. The educational and supportive needs of case managers must be addressed to uphold recovery-oriented services.
Prashant P. Jaju
Full Text Available Idiopathic gingival fibromatosis is a rare condition. We present a case of idiopathic gingival fibromatosis with its multidisciplinary approach of management. The clinical, radiographic, and histopathological features have been described in detail.
Strzelecki, S; Brobst, R
The authors describe the development of an inpatient acute care case manager orientation in a community hospital. Benner's application of the Dreyfus model of skill acquisition provides the basis for the orientation program. The candidates for the case manager position were expert clinicians. Because of the role change it was projected that they would function as advanced beginners. It was also predicted that, as the case managers progressed within the role, the educational process would need to be adapted to facilitate progression of skills to the proficient level. Feedback from participants reinforced that the model supported the case manager in the role transition. In addition, the model provided a predictive framework for ongoing educational activities.
A discussion of energy source devlopments and environmental protection dealing with impacts, and legal aspects of pollution controls and resource management, and case history studies of major energy projects is presented
de Vet, Renée; van Luijtelaar, Maurice J. A.; Brilleslijper-Kater, Sonja N.; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D.
We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness. PMID:23947309
Vivar, Cristina García
This paper is intended to put knowledge in conflict management into practice through reflecting on a nursing case study. Nursing organizations are particularly vulnerable to conflict as the context of nurses' work may be difficult and stressful. Power conflict is argued to be an important source of tension within nursing units. Learning to manage conflict at an early stage is therefore crucial to the effective functioning of nursing organizations. A nursing case study that illustrates power conflict in an oncology nursing unit is displayed and reflection on conflict management from the case is provided. There is no appropriate or inappropriate strategy to deal with conflict. However, detecting initial symptoms of conflict and adopting the most effective behaviour to conflict resolution is essential in nursing units. Further nursing education in conflict management for staff nurses and nurse managers is greatly needed.
B. A. Nicks
Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.
Sørensen, Holger J; Mortensen, Erik L; Reinisch, June M
The risk of schizophrenia has been linked with a family history of schizophrenia and less strongly with other psychiatric disorders in family members. Using data from the Copenhagen Perinatal Cohort and from the Danish Psychiatric Case Register, we studied the relationship between offspring risk...... of schizophrenia and a range of psychotic and non-psychotic psychiatric diagnoses in parents. Psychiatric admission data after 1969 were available for 7047 cohort members born between 1959 and 1961, and for 7006 mothers and 6993 fathers. Univariate analysis showed that neurosis, alcohol and substance dependence...... in both parents were associated with elevated risk of offspring schizophrenia; in addition, maternal schizophrenia, affective disorder and personality disorder were associated with elevated risk. Controlling for parental age, parental social status, and parental psychiatric co-diagnosis, offspring risk...
Full Text Available Introduction. Psychiatric symptoms are not rare manifestations of brain tumors. Brain tumors presented by symptoms of raised intracranial pressure, focal neurological signs, or convulsions are usually first seen by the neurologist or less frequently by the neurosurgeon in routine diagnostic procedures. On the other hand, when psychiatric symptoms are the first manifestation in “neurologically silent” brain tumors, the patients are sent to the psychiatrist for the treatment of psychiatric symptoms and brain tumors are left misdiagnosed for a long period of time. Case Report. We presented three patients with the diagnosed brain tumor where psychiatrist had been the first specialist to be consulted. In all three cases neurological examination was generally unremarkable with no focal signs or features of raised intracranial pressure. CT scan demonstrated right insular tumor in a female patient with obsessive-compulsive disorder (OCD; right parietal temporal tumor in a patient with delusions and depression and left frontal tumor in a patient with history of alcohol dependency. Conclusion. Psychiatric symptoms/disorders in patients with brain tumors are not specific enough and can have the same clinical presentation as the genuine psychiatric disorder. Therefore, we emphasize the consideration of neuroimaging in patients with abrupt beginning of psychiatric symptoms, in those with a change in mental status, or when headaches suddenly appear or in cases of treatment resistant psychiatric disorders regardless the lack of neurological symptoms.
Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote a...
Al Quran, Firas A M; Rashan, Bashar A; Al-Dwairi, Ziad N
The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant fracture is one possible complication that results in ultimate failure of the dental implant. Such a complication poses a management crisis even for the most experienced clinician. This article reports on a case of implant fracture, its possible causes, and how the case was managed.
Full Text Available Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down′s syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of congenital bilateral severe upper eyelid eversion in a normal infant, born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching.
Nguyen, Nam C.; Wegener, Malcolm K.; Russell, Iean W.; Cameron, Donald; Coventry, David; Cooper, Ian M.
Australian farmers operate in one of the most risky farming environments in the world. They have to cope with numerous sources of risk including weather uncertainty, variable market prices, and institutional changes in their business management. This paper reports results from two case studies undertaken to examine the issues of farming risks and risk management strategies in Australia. The first case study found that unpredictable weather, financial risk, marketing risk, and personal risk we...
Mazurek, Grzegorz; Gembicki, Michał; Krzemień, Grzegorz; Przegalińska, Aleksandra K.; Starostka, Justyna; Skorulska, Karolina; Prystupa-Rządca, Kaja
The following publication consists of 12 case studies, which encompass various aspects of the ICT impact on contemporary businesses, focusing – among other things – on such concepts as: crowdsourcing, the internet of things, design thinking, digital entertainment, e-commerce, online and off-line distribution or social media marketing. EEA, Norway Grants Anna Goryńska
Berntson, K.; Kozak, A.; Malcolm, J. S.
In early 2003, Bruce Power restarted two of its previously laid up units in the Bruce A generating station, Units 3 and 4. However, due to challenges relating to the availability of personnel with active Shift Manager licenses, an alternate shift structure was proposed to ensure the safe operation of the station. This alternate structure resulted in a redistribution of responsibility, and a need to assess the resulting changes in workload. Atomic Energy of Canada Limited was contracted to perform a workload assessment based on the new shift structure, and to provide recommendations, if necessary, to ensure Shift Managers had sufficient resources available to perform their required duties. This paper discusses the performance of that assessment, and lessons learned as a result of the work performed during the Restart project. (authors)
Pierce, Mary Ellen
Nursing theory, research, and best practice guidelines contribute substantially to the field of dementia care. Interventional plans are challenged most by those dementias considered progressive and deteriorative in nature, requiring ongoing reassessment and modification of care practices as the clinical course changes. The purpose of this article is to provide guidelines for case managers in the development of effective, individualized care plans for clients with progressive dementia residing in a home setting. The application of these guidelines is illustrated through the presentation of an actual case. The practice setting is a private home in the Pacific Northwest. Geriatric case management is provided by an RN case manager. Progressive dementia presents challenges to home care. Professional case management using comprehensive, holistic assessment, collaborative approaches, and best practice fundamentals serve to create an effective, individualized plan of care. The increasing geriatric population presents great opportunities for case managers in strategic management for creating successful home care models in clients with progressive dementia. Use of nursing diagnoses, dementia research, and collaborative approaches with families and other medical providers creates a viable alternative for clients with progressive dementia.
Salman, R.; Ferroukhi, R.
Since primary commodity producers first took control of their natural resources, they have attempted to utilize production/price management with varying degrees of success. As a tool aimed at regulating, rather than controlling, commodity markets, this type of resource management is an essential means of achieving realistic economic returns, which, in the long run, serves the interests of the producer of the commodity in question, as well as its consumer. By regulating commodity markets in times of stable prices producing countries would benefit from a steady and constant level of export earnings, thus allowing them to achieve a sustainable level of economic development. As far as the oil market is concerned, stable prices, set in a range favourable to both producers and consumers, would give investors the confidence needed for long-term exploration. This is particularly important for a commodity such as oil, at a time when the lead time between exploration starting and actual production getting under way is increasing. Not only would producers benefit from stable export earnings, which are an essential requirement for the planning of their development process, but consuming countries would at the same time benefit in two ways: first, they would gain security of supply; and second, as fluctuations in their expenditure for this commodity are reduced, they would be a position to manage their economies more efficiently. (author)
Nowak, Marta; Gaweda, Agnieszka; Janas-Kozik, Małgorzata
Today, the phenomenon of Euro-orphan is more and more frequently reported in the literature. This term refers to children with one or both parents emigrated from the country for work purposes. In connection with the social transformations of orphan-hood types described in the literature (nature, spiritual, social), the definition has been broadened by the definition ofeuro-orphan. The Ministry of Education describes the euro-orphan as the destruction of the family structure, the disorder of the socialisation process of children and reduction of the emotional exchanges among family members, as a result of migration of their parents. It provides further that not every child whose parents are not present in the country is covered as an euro-orphan. However, this group has become an increasingly larger populations. Lack of physical proximity and accessibility of important persons may have some psychological and pedagogical implications. These in turn can be shaped over time, into pathological symptoms, which are diagnostic entities in developmental psychiatry. It is not know precisely how many children in Poland are Euro-orphans. The aim of this paper is an attempt to understand the social phenomenon of Euro-orphanhood in the light of the observed psychopathologies of children and adolescents. The case study of the psychotherapy of a patient suffering from the Euro-orphanhood syndrome. Euro-orphanhood is a social phenomenon that generates Euro-orphans with a wide range of psychopathological symptoms classified in different diagnostic categories. The type and intensification of the psychopathological symptoms depend on the quality of relationships with meaningful persons prior to the Euro-orphanhood period. The course of the psychotherapeutic work with Euro-orphans should cover an individual aspect taking into consideration the maturity of defensive mechanisms as well as the work-through of negative feelings cumulated due to becoming a Euro-orphan.
Trondsen Marianne V
Full Text Available Abstract Background Today the availability of specialists is limited for psychiatric patients in rural areas, especially during psychiatric emergencies. To overcome this challenge, the University Hospital of North Norway has implemented a new decentralised on-call system in psychiatric emergencies, by which psychiatrists are accessible by videoconference 24/7. In September 2011, the new on-call system was established in clinical practice for patients and health staff at three regional psychiatric centres in Northern Norway. Although a wide variety of therapies have been successfully delivered by videoconference, there is limited research on the use of videoconferenced consultations with patients in psychiatric emergencies. The aim of this study is to explore the use of videoconference in psychiatric emergencies based on the implementation of this first Norwegian tele-psychiatric service in emergency care. Methods/design The research project is an exploratory case study of a new videoconference service in operation. By applying in-depth interviews with patients, specialists and local health-care staff, we will identify factors that facilitate and hinder use of videoconferencing in psychiatric emergencies, and explore how videoconferenced consultations matter for patients, professional practice and cooperation between levels in psychiatric care. By using an on-going project as the site of research, the case is especially well-suited for generating reliable and valid empirical data. Discussion Results from the study will be of importance for understanding of how videoconferencing may support proper treatment and high-quality health care services in rural areas for patients in psychiatric emergencies.
McNamara, T G
Dental ankylosis may be a significant complication in orthodontic clinical practice. This case report describes the management of a malocclusion, complicated by an ankylosed maxillary central incisor, which arose during orthodontic treatment, following an acute traumatic injury. The use of the ankylosed incisor in successfully managing the significant Class II division 1 malocclusion is described.
This research aims to examine the existence of the human capital management through competencies and knowledge management approach in Scientific Research Centers within knowledge based economy. The study was applied to the case of Scientific Research Centers in Algeria, such as: (CREAD, CRSTRA, CDTA, ...
Full Text Available Parkinson′s disease (PD is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control, sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.
Nødset, Ingrid Foss
In this paper I examine the topic of earnings management and use a case example. In the first part of the paper I review theory on two closely related topics - earnings management and fraud - and present and discuss incentives, methods, typical indications and frequency of earnings management in the financial statements. I continue to describe the frameworks and laws that apply to revenue recognition and how income is recognized in the power industry, as this is especially relevant for the ca...
McNamara, C M
This paper reviews the incidence, etiology and location of supernumerary teeth with emphasis on premolar supernumeraries and examines the management of supernumerary premolars of three patients undergoing orthodontics. These cases demonstrate that the management of premolars is assessed individually and treatments based on potential complications, which may occur during the orthodontic and surgical management of the dentition. Progress and posttreatment radiographs are recommended for the assessment of late forming supernumerary teeth.
Silva, Paulino; Silva, Rui
This research, still at an early stage, and then presented in a poster format, intended to explain the management of organizational performance of a family business in the succession process using the case study method. The scripts for semi-structured interviews that will apply to managers, owners and other workers who are deemed suitable for the investigation, which include relatives of the owners of the company are being developed. For this work the model of organizational performance manag...
Sánchez Ruiz, Lidia; Blanco Rojo, Beatriz; Simón, Rosa María
Nowadays due to the crisis, some government measures are aimed at reducing healthcare spending, affecting in some level or another the quality offered. Process management is said to be a useful tool for reducing healthcare costs by improving management without any additional economic investment. That is doing more with the same resources and without reducing the quality offered. In this study an empirical case of a Catalan hospital is presented. Overall, the usefulness of process management i...
Aggarwal, Neil Krishan
This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation's largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges.
Aggarwal, Neil Krishan
This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation’s largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges. PMID:26071640
Ampélas, J F; Wattiaux, M J; Van Amerongen, A P
We present one case of Sjögren's syndrome (SS) secondary to systemic lupus erythematosus (SLE) with predominant psychiatric manifestations, treated with success by cyclophosphamide. From this case, we review the psychiatric aspects of these two autoimmune diseases as described in the literature and we present the etiopathogenic hypothesis and treatment of the psychiatric disorders. Case report--In August 1996, a 38 year old man was admitted in our psychiatric department for agitation. Primary SS had been diagnosed in July 1996. He had previously attempted to suicide but was never hospitalized in a psychiatric department. During the hospitalization in our department, the patient had auditive hallucinations and felt persecuted. He received loxapine 400 mg/day and was remitted in a few days. He was discharged to a convalescent home with the diagnosis of brief psychotic disorder. In October 1996, he was readmitted to our department for agitation. He had shown agitated behavior and aggression in the convalescent home. There were no hallucinations and no affective disorders. He became calm rapidly and was discharged home a few days later. In November 1996, he was found in a coma by a neighbor. He was admitted to an intensive care unit. The lumbar punction revealed blood cells. Cerebral computer tomography showed subarachnoid hemorrhage. The diagnosis was meningeal hemorrhage due to vasculitis. After regaining consciousness, the patient complained of reduced visual acuity. This was believed to be due to retrobulbar neuritis and the patient's vision improved slightly with corticosteroids. The third hospitalization in our department occurred in February 1997 for depression. The patient had shut himself away for days in his apartment. He had suicidal ideas. His mood improved progressively under fluoxetine 40 mg/day. He was discharged to a convalescent home with the diagnosis of major depressive disorder. The fourth and last admission in our department occurred in June 1997
Suzuki, Masahiro; Konno, Chisato; Furihata, Ryuji; Osaki, Koichi; Uchiyama, Makoto
Most psychiatric disorders, such as schizophrenia, mood disorders, or neurotic disorders are associated with sleep disorders of various kinds, among which insomnia is most prevalent and important in psychiatric practice. Almost all patients suffering from major depression complain of insomnia. Pharmacological treatment of insomnia associated with major depression shortens the duration to achieve remission of depression. Insomnia has been recently reported to be a risk factor for depression. In patients with schizophrenia, insomnia is often an early indicator of the aggravation of psychotic symptoms. Electroencephalographic sleep studies have also revealed sleep abnormalities characteristic to mood disorders, schizophrenia and anxiety disorders. A shortened REM sleep latency has been regarded as a biological marker of depression. Reduced amount of deep non-REM sleep has been reported to be correlated with negative symptoms of schizophrenia. Recently, REM sleep abnormalities were found in teenagers having post-traumatic stress disorder after a boat accident. Although these facts indicate that insomnia plays an important role in the development of psychiatric disorders, there are few hypotheses explaining the cause and effect of insomnia in these disorders. Here, we reviewed recent articles on insomnia associated with psychiatric disorders together with their clinical managements.
Graham, Andrew T.
This small-scale case study focused on academic managers to explore the ways in which they control the workload of academic staff and the extent to which they use the workload model in performance management of academic staff. The links that exist between the workload and performance management were explored to confirm or refute the conceptual…
The world of a case manager is a busy one, and you may not have all the resources you need each and every day. If you can maintain a routine it will make the workload more manageable for you and will allow room for those surprises that invariably happen. Whether you are a new or a seasoned case manager, organizing your workload can always help smooth out the rough edges in anyone's hectic day!
Astor Eugênio Hexsel
Full Text Available The Cordilheira de Santana case, from now on referred to simply as Cordilheira, was conducted and reported with the main purpose of contributing to the understanding of the process of strategy formulation in the winery sector. It presents the case of a recently created small firm aiming to compete in the market by offering high quality based on reduced premium line products, with prices established in accordance. Even so, it has not achieved the expected results. The wine industry with its basis in the wineries of the extreme south of Brazil, which is the most productive sector in the whole country, is also discussed. The case study began in 2008, when Rosana, owner and director of the company, travelled from São Paulo to Porto Alegre and highly concerned that the expected results had not been achieved. Data included as a technical note on the wine industry provides information on the industry as a whole, enabling students to reconsider the firm´s positioning in the market. The teaching note that follows provides the professor with information that will allow him to explore several perspectives that will have to be faced by Rosana further. She may choose to strengthen the present strategy or to take it in a new direction.
Yager, Geoffrey G.
The self-management of thoughts and mental images was used in a series of empirical case studies to influence behavior changes. The target behaviors in the cases reported were smoking, overeating, fingernail biting, thinking self-depreciative thoughts, and responding assertively. Self-monitoring, covert positive reinforcement, covert…
Stanford, Nicky David; Hosni, Sara; Morris, Tim
Dental concrescence is a rare dental abnormality resulting in the joining of two teeth at the level of the cementum. This is the first reported case of the orthodontic management of a dental concrescence and the options for patient treatment are discussed. In this case, a compromised occlusal result was accepted with restorative masking of the affected teeth.
Morrison, G.; Greening, H.S.; Yates, K.K.
Tampa Bay, Florida,USA, is a shallow,subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of sea grasses and other selected habitat types, to support estuarine-dependent faunal guilds.
Soliman, M O; Ayyash, E H; Aldahham, A; Asfar, S
To report a rare presentation of necrotizing fasciitis (NF) in the breast and its management. A 61-year-old non-diabetic lady presented with a painful swollen right breast and yellowish discharge associated with fever for the last few days. Based on clinical examination and haematological parameters, a provisional diagnosis of breast abscess was made that later proved to be a case of NF. She was managed conservatively with repeated debridement followed by split-skin grafting with preservation of the breast. This case showed that NF of the breast can present as a simple breast abscess which was managed conservatively. Copyright © 2011 S. Karger AG, Basel.
Safdar, N; Hinderaker, S G; Baloch, N A; Enarson, D A; Khan, M A; Morkve, O
The control of childhood tuberculosis (TB) has been of low priority in TB programmes in high-burden settings. The objective of this paper was to describe the development and testing of tools for the management of childhood TB. The Pakistan National TB Control Programme embarked on a number of activities, including the establishment of policy guidelines for the management of childhood TB and later a guidance document, 'Case Management Desk Guide and Structured Monitoring', to demonstrate the implementation of childhood TB interventions in a programme context. Initial results showed improved case finding and treatment outcome in implementation sites compared with control districts. However, further programme attention is required to improve quality.
With the advent of casemix reimbursement implementation, rapid technological changes, an ageing population and changing consumer behaviour, the Singapore health care industry is faced with the impetus to provide a cost-effective and efficient care delivery system. One ubiquitous tool used is the establishment of a clinical pathway/case management programme within the hospital. As the concept of clinical pathway for patient care is a relatively new concept in Singapore, several critical factors must be considered to ensure successful implementation of clinical pathway/case management programme. One key success factor lies in continued clinician support and acceptance. Other factors include top management leadership and support and a dedicated team of case managers, nurses and paramedical professionals.
Davis, Linda Lindsey; Chestnutt, Deborah; Molloy, Margory; Deshefy-Longhi, Tess; Shim, Bomin; Gilliss, Catherine L
Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer's or Parkinson's disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles. Adapters told stories about applying pre-existing skills to manage home care problems. Strugglers told stories of reoccurring home care problems for which they had few or no management strategies. Case managers' interview stories focused on the challenges of finding and coordinating home care services. These findings suggest that caregiving burden might be influenced more by the caregiver's management style than the demands of the care situation. Suggestions for tailoring support programs for the three types of caregivers are proposed. © The Author(s) 2014.
Full Text Available Creutzfeldt-Jakob disease is a rapidly progressive, degenerative slow virus infection disease of central nervous system. Based on etiologic origins, four different Creutzfeldt-Jakob disease subtypes have been identified: sporadic, genetic, iatrogenic and variant. The clinical course generally begin with apathy, irritability, behavioral changes, speech problems, memory deterioration, rapidly progresses and concludes with death over a period of 3-12 months. Symptoms are observed secondary to brain cortex, cerebellum, corticospinal tracts, spinal anterior horn cells and basal ganglia damage. Unusual (%5-10 cases can survive up to 2 years. The initial symptoms of disease can be sudden which resultsin adjustment problems leading patients to seek psychiatric help. Patients could receive different diagnosis such as psychosis, depression with psychotic features, and treatments at this stages. Early diagnosis is crucial because of management of the disease and treatment approaches. In this article diagnosis and clinical features of Creutzfeldt-Jakob Disease and related psychiatric symptoms have been briefly reviewed. [Archives Medical Review Journal 2013; 22(4.000: 631-643
Full Text Available Susan R Childs,1,* Emma M Casely,2,* Bianca M Kuehler,1 Stephen Ward,1 Charlotte L Halmshaw,1 Sarah E Thomas,1 Ian D Goodall,1 Carsten Bantel1,3 1Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, 2Anaesthetic Department, Hillingdon Hospital, Uxbridge, 3Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK *These authors contributed equally to this manuscript Abstract: Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients’ pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize
Hjorthøj, Carsten Rygaard; Madsen, Trine; Agerbo, Esben
PURPOSE: Knowledge of the epidemiology of suicide is a necessary prerequisite of suicide prevention. We aimed to conduct a nationwide study investigating suicide risk in relation to level of psychiatric treatment. METHODS: Nationwide nested case-control study comparing individuals who died from...... suicide between 1996 and 2009 to age-, sex-, and year-matched controls. Psychiatric treatment in the previous year was graded as "no treatment," "medicated," "outpatient contact," "psychiatric emergency room contact," or "admitted to psychiatric hospital." RESULTS: There were 2,429 cases and 50......,323 controls. Compared with people who had not received any psychiatric treatment in the preceding year, the adjusted rate ratio (95 % confidence interval) for suicide was 5.8 (5.2-6.6) for people receiving only psychiatric medication, 8.2 (6.1-11.0) for people with at most psychiatric outpatient contact, 27...
Full Text Available Introduction: Conservative management is the first option for patients with stress urinary incontinence (SUI. However, successful management of women diagnosed with SUI is dependent on a proper assessment and a tailored treatment plan. This case report aims to show the effectiveness of physiotherapy management in a 42-year-old patient diagnosed with SUI. Patient presentation: The patient’s main complaints were involuntary loss of urine on coughing, sneezing and lifting of heavy objects, which started following the birth of her third child. Management and outcome: The patient was taught the ‘Knack’ manoeuvre and provided with a tailored pelvic floor exercise programme. Improvement was noted at the third visit and the patient no longer had involuntary episodes. Conclusion: This case report shows the successful outcome of conservative management in a patient with stress urinary incontinence.
Wang, A G
of senile psychoses. The total increase amounts to 2.4 times the admission rates of psychiatric cases to the General Hospital and 4.4 times the admission rates to the Psychiatric Hospital in Nykøbing in the last years prior to the start of the local service. The outpatient department has grown steadily...... patients were referred to the local General Hospital and about half of the patients in each diagnostic group were sent on the Psychiatric Hospital in Nykøbing on Zealand, Denmark. Since the establishment of the department, admissions have increased in all diagnostic groups, especially in the group...
Wang, A G
patients were referred to the local General Hospital and about half of the patients in each diagnostic group were sent on the Psychiatric Hospital in Nykøbing on Zealand, Denmark. Since the establishment of the department, admissions have increased in all diagnostic groups, especially in the group...... of senile psychoses. The total increase amounts to 2.4 times the admission rates of psychiatric cases to the General Hospital and 4.4 times the admission rates to the Psychiatric Hospital in Nykøbing in the last years prior to the start of the local service. The outpatient department has grown steadily...
Arthofer, Klaus; Girardi, Dominic
Poor data quality prevents the analysis of data for decisions which are critical for business. It also has a negative impact on business processes. Nevertheless the maturity level of data quality- and master data management is still insufficient in many organizations nowadays. This article discusses the corresponding maturity of companies and a management cycle integrating data quality- and master data management in a case dealing with benchmarking in hospitals. In conclusion if data quality and master data are not properly managed, structured data should not be acquired in the first place due to the added expense and complexity.
Zikos, Dimitrios; Mantas, John
Successful research management requires multifunctional, equal teamwork and efficient coordination, aiming to increase the impact of the research outcomes. Aim of this paper is to present the strategies that have been followed to successfully manage the RN4CAST study, one of the largest multi country research projects ever conducted. The paper focuses on the core research strategies rather than on the administrative management activities also required for the success of this case report. Management of a multi-country nursing survey requires the use of common data collection tools, applicable to every context, research protocols supporting the scope of the research, data models for multi-country analyses and global dissemination strategies.
Unterecker, Stefan; Maloney, Julia; Pfuhlmann, Bruno; Deckert, Jürgen; Warrings, Bodo
To optimize psychiatric consultation service epidemiological information is needed. We compared data on gender, age and diagnoses of patients in the consultation service to psychiatric inpatients. In psychiatric consultation service patients are older (56.6 vs. 44.9 years, p psychiatric consultation service is contacted more often in cases of organic disorders, for females in adjustment disorders (p psychiatric consultation service is different for males and females with relevance for diagnostic and therapeutic procedures. © Georg Thieme Verlag KG Stuttgart · New York.
Wang, Liang-Jen; Wu, Ya-Wen; Chen, Chih-Ken
Case management services have been implemented in suicide prevention programs. To investigate whether case management is an effective strategy for reducing the risks of repeated suicide attempts and completed suicides in a city with high suicide rates in northern Taiwan. The Suicide Prevention Center of Keelung City (KSPC) was established in April 2005. Subjects included a consecutive sample of individuals (N = 2,496) registered in KSPC databases between January 1, 2006, and December 31, 2011, with at least one episode of nonfatal self-harm. Subjects were tracked for the duration of the study. Of all the subjects, 1,013 (40.6%) received case management services; 416 (16.7%) had at least one other deliberate self-harm episode and 52 (2.1%) eventually died by suicide. No significant differences were found in the risks of repeated self-harm and completed suicides between suicide survivors who received case management and those who refused the services. However, a significant reduction in suicide rates was found after KSPC was established. Findings suggest that case management services might not reduce the risks of suicide repetition among suicide survivors during long-term follow-up. Future investigation is warranted to determine factors impacting the downward trend of suicide rates.
Ahmed, Osman I
With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.
Full Text Available Social Customer Relationships Management (CRM is a current business trend providing new channels of two-way communication with customers through social media sites, such as Facebook, Twitter etc. Social CRM enables companies to interact in an easy and contemporary way directly with customers as well as to track customer interactions and their social influence. In this paper we examine the importance of CRM, e-CRM and Social CRM for businesses. We provide perspectives on objectives and types of CRM, the working cycle of CRM, the stages of a CRM Strategy and technology tools that are used in CRM. Social CRM is in particularly analyzed, since this new trend requires active engagement by customers and other stakeholders. The engagement process is essential to successful Social CRM and to successful social business practices. Finally, we describe experiences from three family businesses that introduced Social CRM as a result of a project carried out as an assignment in the ‘Social Media Networking’ module of the MSc course in ‘Web Intelligence’ at the Department of Informatics of Alexander Technological Educational Institute of Thessaloniki. The assignment of the groups was to create a Social CRM Strategy in collaboration with a company. This study is a follow-up of the outcome of the projects carried out in the autumn semester 2014 and 2015. The results show that all three companies consider that Social CRM is an excellent tool for obtaining real time valuable data about customers and a cheap way to reach them.
Kokai, Masahiro [Hyogo Coll. of Medicine, Nishinomiya (Japan); Soejima, Toshinori; Wang, Shangdong; Shinfuku, Naotaka
This review focuses on the mental and psychological effects of medical radiation exposure, the nuclear accident at Three Mile Island, the Chernobyl disaster, atomic bomb explosions at Nagasaki and Hiroshima, and accidents at nuclear power plants and nuclear waste plants. Studies have shown that anxiety about the adverse effects of radiation in medicine (such as infertility, carcinogenicity, and genotoxicity) and fear for exposure has caused psychiatric disorders. Several studies on the mental health effects of the nuclear accident at Three Mile Island were conducted, and the results indicated that psychiatric distress persisted for a certain period of time, particularly in pregnant women and women who have children, even when no evidence of substantial of radiation exposure is seen clinically. The psychological consequences of the Chernobyl disaster have been investigated continuously, and various problems, e.g., acute stress reaction, neurosis, and psychosis, have been identified, although no physical damage due to the radiation or PTSD have been reported. By contrast, PTSD has been seen in survivors of the Nagasaki and Hiroshima nuclear explosions. A study in Ohio, (United States), which has a nuclear waste plant, investigated PTSD in people living near the plant and found that the symptom level was mild. In general, the most common symptoms among people with mental and psychological disorders due to radiation exposure are depression and anxiety, with many people having associated somatoform disorders, and some people complain of PTSD. Vague anxiety and fear of sequelae, regardless of the exposure dose, appears to cause such psychiatric disorders. Although it is rare for psychiatrists to see such cases of psychiatric disorders due to radiation exposure, their number may increase as psychiatric services become more widely available. (K.H.)
Kokai, Masahiro; Soejima, Toshinori; Wang, Shangdong; Shinfuku, Naotaka
This review focuses on the mental and psychological effects of medical radiation exposure, the nuclear accident at Three Mile Island, the Chernobyl disaster, atomic bomb explosions at Nagasaki and Hiroshima, and accidents at nuclear power plants and nuclear waste plants. Studies have shown that anxiety about the adverse effects of radiation in medicine (such as infertility, carcinogenicity, and genotoxicity) and fear for exposure has caused psychiatric disorders. Several studies on the mental health effects of the nuclear accident at Three Mile Island were conducted, and the results indicated that psychiatric distress persisted for a certain period of time, particularly in pregnant women and women who have children, even when no evidence of substantial of radiation exposure is seen clinically. The psychological consequences of the Chernobyl disaster have been investigated continuously, and various problems, e.g., acute stress reaction, neurosis, and psychosis, have been identified, although no physical damage due to the radiation or PTSD have been reported. By contrast, PTSD has been seen in survivors of the Nagasaki and Hiroshima nuclear explosions. A study in Ohio, (United States), which has a nuclear waste plant, investigated PTSD in people living near the plant and found that the symptom level was mild. In general, the most common symptoms among people with mental and psychological disorders due to radiation exposure are depression and anxiety, with many people having associated somatoform disorders, and some people complain of PTSD. Vague anxiety and fear of sequelae, regardless of the exposure dose, appears to cause such psychiatric disorders. Although it is rare for psychiatrists to see such cases of psychiatric disorders due to radiation exposure, their number may increase as psychiatric services become more widely available. (K.H.)
Schmitt, J; Romanos, M; Pfennig, A; Leopold, K; Meurer, M
Atopic eczema (AE) is a common dermatological condition that causes significant problems in everyday life and high levels of illness-related stress in substantial proportions of patients. The extent to which adult AE is associated with clinically relevant psychiatric morbidity is unclear. To investigate the association between adult AE and major psychiatric/psychosomatic disorders. Case-control study utilizing the GKV database Saxony, an interdisciplinary administrative outpatient database from Germany. All patients documented as having AE at least twice within the study period (2003-2004) (n = 3769, mean age 44 years) were individually matched by age and sex to 3769 controls without AE. Logistic regression models were fitted to investigate the relationship of AE with affective, stress-related, behaviour and schizophrenic disorders, considering sociodemographic characteristics, consulting behaviour and allergic comorbidities as potential confounding factors. Eczema was independently associated with affective [adjusted odds ratio (OR) 1.42, 95% confidence interval (CI) 1.13-1.79], stress-related (OR 1.55, 95% CI 1.35-1.77), behaviour (OR 1.52, 95% CI 1.03-2.23) and schizophrenic disorders (OR 2.12, 95% CI 1.22-3.71). For each psychiatric condition the likelihood of being affected significantly increased with each physician visit due to AE, suggesting that the risk of psychiatric comorbidity increases with the severity of AE. This study indicates psychiatric comorbidity of adults with AE. Collaboration between dermatologists and mental health specialists may optimize medical care for a significant subgroup of patients with AE.
Ünver, Kadir; Jensen, Per Anker
Purpose: To investigate how Risk Management (RM) is perceived and practiced in Facilities Management (FM) and corporate management and to evaluate the potential benefits of an increased application. Theory: RM is a generic management discipline, but apparently it has not achieved the attention...... as most critical in each company. Both companies could benefit from a more integrated application of RM covering both corporate management and FM. Originality/value: This is among the first descriptive studies looking at RM from both corporate and FM perspectives, which is essential to increase...... it deserves in FM. Application of RM in FM could help to increase the strategic importance and awareness of FM among corporate managers. Approach: A preliminary study with expert interviews was initially conducted followed by a main study with an interview survey in two Danish case companies - a real estate...
DiPaula, Bethany A; Thomas, Michele D
Varenicline is a novel treatment for smoking cessation; however, the agent has not been well studied in a population with severe mental illness. Varenicline can reportedly cause neuropsychiatric adverse effects, some resulting in hospitalizations and/or suicides. We describe a case of clinician-observed, worsening psychotic symptoms in a patient with chronic mental illness who was receiving varenicline. A 45-year-old woman with bipolar disorder, mixed type with psychotic features, was admitted to a psychiatric hospital due to acute decompensation after she discontinued her drug therapy. Because of the facility's smoke-free policy, the patient was not permitted to smoke cigarettes during her hospitalization. Over the next several weeks, her condition was stabilized with psychotropic drugs. Her symptoms improved, and plans were made for her discharge. Varenicline was prescribed to manage her nicotine cravings. After 2 days of treatment, staff members noted worsening of the patient's psychotic symptoms and agitation. Varenicline was discontinued, the patient's mental status returned to baseline, and she was subsequently discharged. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 7) between the patient's worsening psychosis and her varenicline therapy. This case report provides valuable support of previously published cases that demonstrate the risk of exacerbation of psychotic symptoms with varenicline use in patients with severe mental illness. With proper assessment and management of varenicline-induced neuropsychiatric effects, health care professionals can provide an important role in helping to prevent and manage worsening psychiatric symptoms.
Wang, A G
A comprehensive psychiatric service was established in 1969 in the Faroe Islands. This service was created as a department of a general hospital. The spheres covered by this department, operating in the midst of the community were: acute and chronic patients, a liaison-psychiatric service...
Manjeet Singh Bhatia
Full Text Available Background: Migraine is a common disorder which has psychiatric sequelae. Objective: The objective of this study was to determine the clinical pattern and psychiatric comorbidity of migraine. Materials and Methods: 100 cases of migraine seen over a period of one year were analysed to know the sociodemographic characteristics, clinical pattern and psychiatric morbidity. Results: Maximum patients were between 31-40 years of age group (40%, females (78.0%, married (76% and housewives (56.0%. Family history of migraine was present in 12% cases. Average age of onset was 22 years. Unilateral and throbbing type of headache was most common. The commonest frequency was one to two per week. Migraine without aura was commonest sub-type (80%. Generalized anxiety disorder (F41.1 was the most common psychiatric disorder (34%, followed by mixed anxiety and depressive disorder (F41.2 (18% and depressive episode (F32 (14%. In 22% cases, no psychiatric disorder could be elicited. Conclusion: The present study confirms that majority patients with migraine had psychiatric disorders. This needs timely detection and appropriate intervention to treat and control the migraine effectively.
Merithew, M A; Davis-Satterla, L
The purpose of the qualitative evaluation study discussed in this article was to examine the AIDS case management model under which five nonprofit AIDS service organizations (ASOs) in Midcity were operating. The study was organized around 40 qualitative interviews with executive directors, directors, and case managers. The finding was that AIDS case management is evolving to accommodate the changing environmental/contextual conditions that have resulted from combination drug therapies (protease inhibitors) introduced in 1996. The agencies are responding to the changes individually rather than as a network, and responses vary among the agencies. Institutional theory, an examination of the interconnectedness of clients, the ASOs, and their environmental context guided the analysis of the findings.
The purpose of this thesis was to evaluate a case project and to study whether it was carried out in a correct manner; meaning that did the case project follow the project management models. In addition, part of the study was to determine what could have been improved in the management of the case project. The case project was about creating and launching a communication channel based on a social media service, on a blog platform called Tumblr, for Team Finland in Spain network. The network p...
Lenders, T; Kuster, J; Bispinck, R
To develop an intervention concept for the management of uninhabitable homes. Retrospective analysis of 186 cases of the community mental health service in Dortmund (Germany) presenting with a destitute situation of the domestic environment as core problem. All patients suffered from psychiatric illnesses, mainly from addiction (F1: 41 %), psychosis (F2: 17 %), depression (F3: 17 %), and hoarding disorder (F63.8: 12 %). Main socio-demographic characteristics of our sample are: middle age (45-65 years, 48 %), male gender (73 %), isolated situation (only 7 % married, 84 % living alone), normal schooling (only 4 % without completion of schooling, 7 % attended a school for special needs), after initial integration into employment nearly all patients suffered vocational disintegration (5 % employed, 44 % unemployment benefit, 7 % welfare, 39 % pension or invalidity benefit).Psychosocial interventions differed between the 4 main diagnostic groups: F1: treatment of dependence (rehab) and treatment of concomitant somatic diseases; F2: admission to a psychiatric hospital and implementation of guardianship; F3: mediation of conflicts with neighbours/landlords and implementation of guardianship; F63.8: direct practical help by members of the community mental health team and organisation of home help/waste disposal. In all diagnostic groups, acceptance of help was impaired due to social withdrawal, resistance and psychiatric symptoms. At 13 %, compliance with help and interventions was lowest in the hoarder group (F1: 27 %, F2: 26 %, F3: 38 %). Consequently, in this group the poor outcome categories "nothing accomplished" and "lost flat/eviction" were more frequent (44 %, F1: 27 %, F2: 26 %, F3: 38 %). Concurrent to the deterioration of the domestic situation, patients suffer vocational disintegration as well as family and social isolation. Uninhabitable homes occur in the course of various severe and chronic psychiatric diseases
Khan, A.G.; Irfan, M.; Shamsi, T.S.; Hussain, M.
To identify the psychiatric illnesses in patients with hematological/oncological disorders encountered during blood and bone marrow transplantation. All consecutive patients, aged 15 years and above, who fulfilled inclusion and exclusion criteria and underwent blood and bone marrow transplantation, were enrolled in this study. Psychiatric assessment comprised of a semi-structured interview based on Present Status Examination (PSE). The psychiatric diagnosis was made on the basis of International Classification of Diseases (ICD-10) system of classification devised by W.H.O. Eighty patients, who fulfilled the inclusion criteria, were inducted in this study. Thirty (37.5%) cases were found to have psychiatric disorders. Out of the total, 60 (75%) were males and 20 (25%) females. Adjustment disorder was the most frequent diagnosis (n=12), followed by major depression (n=7). Rest of the diagnoses made were generalized anxiety disorder, acute psychotic disorder, delirium and depressive psychosis. High psychiatric morbidity associated with blood and bone marrow transplantation was observed. It indicates the importance of psychiatric intervention during the isolation period of BMT as well as pre-transplant psychiatric assessment and counseling regarding procedure. (author)
Stanton, Marietta P; Barnett Lammon, Carol Ann
A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.
Crowell, D M
The case manager's role in our complex health care system is demanding and draining without some self-reflective attention. The Wheel of Life is a key tool for individuals to assess how well they are leading a fully balanced life. The eight aspects of a balanced life--values, self-care, work, relationships, leisure, relaxation, exercise, and centering--are explained and discussed. A self-reflective activity is presented that encourages readers to assess their current life balance. This focused clarification of personal and professional life will facilitate a more fully balanced life with rewards for case managers as individuals, and for their family, clients, and the health care organization.
Hesse, Morten; Vanderplasschen, Wouter; Rapp, Richard
). Reference searching; personal communication; conference abstracts; book chapters on case management. Selection criteria Randomized controlled studies that compared a specific model of case management with either treatment as usual or another treatment model, included only patients with at least one alcohol...... or drug related problem. Data collection & analysis Two groups of reviewers extracted the data independently . Standardized mean difference was estimated. Main results In total, we could extract results from 15 studies. Outcome on illicit drug use was reported from 7 studies with 2391 patients. The effect...
Katz, K S; Stowe, A W
Connecticut Community Care, Inc. (CCCI), a statewide, nonprofit case management agency, in collaboration with Connecticut National Bank (CNB), developed a unique model of delivering case management services to bank trust clients. No reports of such a collaborative model have been found in the published literature in the United States. The article presents a historical overview of this innovative initiative; the identification of the target population; the delivery of the assessment, coordination, and monitoring services; and the marketing techniques. Utilization statistics, a synopsis of the model outcomes as viewed by the trust officers, and suggestions for replication are also presented.
Christiansen, Erik; Larsen, Kim Juul
Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Methods: A complete extraction of Danish register data…
Silverman, Michael J.
Because of the relatively poor treatment available, the high financial costs of hospitalization, multiple and complex issues of persons with severe mental illnesses, and advancements in pharmacotherapy, psychiatric patients are often only hospitalized for a few days before they are discharged. Thus, brief psychosocial interventions for persons who…
Alvarado-Esquivel, Cosme; Sánchez-Anguiano, Luis Francisco; Arnaud-Gil, Carlos Alberto; Hernández-Tinoco, Jesús; Molina-Espinoza, Luis Fernando; Rábago-Sánchez, Elizabeth
Little is known about the epidemiology of suicide attempts among psychiatric outpatients in Mexico. This study was aimed to determine the socio-demographic, clinical and behavioral characteristics associated with suicide attempts in psychiatric outpatients in two public hospitals in Durango, Mexico. Two hundred seventy six psychiatric outpatients (154 suicide attempters and 122 patients without suicide attempt history) attended the two public hospitals in Durango City, Mexico were included in this study. Socio-demographic, clinical and behavioral characteristics were obtained retrospectively from all outpatients and compared in relation to the presence or absence of suicide attempt history. Increased prevalence of suicide attempts was associated with mental and behavioral disorders due to psychoactive substance use (F10-19) (P=0.01), schizophrenia, schizotypal and delusional disorders (F20-29) (P=0.02), mood (affective) disorders (F30-39) (Purban residence (OR=2.31, 95% CI: 1.17-4.57; P=0.01), memory impairment (OR=1.91, 95% CI: 1.07-3.40; P=0.02), alcohol consumption (OR=2.39, 95% CI: 1.21-4.70; P=0.01), and sexual promiscuity (OR=3.90, 95% CI: 1.74-8.77; PMexico. Results may be useful for an optimal planning of preventive measures against suicide attempts in psychiatric outpatients.
Sohár, Gábor; Kovács, Mónika; Györkös, Andrea; Gasztonyi, Beáta
The authors present the case history of a patient suffering from hyperthyroidism. The diagnostic procedures revealed the presence of propylthiouracyl induced vasculitis with renal involvement, that recovered completely after the withdrawal of propylthiouracyl and corticosteroid treatment. Thereafter, the patient was treated with thiamasol, that caused agranulocytosis with fever. After transient litium carbonate therapy a succesful thyreoidectomy was performed. Cumulative serious side effects of antithyroid drugs are rare. This case highlights some of the challenges and complications encountered in the management of hyperthyroidism.
That cannabis use may provoke mental disturbances is well known to Scandinavian psychiatrists today. A review of the psychiatric aspects of cannabis use is given, and the clinical signs of 70 cases of cannabis psychoses collected in Sweden are described. The bluntness and "amotivation" following chronic cannabis use are discussed. Anxiety reactions, flashbacks, dysphoric reactions and an abstinence syndrome are all sequels of cannabis use. Three risk groups begin to emerge: a) Young teenage cannabis users who lose some of their capacity to learn complex functions and who flee from reality to a world of dreams. With its sedative effect, cannabis could modify such emotions as anger and anxiety and slow down the liberation process of adolescence. b) Heavy daily users, often persons who cannot cope with depression or their life circumstances. c) Psychiatric patients whose resistance to relapses into psychotic reactions might be diminished according to the psychotropic effects of cannabis.
Tang, Dan; Yu, Ignatius Tak Sun; Luo, Xiaoyuan; Liang, Youxin; He, Yonghua
Return-to-work (RTW) after occupational injuries is an important and challenging issue. Case managers are expected to play a vital role in successful RTW. In China, RTW intervention is in its early phase and requires further research and practice. This case report describes Mr. H's RTW process for illustrating the work of a case management team in China. Suggestions on developing and optimizing the process in China are given. After 9 years of absence from work due to severe burn injuries at work, Mr. H was referred for RTW interventions. Mr. H received social and occupational rehabilitation services of 3 months, and the following workplace visits and work trials. After the job placement, the case manager continued the liaison with the worker and employer. Mr. H showed positive changes in occupational and social adjustment after the case management interventions. This was reflected from the shift from the contemplation to action stage on the Lam Assessment of Stages of Employment Readiness. Despite he did not show significant changes on functional capacity and fear avoidance beliefs, Mr. H passed the job credential test and was offered a maintenance technician position at a new company. Both the worker and the employer were satisfied with the outcome of the case management. The RTW interventions carried out by the case managers appeared to be effective within the Chinese system. The results suggested that professional training of case managers, RTW-related policies and technological standards, early integrated interventions should be further developed in China. Disability Adjustment Group Therapy and RTW Support Groups perhaps are useful approaches in workers' returning to work.
Agarwal, Ravi M; Yeluri, Ramakrishna; Singh, Chanchal; Chaudhry, Kalpna; Munshi, Autar K
A pediatric mandibular fracture can cause a child severe pain and the parent or caregiver extreme worry. While the pattern of fractures and associated injuries in children is similar to adults, the incidence is low. Due to a number of factors, including the anatomical complexity of the developing mandible in a child, management of such fractures differs from that of adults and can greatly challenge the pediatric dentist. Various treatment modalities of managing mandibular fracture are available, such as closed/open cap splint with circummandibular wiring, arch-bar fixation, and cementation of the cap splint. This article reviews 19 cases in the management of pediatric facial fracture using varied treatment methods.
Full Text Available This paper aims to highlight a link between publishing business innovation and how editors manage creativity in the digital era. Examining the changing industrial and historical business context for the U.K. magazine publishing industry, two case studies are analyzed as representatives of different ends of the publishing company spectrum (one a newly launched magazine published by a major, the other an independent ‘magazine’ website start-up. Qualitative data analysis on publishing innovation and managing creativity is presented as a springboard for further research on magazine media management.
Spangsberg Boesen, Magnus; Thygesen, Lau Caspar; Uldall, Peter Vilhelm
BACKGROUND: Pediatric-onset multiple sclerosis (MS) affects life at a stage vital for social and educational achievements and psychiatric co-morbidity is common after MS onset. Few studies have examined psychiatric morbidity before MS onset. METHODS: In this nationwide study, detailed case...... with psychiatric morbidity as exposure and MS as outcome, and a matched cohort study with MS as exposure and psychiatric co-morbidity as outcome. Hazard ratios (HR) including 95% confidence intervals (CI) were estimated using Cox regression. RESULTS: We identified 212 children with MS and 1060 controls....... No association between psychiatric morbidity and the rate of MS was found before MS onset. After MS onset, children with MS had two times higher hazard for psychiatric co-morbidity compared with children without MS (HR=2.0; 95% CI=1.3-3.1; pPsychiatric morbidity seems to commence after MS...
Gabrielli, Francesco; Amato, Alessia; Balducci, Susanna; Magi Galluzzi, Lorenzo; Beolchini, Francesca
The geomorphology of the Italian territory causes the incidence of many disasters like earthquakes and floods, with the consequent production of large volumes of waste. The management of such huge flows, produced in a very short time, may have a high impact on the whole emergency response. Moreover, historical data related to disaster waste management are often not easily accessible; on the other hand, the availability of data concerning previous events could support the emergency managers, that have to take a decision in a very short time. In this context, the present paper analyses four relevant recent case studies in Italy, dealing with disaster waste management after geologic and hydrologic natural events. Significant differences have been observed in the quantity and types of generated wastes, and, also, in the management approach. Such differences are mainly associated with the kind of disaster (i.e. earthquake vs. flood), to the geographical location (i.e. internal vs. coastal area), to the urbanisation level (i.e. industrial vs. urban). The study allowed the identification of both strengths and weaknesses of the applied waste management strategies, that represent "lessons to learn" for future scenarios. Even though it deals with Italian case studies, this manuscript may have a high impact also at international level, making available for the first-time emergency waste management data, that are considered an indispensable support for decision makers. Copyright © 2017 Elsevier Ltd. All rights reserved.
Nicks, B A; Manthey, D M
Objectives. Studies have demonstrated the adverse effects of emergency department (ED) boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits) from January 2007-2008. The main outcomes were ED length of stay (LOS) and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1%) requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years), with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039-1140) versus 340 min, CI (304-375); P boarding accounted for a direct loss of ($1,198) compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients) per psychiatric patient, and decreasing financial revenue.
Bratek, Agnieszka; Koźmin-Burzyńska, Agnieszka; Górniak, Eliza; Krysta, Krzysztof
Cushing's syndrome is the term used to describe a set of symptoms associated with hypercortisolism, which in most cases is caused by hypophysial microadenoma over-secreting adrenocorticotropic hormone. This endocrine disorder is often associated with psychiatric comorbidities. The most important include mood disorders, psychotic disorders, cognitive dysfunctions and anxiety disorders. The aim of this article was to review the prevalence, symptoms and consequences of psychiatric disorders in the course of Cushing's syndrome. We therefore performed a literature search using the following keywords: Cushing's syndrome and psychosis, Cushing's syndrome and mental disorders, Cushing's syndrome and depression, Cushing's syndrome and anxiety. The most prevalent psychiatric comorbidity of Cushing's syndrome is depression. Psychiatric manifestations can precede the onset of full-blown Cushing's syndrome and therefore be misdiagnosed. Despite the fact that treatment of the underlying endocrine disease in most cases alleviates psychiatric symptoms, the loss of brain volume persists. It is important to be alert to the symptoms of hypercortisolism in psychiatric patients to avoid misdiagnosis and enable them receiving adequate treatment.
Wetterling, Tilman; Schneider, Barbara
Due to demographic changes there will be a fraction of elderly patients with substance use disorders. However, only a few data have been published about elderly abusers of prescription drugs. Since substance abuse is frequently comorbid with psychiatric disorders, treatment in a psychiatric hospital is often needed. In this explorative study elderly people with prescription drug abuse who required psychiatric inpatient treatment should be characterized. This study was part of the gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within a period of 3 years. Among 1266 documented admissions in 110 cases (8.7 %) (mean age: 75.7 ± 7.1 years) prescription drug abuse, mostly of benzodiazepines was diagnosed. Females showed benzodiazepine abuse more often than males. In only a small proportion of the cases the reason for admission was withdrawal of prescribed drugs. 85.5 % suffered from psychiatric comorbidity, mostly depression. As risk factors for abuse depressive symptoms (OR: 3.32) as well as concurrent nicotine (OR: 2.69) or alcohol abuse (OR: 2.14) were calculated. Psychiatric inpatient treatment was primarily not necessary because of prescription drug abuse but because of other psychopathological symptoms. © Georg Thieme Verlag KG Stuttgart · New York.
Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce
Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…
Chan, Monica; Guydish, Joseph; Prem, Rosemary; Jessup, Martha A.; Cervantes, Armando; Bostrom, Alan
Based on availability of case management services, drug-involved women offenders entered either a probation case management (PCM) intervention(n = 65) or standard probation(n = 44). Participants were placed in the case management condition until all slots were filled, then placed in standard probation until case management slots opened.…
Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs
semantics that supports both run time changes and formal verification. We show how these techniques are being implemented in industry as a component of the Exformatics case management tools. Finally we discuss the planned future work, which will aim to allow changes to be tested for conformance wrt policies...
Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs
We describe how the declarative Dynamic Condition Response (DCR) Graphs process model can be used for trustworthy adaptive case management by leveraging the flexible execution, dynamic composition and adaptation supported by DCR Graphs. The dynamically composed and adapted graphs are verified for...
Objective: Evaluate the performance of volunteers in providing Community Case Management (CCM) for diarrhea, fever and pneumonia – in a pre-HEW setting in Liben Woreda, Oromiya Regional State. Methods: Save the Children supported Ministry of Health and communities to deliver child survival interventions from ...
A case report on the management of Congestive Heart Failure is presented with emphasis on the use of DIGOXIN. Keywords: Congestive heart failure, Failing heart syndrome, Digoxin, Digoxin Toxicity. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.
Healthcare waste generation and its management system: the case of health ... of an environmental risk to health care workers, the public and the environment at large. ... Only four out of ten health centers used local type of incinerators, while ...
Desai, Manthan; Jain, Anoop; Sumra, Nida
The idea of absolute anchorage has always been an elusive goal for clinicians. Orthodontic mini-implants or temporary anchorage devices allow tooth movements previously thought to be impossible or difficult. Although extensive literature exists on use of temporary anchorage devices, their failures have been hardly focused upon, especially implant fracture. The following case report describes successful management of fractured orthodontic mini-implant.
Conclusions: This is the first case series highlighting the differing strategies and challenges faced by clinicians managing gallstone sigmoid ileus. Conservative measures (including manual evacuation, endoscopy, lithotripsy and surgery all play important roles in relieving large bowel obstruction. It is essential to tailor care to individual patients’ needs given the complexities of this potentially life threatening condition.
Case studies of British and Australian multinational corporations in the food and drink industry investigated how training and development are managed. Competency-based education and industry boards are important elements in both countries. Lack of a training culture in the industry and little innovation in training were observed. (SK)
records, the existence or non-existence of records management policies and procedures, as well as records security measures at GCC. A case study methodology was used and questionnaires were distributed to 35 officers selected from senior members of staff and records/ administrative personnel. Personal observations ...
DeClerck, F.; Pels, H.J.; Otter, den A.F.H.J.; Emmitt, S.; Prins, M.; Otter, den A.F.
In this chapter the use and organization of use of a project website is described in the design and realization of a construction project. The case concerns a complicated project with a high number of different parties involved, managed by an architectural office and having an internationally
Moreno-Ventas Garcia, V.; Gimeno Serrano, F.
The proper management of emergencies, is a challenge for which it is essential to be prepared. Integrated Software Performance Chips In case of fire and rapid access to information, make this application a must to effectively drive any emergency due to fire at any nuclear facility.
Snodgrass, Lyn; Blunt, Richard
This is a case study of a conflict management intervention in two secondary schools in post-apartheid South Africa. The feature of the intervention that we examine is the use of play as an educational strategy. The literature attests that play can facilitate change by allowing learners freedom to change their behaviour and opportunities to explore…
Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.
Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…
Reinders, M.F.; Geertzen, J.H.B.; Eisma, W.H.
This clinical note describes the case of a nine-year-old girl with classical Volkmann's contracture of the left forearm. The report demonstrates the results and follow-up of conservative orthotic management used as a mode of treatment by a multidisciplinary team. When using an orthosis it is
Gokce Nur Say
Full Text Available Oxytocin is a neuropeptide that plays critical role in mother-infant bonding, pair bonding and prosocial behaviors. Several neuropsychiatric disorders such as autism, schizophrenia, affective disorders, anxiety disorders, attention deficit/hyperactivity disorder, alcohol/substance addiction, aggression, suicide, eating disorders and personality disorders show abnormalities of oxytocin system. These findings have given rise to the studies searching therapeutic use of oxytocin for psychi-atric disorders. The studies of oxytocin interventions in psychiatric disorders yielded potentially promising findings. This paper reviews the role of oxytocin in emotions, behavior and its effects in psychiatric disorders. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2: 102-113
Ølholm, Anne Mette; Christensen, Janne B; Kamionka, Stine Lundstrøm
management programme might include reducing inequality and improving clinical outcomes. No studies supporting the argument that specialized hospital care is stigmatizing or reduces quality of care were identified. Conclusion: The review highlights a fundamental lack of evidence against specialized care...... to patients with a refugee or immigrant background. Provision of specialized services for migrant patients, including case management with multidisciplinary physical, cognitive and social interventions, has been suggested as a way to tackle inequalities in response to a growing recognition of the complexity...... - b ased case management for ethnic minority patients. Methods: This review used a health technology assessment model, including a systematic search of literature in the PubMed, Embase, the Cochrane Library, Sociological Abstracts, the Cumulative Index to Nursing and Allied Health Literature databases...
Full Text Available In 2011, revised international guidelines were issued jointly by the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society and the Latin American Thoracic Association, which provide a valuable framework for the diagnosis and management of idiopathic pulmonary fibrosis (IPF. However, due to the complexity of IPF, these guidelines may not comprehensively account for the management of individual IPF patients in clinical practice. We describe three patient cases that were presented and discussed during the 2013 AIR: Advancing IPF Research meeting in Nice, France. These cases highlight the heterogeneity in the presentation, history and clinical course of IPF, together with expert insights regarding the diagnosis and management of IPF in the real-life setting.
PRIMARY PRACTICE SETTING(S):: Applicable to health and behavioral health settings, wherever case management is practiced. The SDH pose major challenges to the health care workforce in terms of effective resource provision, health and behavioral health treatment planning plus adherence, and overall coordination of care. Obstacles and variances to needed interventions easily lead to less than optimal outcomes for case managers and their health care organizations. Possessing sound knowledge and clear understanding of each SDH, the historical perspectives, main theories, and integral dynamics, as well as creative resource solutions, all support a higher level of intentional and effective professional case management practice. Those persons and communities impacted most by the SDH comprise every case management practice setting. These clients can be among the most vulnerable and disenfranchised members of society, which can easily engender biases on the part of the interprofessional workforce. They are also among the costliest to care for with 50% of costs for only 5% of the population. Critical attention to knowledge about managing the SDH leverages and informs case management practice, evolves more effective programming, and enhances operational outcomes across practice settings.
Drabo, Koiné Maxime; Nana, Félicité; Kouassi, Kouassi Lazare; Konfé, Salifou; Hien, Hervé; Saizonou, Jacques; Ouedraogo, Tinoaga Laurent
The global initiative for poliomyelitis eradication can only remain relevant if survey systems are regularly assessed. In order to identify shortcomings and to propose improvement, the data collection and transmission during case investigation were assessed in the Banfora health district in Burkina Faso. The survey targeted six (6) primary health centres, the district laboratory and the national laboratory, all involved in the poliomyelitis surveillance system. Data from registers, forms documenting suspected cases, stool sample forms and weekly reports were collected by means of a data grid. Data from actors involved in the poliomyelitis case investigation system were collected by means of an individual questionnaire. The reactivity of investigating suspected cases was satisfactory with a median alert questionnaire notification time of 18 hours. The completeness of the reporting system was satisfactory. Nevertheless, the promptness of data management by primary heath centres and the national laboratory remained unsatisfactory. Evaluation of data management revealed logistic and organization shortcomings. The overall efficacy of the poliomyelitis surveillance could be improved by using management tools for laboratory supplies, collecting data related to the homes of suspected cases and implementing a cold chain maintenance plan.
Godley, Susan H; Smith, Jane Ellen; Passetti, Lora L; Subramaniam, Geetha
Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psychiatric disorders is recommended; however, there are few studies that have evaluated integrated treatment approaches. This paper includes a brief review of cognitive-behavioral and family therapies, since they have been demonstrated to be effective treatments for the disorders that commonly co-occur with substance use. It also describes how an integrated treatment paradigm has been implemented using one Empirically Supported Treatment, the Adolescent Community Reinforcement Approach (A-CRA). There is existing research that supports the use of several A-CRA procedures to treat substance use and commonly co-occurring psychiatric disorders. In the absence of further research, it is reasonable in the interim to train clinicians in treatments that incorporate components that have been found to be effective for both substance use and commonly co-occurring psychiatric disorders. These treatments can then be adapted as needed based on an individual youth's set of problems. Further research is needed to test treatments for various combinations of SUDs and psychiatric disorders (i.e., depression, trauma-related problems, conduct disorder/behavior problems, and attention-deficit/hyperactivity disorder [ADHD]).
Evaluación de la efectividad de un programa de gestión de casos para pacientes esquizofrénicos en centros de salud mental / Assessment of the effectiveness of a case management programme for schizophrenic patients in mental health centres
[eng] The psychiatric deinstitutionalization leaded to an increase of community resources for persons with Severe Mental Illness (SMI). These resources include the so-called case management programs that aim to organize, coordinate and integrate the resources available for patient care through continuous contact with one or more key workers. The Mental Health Strategy of the Spanish National Health System (2007) recommends case management programs for the coordination, access and use of menta...
Full Text Available Knowledge is the new strategic imperative of organizations. The ability to manage knowledge is a crucial part of any organizations operational processes. The creation and diffusion of knowledge have become ever more important factors in competitiveness. This paper investigates the Knowledge Management and flow information and in small design firms. It is divided into three main parts. The first part of this paper describes the importance of Knowledge Management for organizations are described together with responsibilities needed to ensure successful Knowledge Management implementations and the Spiral of Organizational Knowledge Creation conception. The second part approaches literature available about process and organizational structure and information flow related to Brazilian design firms. Finally, this paper presents a case study of small design office of Civil Engineering identifying organizational process, verifying the types of communication practices and identifying the types of dynamic process of The Spiral of Organizational Knowledge Creation, KM strategy and dynamic through Knowledge Transfer.
Costa, Andrew P; Poss, Jeffery W; McKillop, Ian
Case mix classifications are the frameworks that underlie many healthcare funding schemes, including the so-called activity-based funding. Now more than ever, Canadian healthcare administrators are evaluating case mix-based funding and deciphering how they will influence their organization. Case mix is a topic fraught with technical jargon and largely relegated to government agencies or private industries. This article provides an abridged review of case mix classification as well as its implications for management in healthcare. © 2015 The Canadian College of Health Leaders.
Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind
Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. We aimed to investigate the association and temporal relation between hyperthyroidism and psychiatric morbidity.......Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. We aimed to investigate the association and temporal relation between hyperthyroidism and psychiatric morbidity....
Full Text Available BACKGROUND Opioid dependence is a major public health problem in Kerala. Presence of psychiatric disorder among opioid dependent patients worsens the scenario. To date no attempts have been made to analyse the magnitude and pattern of comorbid psychiatric disorders in the state. MATERIALS AND METHODS We assessed 30 patients with ICD-10 diagnosis of opioid dependence syndrome for the presence of comorbid psychiatric disorders using structured clinical interview for DSM IV Axis 1 disorder (SCID-1. Patients with opioid withdrawal state, delirium and acute medical emergencies were excluded. RESULTS 56.7% of our subjects had a comorbid psychiatric disorder. Major depressive disorder was the most common one (n=7, 23.3%. Prevalence of other disorders were generalised anxiety disorder (n=6, 20%, bipolar affective disorder (n=3, 10% and schizophrenia (n=1, 3.3%. CONCLUSION Comorbid Psychiatric disorders are highly prevalent in opioid dependence. There is a need for further large sample studies in the areas of comorbidities and in the integrated strategies for the identification and management of both opioid dependence and comorbid psychiatric disorders.
Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal
Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building
Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal
Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.
Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd [School of Technology Management and Logistics, Universiti Utara Malaysia, 06010 Sintok, Kedah (Malaysia); Baharum, Mohd Faizal [School of Building, Housing and Planning, Universiti Sains Malaysia, 11800 Penang (Malaysia)
Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.
James, Caryl C A B; Carpenter, Karen A; Peltzer, Karl; Weaver, Steve
The aim of this study was to examine illness presentation and understand how psychiatric patients make meaning of the causes of their mental illnesses. Six Jamaican psychiatric patients were interviewed using the McGill Illness Narrative Interview Schedule. Of the 6, 3 representative case studies were chosen. The hermeneutic phenomenological approach and the common sense model were used in the formulation of patients' explanatory models. Results indicate that psychiatric patients actively conceptualized the causes and resultant treatment of their mental illnesses. Patients' satisfaction and compliance with treatment were dependent on the extent to which practitioners' conceptualization matched their own, as well as practitioners' acknowledgement of patients' concerns about causation, prognosis, and treatment.
Deployments in the United States military have increased greatly in the past 10 years. Families and children are psychiatrically affected by these deployments, and recent studies are clarifying these effects. This article focuses on the psychiatric effects of deployment on children and uses a composite case example to review the use of play therapy to treat children who are having psychiatric issues related to the deployment of one or both parents. PMID:22468239
Kumar, Vinod; Daria, Usha
Background: Prisoners are having high percentage of psychiatric disorders. Majority of studies done so far on prisoners are from Western countries and very limited studies from India. Aim: Study socio-demographic profile of prisoners of a central jail and to find out current prevalence of psychiatric disorders in them. Materials and Methods: 118 prisoners were selected by random sampling and interviewed to obtain socio-demographic data and assessed on Indian Psychiatric Interview Schedule (IPIS) with additional required questions to diagnose psychiatric disorders in prisoners. Results: Mean age of prisoners was 33.7 years with 97.5% males, 57.6% from rural areas and 65.3% were married. Average education in studied years was 6.6 years and 50.8% were unskilled workers. 47.4% were murderers while 20.3% of drugs related crimes. 47.5% were convicted and history of criminal behavior in family was in 32.2% prisoners. Current prevalence of psychiatric disorders was 33%. Psychotic, depressive, and anxiety disorders were seen in 6.7%, 16.1%, and 8.5% prisoners respectively. 58.8% had history of drug abuse/dependence prior to imprisonment. Conclusion: One prison of Hadoti region of Rajasthan is full of people with mental-health problems who collectively generate significant levels of unmet psychiatric treatment need. Prisons are detrimental to mental-health. Beginning of reforms is the immediate need. PMID:24459308
Aug 8, 2008 ... psychiatric illness significantly differentiates cases from non-cases on all measures of morbidity. Conclusion:the ..... with the onerous task of sifting out several variables .... strategy in providing services targeted to high-risk.
Umeki, H.; Osawa, H.; Naito, M.; Nakano, K.; Makino, H.; Mc Kinley, I.G.
The safety case for a radioactive waste repository involves many complex, multi-disciplinary issues; these must be summarised in a comprehensive and concise manner, with links to all supporting information. The safety case can thus be considered an edifice built on structured knowledge. Knowledge is defined here in the very widest sense; including all of the information underpinning a repository project. Knowledge management covers all aspects of the development, integration, quality assurance, communication and maintenance/archiving of such knowledge. When seen from this perspective, the exponential expansion of the knowledge base represents a little-discussed challenge to safety case development. Indeed, knowledge production rates in this area are rapidly reaching, if not already surpassing, the limits of traditional management methods. This problem has been recognised in Japan and thus a project has been initiated to develop a next generation knowledge management system (KMS). This will utilize advanced electronic information management technology to handle the vast quantity of material involved. Autonomic systems will perform many of the information processing functions, helping ensure that required knowledge is accessible to all stakeholders and that gaps can be identified and supporting R and D prioritized. In a departure from conventional structuring by technical discipline, the prototype KMS utilizes a safety case structure. This should facilitate use of the core of neutral scientific and technical knowledge by both the implementer and the regulator. Flexibility is built into the system, to allow it to be restructured to match the user needs or even interfaced directly to a formal requirements management system. (authors)
Bowman, Elizabeth K; Palley, Howard A
Our findings indicate how health outcomes regarding adolescent pregnancy and maternal and infant health care are intertwined with a case management process that fosters measures that are social in nature-the provision of direct services, as well as the encouragement of informal social supports systems. They also show how case managed services in a small, nongovernmental organization (NGO) with a strong commitment to its clients may provide the spontaneity and caring which results in a "match" between client needs and the delivery of services-and positive outcomes for pregnant women, early maternal health and infant health. The delivery of such case managed services in a manner which is intensive, comprehensive, flexible and integrated contributes significantly to such improved health outcomes.
Full Text Available In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM, for people dealing with multiple comorbid conditions, including HIV. The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment. Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500. When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of
HIV/AIDS Management and The Mobile Workforce: A Case Study of Security Forces in Namibia. ... Rwanda Journal ... Conclusively, it is recommended that management should henceforth adopt strategic management approach to managing ...
Reilly, Siobhan; Miranda-Castillo, Claudia; Malouf, Reem; Hoe, Juanita; Toot, Sandeep; Challis, David; Orrell, Martin
Over 35 million people are estimated to be living with dementia in the world and the societal costs are very high. Case management is a widely used and strongly promoted complex intervention for organising and co-ordinating care at the level of the individual, with the aim of providing long-term care for people with dementia in the community as an alternative to early admission to a care home or hospital. To evaluate the effectiveness of case management approaches to home support for people with dementia, from the perspective of the different people involved (patients, carers, and staff) compared with other forms of treatment, including 'treatment as usual', standard community treatment and other non-case management interventions. We searched the following databases up to 31 December 2013: ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group,The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, Web of Science (including Science Citation Index Expanded (SCI-EXPANDED) and Social Science Citation Index), Campbell Collaboration/SORO database and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group. We updated this search in March 2014 but results have not yet been incorporated. We include randomised controlled trials (RCTs) of case management interventions for people with dementia living in the community and their carers. We screened interventions to ensure that they focused on planning and co-ordination of care. We used standard methodological procedures as required by The Cochrane Collaboration. Two review authors independently extracted data and made 'Risk of bias' assessments using Cochrane criteria. For continuous outcomes, we used the mean difference (MD) or standardised mean difference (SMD) between groups along with its confidence interval (95% CI). We applied a fixed- or random-effects model as appropriate. For binary or dichotomous data, we generated the corresponding odds
McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt
Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change
Bejoy J Thomas
Full Text Available Knowledge about the external and internal anatomy of the tooth is essential for successful dental practice. Anomalies in the tooth are often encountered which poses difficulties in dental treatments. As like any other tooth, mandibular first molars are also prone for anatomic malformations. One such anatomic variation is the presence of extra root distolingually. This distolingual root is called radix entomolaris (RE. The presence of an additional root can lead to difficulties during endodontic therapy. This article is a report of two cases describing the management of the first mandibular molars with an RE and clinical guidelines for its management.
Full Text Available Gender identity disorder (GID is a complex disorder and can be defined as a group of disorders whose common feature is a strong and persistent preference for living as a person of the other sex. It is associated with significant impairment in social, occupational, interpersonal, and other areas of functioning. We describe the case of an adolescent, biologically male who was brought to our outpatient department primarily with symptoms of adjustment disorder with GID and the management provided. The role of a psychiatrist in the management, ethical and legal issues involved is also discussed.
Bankston White, Cheri; Birmingham, Jackie
Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role.This is Part 2 of a two-part article written for case management directors, particularly new ones.Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes.This article attempts to answer the following questions: : The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Part 1 found that case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations that include payer, provider, and regulatory agencies. At the same time, they must also develop the skills to positively influence the revenue cycle and financial health of both the organization for which they work and those to whom they transition patients. A director of case management with responsibility for transitions of care has more power and influence over patient safety than is commonly known. Few of the
Bankston-White, Cheri; Birmingham, Jackie
Case management directors are in a dynamic position to affect the transition of care for patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role. The purpose of this two-part article is to provide case management directors, particularly new ones, with a framework for understanding and fulfilling their role.We have divided the guide into seven tracks of responsibility. Part 1 discusses the first four tracks: (1) staffing and human resources, (2) compliance and accreditation, (3) discharge planning, and (4) utilization review and revenue cycle. Part 2 addresses (5) internal departmental relationships (organizational), (6) external relationships (Community agency), and (7) quality and program outcomes. The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems, and have frontline case managers reporting to them. Case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. New directors would benefit from mentoring and networking with one another. As new regulations and models of care bring increased emphasis and focus to transitions of care, the role of the case management director continues to evolve, growing in importance and complexity. The growing financial impact of readmissions also brings added scrutiny and increased pressure to get the transitions of care right the first time.To operate most effectively, case management directors must understand the full range of their responsibilities and impact. They must find opportunities for themselves and their departments to learn and stay
Visescu, Mircea; Beilicci, Erika; Beilicci, Robert
Hydrographical basins are important from hydrological, economic and ecological points of view. They receive and channel the runoff from rainfall and snowmelt which, when adequate managed, can provide fresh water necessary for water supply, irrigation, food industry, animal husbandry, hydrotechnical arrangements and recreation. Hydrographical basin planning and management follows the efficient use of available water resources in order to satisfy environmental, economic and social necessities and constraints. This can be facilitated by a decision support system that links hydrological, meteorological, engineering, water quality, agriculture, environmental, and other information in an integrated framework. In the last few decades different modelling tools for resolving problems regarding water quantity and quality were developed, respectively water resources management. Watershed models have been developed to the understanding of water cycle and pollution dynamics, and used to evaluate the impacts of hydrotechnical arrangements and land use management options on water quantity, quality, mitigation measures and possible global changes. Models have been used for planning monitoring network and to develop plans for intervention in case of hydrological disasters: floods, flash floods, drought and pollution. MIKE HYDRO Basin is a multi-purpose, map-centric decision support tool for integrated hydrographical basin analysis, planning and management. MIKE HYDRO Basin is designed for analyzing water sharing issues at international, national and local hydrographical basin level. MIKE HYDRO Basin uses a simplified mathematical representation of the hydrographical basin including the configuration of river and reservoir systems, catchment hydrology and existing and potential water user schemes with their various demands including a rigorous irrigation scheme module. This paper analyzes the importance and principles of integrated hydrographical basin management and develop a case
Full text: Over the past several years, many nuclear organizations in IAEA’s Member States have accumulated considerable experiences and achievements in the development and application of nuclear knowledge management (NKM) methodology and tools to improve their organizational performance. The IAEA NKM Section has initiated a project entitled “NKM Case Studies Catalogue (NKM CSC)” to capture and document, as well as preserve NKM experience and facilitate its sharing among NKM practitioners and experts. This is done through collection and preservation of information of relevant experiential knowledge in “case study” format. The catalogue will therefore support community of practice mechanisms. An input template is currently under development and will be used to help contributors in Member States who are providing concise set of information about their respective case studies. This information will be made searchable and easily retrievable through a platform that supports collaboration among NKM practitioners and experts. It is planned to launch the Nuclear Knowledge Management Case Studies Catalogue “NKM CSC” at the occasion of the “Third International Conference on Nuclear Knowledge Management—Challenges and Approaches, 7-–11 November 2016, Vienna, Austria”, and to include the accepted case studies submitted to this Conference. (author
Cooper, Claudia; Livingston, Gill
Elder abuse may be defined as a violation of a vulnerable older person's human and civil rights. Psychiatric illness is an important cause of vulnerability to abuse, especially when it is comorbid with other risk factors, such as physical frailty, sensory impairment, social isolation, and physical dependency. Health care providers are likely to encounter elder abuse regularly, and therefore have an important role in its detection and management, and in the treatment of subsequent psychiatric illness. This article reviews the relationships between psychiatric illnesses and elder abuse and neglect, examines the psychiatric consequences, and discusses how these may be treated. Copyright © 2014 Elsevier Inc. All rights reserved.
Branch, Kristi M.; Peffers, Melissa S.; Ruegg, Rosalie T.; Vallario, Robert W.
This guide takes the science manager through the steps of planning, implementing, validating, communicating, and using case studies. It outlines the major methods of analysis, describing their relative merits and applicability while providing relevant examples and sources of additional information. Well-designed case studies can provide a combination of rich qualitative and quantitative information, offering valuable insights into the nature, outputs, and longer-term impacts of the research. An objective, systematic, and credible approach to the evaluation of U.S. Department of Energy Office of Science programs adds value to the research process and is the subject of this guide.
La Torre, G; De Giusti, M; Mannocci, A; De Waure, C; Agostinelli, A; Schena, S; Capelli, G; Ricciardi, W; Boccia, A; Damiani, G; von Pinoci, M; Fanton, C; Federico, B
Disability Management can be defined as a practice to improve workers' health and to reduce the impact and costs of disability. The aim of the study was to estimate the diffusion of DM in Italian companies. A survey was conducted using a questionnaire, the Worksite Disability Management Audit. The questionnaire was structured into five parts addressing the following domains: 1) characteristics of the company; 2) health promotion activities; 3) preventive measures; 4) case management; 5) disability management. We selected public and private companies and collected information by direct interview. Twenty companies entered the survey. Twelve Companies (60%) indicated that health promotion programs and sensibilisation campaigns are usually carried out. The presence of an individual who provided workplace safety indications and materials was stated by 19 companies (95%). Periodical medical examinations are carried out by 19 companies (95%); 16 (80%) have an evaluation process for ergonomics concerns. Risk assessment and analysis are performed by all companies and the security procedures and policies are updated at least once in a year in 40% of cases. Health status monitoring of injured workers is performed in eight (40%) of the companies, while Disability Management is present as a whole in only three companies. This survey highlights that Disability Management is not undertaken in most companies and that, where applied, there is still confusion and disorganization about ways to promote health and manage workers' illness and disability. Hence, there is still the need to promote an all-inclusive evaluation and management of workers' safety, illness and disabilities.
Full Text Available When asked to give a diagnosis in legal settings practitioners should be mindful of the tentative nature of psychiatric diag- noses and that courts require that such a diagnosis must have scientific credibility. South African courts are not explicit about the test they will apply to determine whether a diagno- sis is scientifically credible, but some guidance can be found in United States case law. This paper examines these criteria with reference to the disorders included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR.
Balard, Frédéric; Corre, Stéphanie Pin Le; Trouvé, Hélène; Saint-Jean, Olivier; Somme, Dominique
By matching needs to resource services, case management could be a useful tool for improving the care of older people with complex living conditions. Collecting and analysing the users' experiences represents a good way to evaluate the effectiveness and efficiency of a case-management service. However, in the literature, fieldwork is very rarely considered and the users included in qualitative research seem to be the most accessible. This study was undertaken to describe the challenges of conducting qualitative research with older people with complex living conditions in order to understand their experiences with case-management services. Reflective analysis was applied to describe the process of recruiting and interviewing older people with complex living conditions in private homes, describing the protocol with respect to fieldwork chronology. The practical difficulties inherent in this type of study are addressed, particularly in terms of defining a sample, the procedure for contacting the users and conducting the interview. The users are people who suffer from a loss of autonomy because of cognitive impairment, severe disease and/or psychiatric or social problems. Notably, most of them refuse care and assistance. Reflective analysis of our protocol showed that the methodology and difficulties encountered constituted the first phase of data analysis. Understanding the experience of users of case management to analyse the outcomes of case-management services requires a clear methodology for the fieldwork.
Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D
Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.
Aprile, Giuseppe; Ortu, Eleonora; Cattaneo, Ruggero; Pietropaoli, Davide; Giannoni, Mario; Monaco, Annalisa
Managing orthodontic treatment is often very difficult for the orthodontist. Many devices are used during the orthopedic phase of orthodontic treatment, always with different functions. We describe a case of orthodontic management treated with the Equilibrator O.S.A. device (equilibrator designed by Ovidi, Santi, and Aprile for Eptamed SRL; Cesena, Italy; www.eptamed.com ). A healthy 10-year-old white boy presented with a skeletal class II, division 1 malocclusion, molar class II, exhibiting an overjet of 7 mm prior to treatment. For treatment, we only used the Equilibrator O.S.A. device. We successfully treated an orthopedic/orthodontic case with a particular device that we describe here.
... Operations Casing Pressure Management § 250.518 What are the requirements for casing pressure management... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What are the requirements for casing pressure management? 250.518 Section 250.518 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR...
Sáiz, Pilar A; Rodríguez-Revuelta, Julia; González-Blanco, Leticia; Burón, Patricia; Al-Halabí, Susana; Garrido, Marlen; García-Alvarez, Leticia; García-Portilla, Paz; Bobes, Julio
Prevention of suicidal behaviour is a public health priority in the European Union. A previous suicide attempt is the best risk predictor for future attempts, as well as completed suicides. The primary aim of this article is to describe a controlled study protocol designed for prevention of recurrent suicidal behaviour that proposes case management, and includes a psychoeducation program, as compared with the standard intervention (PSyMAC). Patients admitted from January 2011 to June 2013 to the emergency room of the Hospital Universitario Central de Asturias were evaluated using a protocol including sociodemographic, psychiatric, and psychosocial assessment. Patients were randomly assigned to either a group receiving continuous case management including participation in a psychoeducation program (experimental group), or a control group receiving standard care. The primary objective is to examine whether or not the period of time until recurrent suicidal behaviour in the experimental group is significantly different from that of the control group. PSyMAC proposes low cost and easily adaptable interventions to the usual clinical setting that can help to compensate the shortcoming of specific action protocols and suicidal behaviour prevention programs in our country. The evaluation of PSyMAC results will determine their real effectivity as a case-magament program to reduce suicidal risk. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.
Minden, Sarah L; Feinstein, Anthony; Kalb, Rosalind C; Miller, Deborah; Mohr, David C; Patten, Scott B; Bever, Christopher; Schiffer, Randolph B; Gronseth, Gary S; Narayanaswami, Pushpa
To make evidence-based recommendations for screening, diagnosing, and treating psychiatric disorders in individuals with multiple sclerosis (MS). We reviewed the literature (1950 to August 2011) and evaluated the available evidence. Clinicians may consider using the Center for Neurologic Study Emotional Lability Scale to screen for pseudobulbar affect (Level C). Clinicians may consider the Beck Depression Inventory and a 2-question tool to screen for depressive disorders and the General Health Questionnaire to screen for broadly defined emotional disturbances (Level C). Evidence is insufficient to support/refute the use of other screening tools, the possibility that somatic/neurovegetative symptoms affect these tools' accuracy, or the use of diagnostic instruments or clinical evaluation procedures for identifying psychiatric disorders in MS (Level U). Clinicians may consider a telephone-administered cognitive behavioral therapy program for treating depressive symptoms (Level C). Although pharmacologic and nonpharmacologic therapies are widely used to treat depressive and anxiety disorders in individuals with MS, evidence is insufficient to support/refute the use of the antidepressants and individual and group therapies reviewed herein (Level U). For pseudobulbar affect, a combination of dextromethorphan and quinidine may be considered (Level C). Evidence is insufficient to determine the psychiatric effects in individuals with MS of disease-modifying and symptomatic therapies and corticosteroids; risk factors for suicide; and treatment of psychotic disorders (Level U). Research is needed on the effectiveness in individuals with MS of pharmacologic and nonpharmacologic treatments frequently used in the non-MS population.
Sfasciotti, Gian Luca; Marini, Roberta; Bossù, Maurizio; Ierardo, Gaetano; Annibali, Susanna
This paper reports the management of two clinical cases, in which the upper right central incisor was fused with a supernumerary tooth and the upper left central incisor was macrodontic. A radiographic examination revealed that the fused teeth had two separate roots. Hemisectioning of the fused teeth was performed, the supernumerary portion was extracted and the remaining part was reshaped to remove any sharp margins and to achieve a normal morphology. The macrodontic central incisors were no...
LATIF, Hasan; ELMAS, Tuğçe
Abstract. Effective communication may be sufficient under normal conditions, but in chaos conditions strategic communication is required. There has been cases of unsuccessful management during times of sudden huge problems due to the use of wrong communication behaviors. This work presents together an example and the requisites of a successful a strategic communicator in chaotic conditions. The study begins with examples of mismanagement behaviors in strategic communication. It establishes a ...
Cardiac involvement is common in Friedreich\\'s Ataxia and is a common cause of premature death. Evidence regarding treatment of congestive heart failure in patients with Friedreich\\'s Ataxia is lacking. The case of a 31-year-old male with advanced Friedreich\\'s Ataxia who presented with an acute diarrhoeal illness and features of acute heart failure is discussed. We then review the reported cardiac manifestations of Friedreich\\'s Ataxia and discuss management options.
Bane, Chuck Howard, Jr.
Approved for public release; distribution is unlimited. This thesis is a case study of the implementation of telecommuting by CalComp at the Telecommuting Workcenter of Riverside County and is a real life example of the management issues that surround telecommuting. The issues brought forth in this study will enable those responsible for implementing a telecommuting program to better understand the impact of this change on their organization and how a telecommuting center may be used in th...
Full Text Available Acute Respiratory Distress Syndrome (ARDS is a permeability pulmonary edema characterized by increased permeability of pulmonary capillary endothelial cells and alveolar epithelial cells, leading to hypoxemia that is refractory to usual oxygen therapy. ARDS is characterized by a brief precipitating event followed by rapidly developing dyspnea. These patients have markedly impaired respiratory system compliance and reduced lung volume. The hypoxemia is refractory to low fraction of oxygen concentration and low positive end expiratory pressure (PEEP. The mortality of ARDS is around 35-40%. Current therapy of ARDS resolves around treatment of underlying cause, lung protective ventilatory strategy and appropriate fluid management. We present a case of ARDS managed in our ICU along with a detailed discussion about the pathophysiology and treatment modalities for the management of a patient with ARDS.
The nuclear knowledge management (NKM) has become a major growing issue in the IAEA's Agenda. The use of nuclear technology in variety of application related to sustainable development, demands the preservation of nuclear knowledge. In developing countries the use of nuclear technology is much smaller compared to developed world. The nuclear knowledge management situation in the developing countries are not understood clearly. In case of Pakistan, the nuclear technology is being used in many areas of human need. These include energy, agricultural, medical and industrial applications. Also by the end of third decade, the authorities have set target to go for generating electricity through nuclear technology near to 800 MW. NKM is also vital for the new generation to understand the technology from elder's experiences and through proper knowledge preservation. This could only be done by adopting a proper nuclear knowledge management strategy. (author)
Wagh, P.M.; Singh, Jitendra
Nuclear Power Corporation of India Limited (NPCIL) is responsible for the design, construction, commissioning and operation of nuclear power plants in India for electricity generation. NPCIL presently has fourteen units in commercial operation. Over the last few years, the performance of Indian nuclear power plants have registered a marked improvement. This has been achieved through sustained and systematic efforts to upgrade all aspects of the plant activities on one hand and on the other, development and implementation of latest tools, techniques and management systems to further enhance their effectiveness. In addition, development and implementation of International Standards on Environmental, Safety and Quality Management have been institutionalized for continual improvement. WANO (World Association of Nuclear Operators) Peer Reviews are also being conducted. The present paper is an attempt to present a case study of Nuclear Power Corporation of India Limited in view of the changing perceptions on environmental management and overall business plan. (author)
Full Text Available Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment.
O'Sullivan, S T
Deliberate and recurrent foreign body ingestion is a common problem among institutionalised patients. We review our experience with 36 cases of deliberate foreign body ingestion by prisoners or psychiatric patients, thirty of whom were institutionalised at the time of ingestion. Symptoms were frequently severe in the prison inmate group but, in contrast, psychiatric patients presented with few, if any, symptoms. A majority of objects pass spontaneously or remain in situ without complication. Twenty-four patients were discharged following initial evaluation and without specific treatment. Eight of these were reviewed electively and discharged within one week. Twelve patients were admitted for observation, seven of whom were discharged within 48 hrs. Upper gastrointestinal endoscopy was performed in four patients and an intragastric foreign body identified in two cases. Laparotomy was performed in two cases for unresolving mechanical intestinal obstruction. Management should be conservative when possible, with surgery indicated only for complications.
Akhtar, M.U.; Nazir, A.; Montmorency College of Dentistry, Lahore; Kiran, S.; Montmorency College of Dentistry, Lahore
Generalized gingival enlargement is characterized by massive and exuberant gingival overgrowth that poses social, aesthetic, phonetic and functional problems for the patient. Therefore, it requires meticulous management. Objective: To describe the surgical management of generalized gingival enlargement by electrosurgical excision of patients presenting to a tertiary care centre. Study Design: Case series. Materials and Methods: The study was conducted at the Department of Oral and Maxillofacial Surgery, de'Montmorency College of Dentistry, Lahore, from January 2010 to December 2012. A total of sixteen patients were operated by using electrosurgical approach under general anaesthesia for surgical excision of generalized gingival enlargement. Results: All of the sixteen patients, 11 males and 5 females, showed excellent healing postoperatively without any recurrent gingival overgrowth. Discussion: To the best of our knowledge, the current study presents the largest case series of generalized gingival enlargement. Most of these cases were with massive disease due to lack of information of the study population about their disease, delay in referral by the general dental practitioners, painless and innocent nature of the problem. Early referral of such patients to tertiary care centers can prevent the patients from social and psychological embarrassment. Conclusion: Electrosurgical excision is an excellent surgical technique for management of generalized gingival enlargement. Moreover, cross comparative studies are required to establish some diagnostic and therapeutic standards for such patients. (author)
Baig, L A; Thaver, I
Improvement in diarrhoea case management through training of health care providers in the government and the private sector was the key element of diarrhoea policy in Pakistan in 1989. Numerous training sessions were organized by the Child Survival project. The aim of this project was to look at the effect of training on quality of diarrhoea case management at the oral rehydration therapy (ORT) corners and diarrhoea treatment units (DTUs) of Sindh. A systematic random sample of 62 ORT corners and DTUs in Sindh was assessed using the WHO drafted Health Facility Survey manual. It was observed that the trained health providers were better in taking history for blood in stools (P Plan A" and correct rehydration (p management. Thus diagnosis was good and training did improve the quality of assessment of child but treatment (inclusive of advice giving) was not significantly affected by training, except for a child with no dehydration. It is recommended that on the job training should emphasize on skills for management of diarrhoea. Further studies are needed to identify why inspite of training. Health providers do not offer better treatment than the untrained ones.
Granek, E F; Madin, E M P; Brown, M A; Figueira, W; Cameron, D S; Hogan, Z; Kristianson, G; de Villiers, P; Williams, J E; Post, J; Zahn, S; Arlinghaus, R
Globally, the number of recreational fishers is sizeable and increasing in many countries. Associated with this trend is the potential for negative impacts on fish stocks through exploitation or management measures such as stocking and introduction of non-native fishes. Nevertheless, recreational fishers can be instrumental in successful fisheries conservation through active involvement in, or initiation of, conservation projects to reduce both direct and external stressors contributing to fishery declines. Understanding fishers' concerns for sustained access to the resource and developing methods for their meaningful participation can have positive impacts on conservation efforts. We examined a suite of case studies that demonstrate successful involvement of recreational fishers in conservation and management activities that span developed and developing countries, temperate and tropical regions, marine and freshwater systems, and open- and closed-access fisheries. To illustrate potential benefits and challenges of involving recreational fishers in fisheries management and conservation, we examined the socioeconomic and ecological contexts of each case study. We devised a conceptual framework for the engagement of recreational fishers that targets particular types of involvement (enforcement, advocacy, conservation, management design [type and location], research, and monitoring) on the basis of degree of stakeholder stewardship, scale of the fishery, and source of impacts (internal or external). These activities can be enhanced by incorporating local knowledge and traditions, taking advantage of leadership and regional networks, and creating collaborations among various stakeholder groups, scientists, and agencies to maximize the probability of recreational fisher involvement and project success.
Pereira, Ana Gabriella Amorim Abreu
Knowledge management is paramount nowadays. In order to enable the members of an organization to deal with their current situations effectively it is mandatory to know and enhance its intellectual capital. Managing the organization knowledge is important to the extent that it allows and reinforce its mission (what we are trying to accomplish?), and performance (how do we deliver the results?). As a result of a knowledge management effort, the organization can create value for itself and for society as a whole. In this paper, we argue that a technology developed at a research institute and transferred to an industry is knowledge to be managed in order to create value, both for the society and for the Institute. In order to manage such knowledge, it is proposed an approach to enhance the value creation potential of a technology transfer. This paper propose an investigation to expand the understanding on how a public research institute and a private firm could introduce their value creation wishes into a technology transfer agreement in a way to reflect and provide the realization of those wishes. It is proposed that, from the identification of the organizations expectations it is possible to infer which agreement attributes will contribute to that value creation and to establish satisfactory agreement configurations. These configurations have the potential to generate those consequences, given that, through the transfer, each organization seeks to increase potential benefits and to reduce potential sacrifices. Supported by exchange flow and value creation models, by the knowledge management and the means-end theory, an approach to increase the value creation potential of a technology transfer is proposed. Evidences from a case study sustain the proposed approach. The case study unity is the Instituto de Engenharia Nuclear, a public research institute. (author)
Full Text Available Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society's expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.Consequences of infertility arise from short and long-term devastating effects on both individual's physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders (depression, anxiety, grief, marital conflict, gender differences, relation between the causes of infertility and psychopathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self, and genetic continuity. In this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 165-185
Cherry, J C; Colliflower, S J; Tsiperfal, A
The article presents an overview of some of the current trends in health care and the challenges faced by nurse case managers who are providing disease management services. It discusses some of the emerging technologies available today for innovative case management. In particular, this article describes a program run by a healthcare system in Sacramento, California that uses an Internet-based technology to enhance their nurse case management model. The article demonstrates how the Health Hero platform enables interactive communication between nurse case managers and their patients, thereby meeting some of the challenges the nurse case managers are faced with in the modern disease-management world.
Avidan, Alexander; Weissman, Charles; Levin, Phillip D
Quick response (QR) codes containing anesthesia syllabus data were introduced into an anesthesia information management system. The code was generated automatically at the conclusion of each case and available for resident case logging using a smartphone or tablet. The goal of this study was to evaluate the use and usability/user-friendliness of such system. Resident case logging practices were assessed prior to introducing the QR codes. QR code use and satisfactions amongst residents was reassessed at three and six months. Before QR code introduction only 12/23 (52.2%) residents maintained a case log. Most of the remaining residents (9/23, 39.1%) expected to receive a case list from the anesthesia information management system database at the end of their residency. At three months and six months 17/26 (65.4%) and 15/25 (60.0%) residents, respectively, were using the QR codes. Satisfaction was rated as very good or good. QR codes for residents' case logging with smartphones or tablets were successfully introduced in an anesthesia information management system and used by most residents. QR codes can be successfully implemented into medical practice to support data transfer. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
The prevalence of HIV infection among cannabis-abused psychiatric patients: the case of federal psychiatric hospital, Calabar. ... called “Prevalence of HIV infection and Cannabis-Abused Questionnaire” (P.H.I.C.Q.), while data obtained were subjected to statistical analysis using contingency chi-square (X2) technique.
Method: This paper utilized the framework of relevant case series and a focused review of the relevant literature to describe and annotate the psychiatric problems of the victims and perpetrators of intimate partner violence in southeast Nigeria. Results: The major barriers to detection of the psychiatric disorders occurring in ...
Wong Paul WC
Full Text Available Abstract Background Considerable attention has been focused on the study of suicides among those who have received help from healthcare providers. However, little is known about the profiles of suicide deceased who had psychiatric illnesses but made no contact with psychiatric services prior to their death. Behavioural model of health service use is applied to identify factors associated with the utilization of psychiatric service among the suicide deceased. Methods With respect to completed suicide cases, who were diagnosed with a mental disorder, a comparison study was made between those who had (contact group; n = 52; 43.7% and those who had not made any contact (non-contact group; n = 67; 56.3% with a psychiatrist during the final six months prior to death. A sample of 119 deceased cases aged between 15 and 59 with at least one psychiatric diagnosis assessed by the Structured Clinical Interview for DSM-IV-TR (SCID I were selected from a psychological autopsy study in Hong Kong. Results The contact and non-contact group could be well distinguished from each other by "predisposing" variables: age group & gender, and most of the "enabling", and "need" variables tested in this study. Multiple logistic regression analysis has found four factors are statistically significantly associated with non-contact suicide deceased: (i having non-psychotic disorders (OR = 13.5, 95% CI:2.9-62.9, (ii unmanageable debts (OR = 10.5, CI:2.4-45.3, (iii being full/partially/self employed at the time of death (OR = 10.0, CI:1.6-64.1 and (iv having higher levels of social problem-solving ability (SPSI (OR = 2.0, CI:1.1-3.6. Conclusion The non-contact group was clearly different from the contact group and actually comprised a larger proportion of the suicide population that they could hardly be reached by usual individual-based suicide prevention efforts. For this reason, both universal and strategic suicide prevention measures need to be developed specifically in non
Full Text Available The Information Technology (IT sector is regarded as strategic for national economy. In Brazil, this sector is formed mostly of micro and small businesses. This article aims at understanding how does the strategic management process occurs in a small IT company, according to the schools of strategy and the strategy-as-practice approach. The method applied was a single case study of a small IT company, located in Rio Grande do Sul. The analyzed data revealed that the company adopts an informal strategic management centered on its directors, which may be related to the entrepreneurial school of strategy. However, data also indicate the presence of features of other schools of strategy along the company trajectory. We analyzed the strategy as social practice at the strategic level and also at the tactical level of the organization, through the guidance of managers, their interactions with customers and suppliers, their decision-making processes, among other practices related to everyday life. The results of the article shed light on the process of strategic management in micro and small IT companies, generating insights that can be useful for managers of similar companies.
Mingoli, Andrea; Saracino, Andrea; Brachini, Gioia; Mariotta, Giovanni; Migliori, Emanuele; Silvestri, Vania
Over the past 20 years the management of blunt liver trauma has evolved from a primary operative approach to a nonoperative one, for both low and high grade injuries, only on the basis of hemodynamic stability. However, in spite of a high success rate of non operative management, it is frequently observed, also in our country, an old fashioned way to approach these patients, based on habit more than observation and evidence based medicine. We present a case of successful nonoperative treatment of a grade IV blunt liver trauma (lacero-contusive injury of V, VI and VII segments) in a 34-year-old woman. Nowadays more than 85% of liver injuries are managed without operative intervention, irrespective of the injury grade. Success rate of the conservative approach ranges from 82% to 100% and almost all complications (14% in high grade injuries) can be managed with interventional radiology procedures, still avoiding major surgery. Today, in the absence of other abdominal injuries requiring surgical exploration, hemodynamic instability from ongoing hemorrhage after primary evaluation and resuscitative treatment, is the only indication to an operative management of traumatic liver injuries.
Identificação de casos psiquiátricos em estudos epidemiológicos multifásicos: métodos, problemas e aplicabilidade Psychiatric cases identification by multi steps epidemiological studies: methods, problems and applicability
Sérgio B Andreoli
Full Text Available OBJETIVO: Discutir aspectos metodológicos da estratégia de identificação de casos psiquiátricos, em duas etapas, em estudos epidemiológicos. MÉTODOS: Analisa-se a metodologia utilizada no Estudo Multicêntrico de Morbidade Psiquiátrica do Adulto realizado em três cidades brasileiras, entre 1990-1991. Na primeira etapa do citado estudo, uma amostra aleatória (6.740 indivíduos da população foi selecionada e submetida a um rastreamento com o Questionário de Morbidade Psiquiátrica do Adulto -- QMPA. Na segunda etapa, uma subamostra (775 indivíduos foi selecionada e submetida ao Inventário de Sintomas do DSM-III (Diagnostic and Statistical Manual of Mental Disorders, aplicado por psiquiatras e psicólogos treinados, para confirmação-diagnóstica. RESULTADOS: São descritos os procedimentos empregados para a estimativa das prevalências, mostrando que o fraco desempenho da escala de rastreamento não compromete o método. CONCLUSÃO: A vantagem da metodologia é a de corrigir as distorções apresentadas pelos instrumentos atuais de identificação de casos psiquiátricos.OBJECTIVE: To discuss methodological aspects of the two stages in the identification of psychiatric cases in epidemiological studies. METHODS: Analyze the methodology used in the Multicentric Psychiatric Morbidity Study, which was conducted in three Brazilian cities (São Paulo, Brasília and Porto Alegre. In the first stage of that study, a random sample (6,740 individuals of the population was drawn and all the participants were screened with the Questionnaire of Psychiatric Morbidity of the Adult (QMPA. In the second stage, a sample (775 individuals of this population was drawn and these individuals were submitted to the Inventory of Symptoms of DSM-III, carried out by psychiatrists and trained psychologists. RESULTS: The study procedure for estimating the prevalence is described in details, showing that though the screening scales are a weak tool, they don
Rifi, Loubna; Barkat, Amina; El Khamlichi, Abdeslam; Boulaadas, Malek; El Ouahabi, Abdessamad
Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of brain tissue and meninges through a defect in the cranium, in frontal, orbital, nasal and ethmoidal regions. The management of this complex congenital malformation is controversial according to whether use, an intracranial, extra-cranial or combined approach. This is the first largest series published in Africa, in which we present our experience in the operative management of AME; we share our recommendation in technical consideration for surgical approach with review of the literature. All patients beneficed of neuro-radiological investigations including Plan X rays, Spiral Three dimensional CT scan and MRI. Ophthalmologic and maxillo-facial evaluations were done in all the cases. MEA are surgically approached in various ways, mainly on the basis of its location and type, by cranio-facial approach in one-step, or in two stages by intracranial approach followed by facial approach, only by cranial approach or facial approach. The surgical results were evaluated in the follow up on the basis of disappearance of cranio-facial tumefaction with correction of hypertelorism. 60 children with AME were treated in our department between January 1992 and December 2012. The mean age at time of surgery was 14 months (20 days to 18 years) with slight men predominance (28 females/32 males). Cranio-facial team operated 21 patients, 16 were operated in two stages by intracranial approach followed by facial approach, 20 cases beneficed the neurosurgical approach and three only the facial approach Some post operative complications were observed: 2 cases of post operative hydrocephalus underwent shunt; CSF fistulas in three cases cured by spinal drainage, one death due to per operative hypothermia, 3 cases of recurrence how needed second surgery. After mean follow up for 80 months (1 year to 19 years) theses techniques permitted a good cosmetics results in 42 cases, average cosmetics
Brown, Willie L., Jr.
Global terrorism continues to persist despite the great efforts of various countries to protect and safely secure their citizens. As airports form the entry and exit ports of a country, they are one of the most vulnerable locations to terror attacks. Managers of international airports constantly face similar challenges in developing and implementing airport security protocols. Consequently, the technological advances of today have brought both positive and negative impacts on security and terrorism of airports, which are mostly managed by the airport managers. The roles of the managers have greatly increased over the years due to technological advances. The developments in technology have had different roles in security, both in countering terrorism and, at the same time, increasing the communication methods of the terrorists. The purpose of this qualitative multiple case study was to investigate the perspectives of airport managers with regard to societal security and social interactions in the socio-technical systems of the National Terrorism Advisory System (NTAS). Through the data gained regarding managers' perception and experiences, the researcher hoped to enable the development of security measures and policies that are appropriate for airports as socio-technical systems. The researcher conducted interviews with airport managers to gather relevant data to fulfill the rationale of the study. Ten to twelve airport managers based in three commercial aviation airports in Maryland, United States participated in the study. The researcher used a qualitative thematic analysis procedure to analyze the data responses of participants in the interview sessions.
Euthanasia motivated by mental disorders is legal in only a few countries and has a short history. In a recent report of all psychiatric euthanasia cases in Belgium between 2002 and 2013, Dierickx and colleagues suggest that the number of these cases is increasing, and provide a profile of the applicants. To date, knowledge of the practice of psychiatric euthanasia is limited, but rising public awareness might increase the number of requests. The authors reveal several shortcomings in cases o...
Nilda Maria de Clodoaldo Pinto Guerra Leone
Full Text Available Small family businesses present a series of peculiarities and challenges, especially when it comes to the management of human resources. This case describes the true situation of an enterprise, Restaurante Sabor de Casa, and portrays the relationship between the founder and successor and its consequences on the practice and policy of human resources. The story is told from the point of view of the successor, who thinks about the situation of the company and his deep involvement in the dynamic and complex stage of working with his mother, the founder of the company, whose performance is that of an entrepreneur, albeit a traditional one. It shows his reflections on the directions the company has taken, the opinions of employees, based on research conducted in 2006 by university students and their questions about the way the contributions of the employees are managed, mainly by recognizing their importance for both the present and the future of the company. This case deals with the complexity of the management of human resources in a family organizational environment.
Full Text Available Introduction Larsen syndrome is a congenital skeletal disorder manifested by several facial, ligamentous and spinal complications. Cervical kyphosis is one of the serious manifestations of the Larsen syndrome. However, there is no consensus regarding the best procedure of cervical kyphosis management in these patients. Case Presentation A 1-year-old boy with the diagnosis of the Larsen syndrome was admitted to our hospital and undergone several corrective surgeries for knee, hip and foot deformities. At the age of 2 years, scoliosis was diagnosed and surgically managed. At the same time, cervical kyphosis was observed and monitored until the symptoms of neurological deficit due to cord compression led to the correction of cervical Kyphosis at the age of 4.5 years. Accordingly, an anterior/posterior (360 degree cervical spinal fusion surgery was performed. Subsequently, cervicothoracic fusion was performed to correct cervicothoracic instability. No neurological complications were reported afterward. Conclusions In spite of existing controversy around the best method of cervical kyphosis management in Larsen syndrome’s patients older than 2- year old, anterior release and posterior fixation followed by anterior spinal fusion and strut grafting led to the satisfactory result in our case.
Euthanasia motivated by mental disorders is legal in only a few countries and has a short history. In a recent report of all psychiatric euthanasia cases in Belgium between 2002 and 2013, Dierickx and colleagues suggest that the number of these cases is increasing, and provide a profile of the applicants. To date, knowledge of the practice of psychiatric euthanasia is limited, but rising public awareness might increase the number of requests. The authors reveal several shortcomings in cases of psychiatric euthanasia and open avenues for future research.Please see related article: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1369-0.
Sno, H. N.; Storosum, J. G.; Swinkels, J. A.
A psychiatric consultation was requested in 51 in-patient cases of HIV infection. Reasons for referral included counselling, the evaluation of depressive symptoms, and the treatment of delirium. The most common DSM-III diagnoses included: delirium (n = 13), major depressive disorders (n = 12),
Moffic, H Steven; Saeed, Sy Atezaz; Silver, Stuart; Koh, Steve
As with all professional ethical principles, those in psychiatry have to evolve over time and societal changes. The current ethical challenges for psychiatric administration and leadership, especially regarding for-profit managed care, need updated solutions. One solution resides in the development by the American Association of Psychiatric Administrators (AAPA) of the first set of ethical principles designed specifically for psychiatric administrators. These principles build on prior Psychological Theories of leadership, such as those of Freud, Kernberg, and Kohut. Supplementing these theories are the actual real life models of psychiatrist leadership as depicted in the memoirs of various psychiatrists. Appreciating these principles, theories, and models may help emerging leaders to better recognize the importance of ethical challenges. A conclusion is that psychiatrists should have the potential to assume more successful leadership positions once again. In such positions, making the skills and well-being of all in the organization seems now to be the foremost ethical priority.
The case management process is a critical management and operational component in the delivery of customer services across the patient care continuum. Case management has transcended time and will continue to be a viable infrastructure process for successful organizations in the future. A key component of the case management infrastructure is information systems and technology support. Case management challenges include effective deployment and use of systems and technology. As more sophisticated, integrated systems are made available, case managers can use these tools to continue to expand effectively beyond the patient's episodic event to provide greater levels of cradle-to-grave management of healthcare. This article explores methods for defining case management system needs and identifying automation options available to the case manager.
Aguilar-Escobar, V G; Garrido-Vega, P
To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. This study is based on a case study. 2005-10. Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.
Full Text Available The global air transport industry is predicted to continue its rapid growth. A by-product of air transport operations, however, is the substantial volumes of waste generated at airports. To mitigate the environmental impact of waste and to comply with regulatory requirements, airports are increasingly implementing sustainable waste management policies and systems. Using an in-depth case study research design, this study has examined waste management at Kansai International Airport from 2002 to 2015. Throughout its history the airport has implemented world best practices to achieve its goal of being an eco-friendly airport. The qualitative data gathered for the study were analysed using document analysis. The quantitative data were analysed using t-tests. Statistically significant results were found in the reduction in waste per passenger and aircraft movement (for total waste, incinerated waste, and landfill waste. In addition, a statistically significant increase in the proportion of waste recycled, and a decrease in the proportion of waste sent to landfill was observed. As such, quantitatively speaking, Kansai International Airport has shown significant waste management improvements. The study concludes that Kansai Airport’s waste management approaches and policies can be transferred to other airport facilities. This would greatly improve sustainability across airports, globally.
LeDee, Olivia E.; Ribic, Christine
A burgeoning dialogue exists regarding how to allocate resources to maximize the likelihood of long-term biodiversity conservation within the context of climate change. To make effective decisions in natural resource management, an iterative, collaborative, and learning-based decision process may be more successful than a strictly consultative approach. One important, early step in a decision process is to identify priority species or systems. Although this promotes the conservation of select species or systems, it may inadvertently alter the future of non-target species and systems. We describe a process to screen terrestrial wildlife for potential sensitivity to climate change and then use the results to engage natural resource professionals in a process of identifying priorities for monitoring, research, and adaptation strategy implementation. We demonstrate this approach using a case study from Wisconsin. In Wisconsin, experts identified 23 out of 353 species with sufficient empirical research and management understanding to inform targeted action. Habitat management and management of hydrological conditions were the common strategies for targeted action. Although there may be an interest in adaptation strategy implementation for many species and systems, experts considered existing information inadequate to inform targeted action. According to experts, 40% of the vertebrate species in Wisconsin will require near-term intervention for climate adaptation. These results will inform state-wide conservation planning as well as regional efforts.
Full Text Available Abstract Eosinophilic gastroenteropathies, such as eosinophilic esophagitis and eosinophilic colitis, have classically been treated with swallowed inhaled corticosteroids or oral corticosteroids. More recent studies have found elimination and elemental diets to be effective treatment alternatives to steroids. In this case series we describe the treatment of three children using nutritional management in a community setting. Elimination diets and elemental diets based on patch testing and skin prick tests reduced the eosinophil counts to normal levels in all three children. Food items which tested positive were then reintroduced while symptoms and eosinophil counts were monitored. Nutritional management of eosinophilic esophagitis and eosinophilic colitis was found to be effective in reducing symptoms. However, obstacles facing patients who choose this type of therapy include limitations due to the cost of repeated endoscopies, palatability of elimination/elemental diets and the availability of subspecialists trained in management (e.g. Allergy, Gastroenterology, and Pathology. It may be a worthwhile endeavour to overcome these obstacles as nutritional management minimizes the potential long-term effects of chronic steroid therapy.
Full Text Available Knowledge management (KM was a well-founded management approach that held significant benefits for public sector organisations. KM as a management philosophy had an impact on various components of an organisation and it could therefore significantly advance organisational efficiency. The successful implementation of KM initiatives had to be ensured because, different organisational processes and departments had to collaborate and functional silos had to be eliminated. KM required long-term commitment and dedication from all organisational members. Furthermore, there were certain knowledge management enablers in an organisation that needed to be developed and that were necessary for the achievement of organisational effectiveness. These enablers were the organisational culture, human resources, information technology, organisational structure and, the organisation’s strategy and leadership. This article assessed each of these enablers and how they impacted on an organisation’s KM efforts. Stellenbosch Municipality was used as a case in point. The article further examined how local governments were able to effectively implement KM practices as strategic tools used to achieve service delivery and operational goals. The article concluded with a number of recommended strategies, (1 to develop the KM enablers that were present in organisations and (2 to aid the implementation of successful organisational KM initiatives.
Ana González Rodríguez
Full Text Available Los programas de continuidad de cuidados surgen a finales de los años 70 en EEUU, en respuesta a los problemas detectados durante del proceso de desintitucionalización de los hospitales psiquiátricos. Desde entonces, se han extendido por todo el mundo, con variaciones y peculiaridades según las regiones, convirtiéndose en piedra angular de la atención a las personas con enfermedad mental grave y persistente. En este artículo se revisa el origen de estos programas, su desarrollo a lo largo de más de treinta años, la filosofía que los ha guiado en su devenir, así como los éxitos y fracasos en su desarrollo.The case management programs arise in the late 70's in the U.S., in response to problems identified during the process of deinstitutionalization of psychiatric hospitals. Since then, the case management and the assertive community treatment programs have spread throughout the world, with variations and particularities in different regions, becoming the cornerstone of the community care for people with severe and persistent mental illness. This article reviews the origins of these programs in U.S., their development for over thirty years around the world, the philosophy and objectives that have guided its evolution, as well as successes and failures in their development.
Full Text Available Pneumatosis intestinalis (PI, defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007, Morris et al. (2008, and Peter et al. (2003. Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.
Full Text Available Congenital laryngeal web is a rare anomaly with incidence of 1 in 10,000 births. Its clinical presentation may range from an asymptomatic patient or mild hoarseness of voice to severe respiratory stridor. The primary goals of surgical intervention for congenital laryngeal web are to establish a patent airway and to achieve a good voice quality. As recurrence rate after plain excision of laryngeal web is very high, its removal may be coupled by placement of a silastic keel in between vocal cords. Endolaryngeal placement of a keel is definitely less invasive than laryngofissure, but little is known about its anesthesia management. Frequent ventilatory adjustment and endotracheal tube (ETT manipulations are needed along with vigilant monitoring. Risk of perforation or accidental dislodgment of the ETT and laryngeal edema are other concerns in management. We report a case.
Crouzon Syndrome is an autosomal dominant disorder with complete penetrance and variable expressivity. Described by a French neurosurgeon in 1912, it is a rare genetic disorder. Crouzon syndrome is caused by mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. The disease is characterized by premature synostosis of coronal and sagittal sutures which begins in the first year of life. Once the sutures become closed, growth potential to those sutures is restricted. However, multiple sutural synostoses frequently extend to premature fusion of skull base causing midfacial hypoplasia, shallow orbit, maxillary hypoplasia and occasional upper airway obstruction.The case of a 7-year-old South African black boy with Crouzon Syndrome is presented. He presented with characteristic triad of cranial deformity, maxillary hypoplasia and exophthalmos. The clinical, cephalometric features and initial orthodontic management of this patient are discussed as part of multidisciplinary management.
Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil
Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated...
Stevens, Hanne; Nordentoft, Merete; Agerbo, Esben
INTRODUCTION: Previous Danish studies of the increasing number of sentences to psychiatric treatment (SPT) have compared prevalent populations of persons undergoing treatment with incident measures of reported crimes. Examining the period 1990-2006, we studied incident sentences, taking the type...
MacDonald, A; Ahring, K; Almeida, M F; Belanger-Quintana, A; Blau, N; Burlina, A; Cleary, M; Coskum, T; Dokoupil, K; Evans, S; Feillet, F; Giżewska, M; Gokmen Ozel, H; Lotz-Havla, A S; Kamieńska, E; Maillot, F; Lammardo, A M; Muntau, A C; Puchwein-Schwepcke, A; Robert, M; Rocha, J C; Santra, S; Skeath, R; Strączek, K; Trefz, F K; van Dam, E; van Rijn, M; van Spronsen, F; Vijay, S
The few published case reports of co-existent disease with phenylketonuria (PKU) are mainly genetic and familial conditions from consanguineous marriages. The clinical and demographic features of 30 subjects with PKU and co-existent conditions were described in this multi-centre, retrospective cohort study. Diagnostic age of PKU and co-existent condition, treatment regimen, and impact of co-existent condition on blood phenylalanine (Phe) control and PKU management were reported. 30 patients (11 males and 19 females), with PKU and a co-existent condition, current median age of 14 years (range 0.4 to 40 years) from 13 treatment centres from Europe and Turkey were described. There were 21 co-existent conditions with PKU; 9 were autoimmune; 6 gastrointestinal, 3 chromosomal abnormalities, and 3 inherited conditions. There were only 5 cases of parental consanguinity. Some patients required conflicting diet therapy (n=5), nutritional support (n=7) and 5 children had feeding problems. There was delayed diagnosis of co-existent conditions (n=3); delayed treatment of PKU (n=1) and amenorrhea associated with Grave's disease that masked a PKU pregnancy for 12 weeks. Co-existent conditions adversely affected blood Phe control in 47% (n=14) of patients. Some co-existent conditions increased the complexity of disease management and increased management burden for patients and caregivers. Occurrence of co-existent disease is not uncommon in patients with PKU and so investigation for co-existent disorders when the clinical history is not completely consistent with PKU is essential. Integrating care of a second condition with PKU management is challenging. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Introduction: The paper presents the organizational measures for managing violence in psychiatric settings and the study that introduces the preliminary success rate of the proposed model. Methods: For the purpose of this study a non-experimental sampling method was employed using a structured questionnaire as a data collection instrument. The sample covered the personnel most frequently exposed to violence namely, the nursing staff in closed and/or intensive psychiatric units in 5 Slovenian psychiatric hospitals, 3 psychiatric homes and 2 special education, and work and care centres. The data were statistically analysed with the SPSS v20 software package, with p < 0.05 indicating statistical significance. Results: The practical part of the functional training was conducted between 2010 and 2013 in specific psychiatric hospitals and wards. In a study carried out in 2013, preliminary results indicating the success rate of the proposed model were obtained. Discussion and conclusions: Health care workers in psychiatry are responsible for providing safe and high quality treatment even in cases of aggressive outbursts, but they lack the necessary functional knowledge to cope with aggression in the workplace. The paper presents an organizational model for ensuring the safety of the patients and the quality of their treatment in case of an aggressive outburst, along with the presentation of the required functional training.
... News Legal Issues Search for: About PADs A psychiatric advance directive (PAD) is a legal document that ... decisions during a mental health crisis. Getting Started Psychiatric advance directives (PADs) are relatively new legal instruments ...
Slaats, Tijs; Mukkamala, Raghava Rao; Hildebrandt, Thomas
Declarative workflow languages have been a growing research subject over the past ten years, but applications of the declarative approach in industry are still uncommon. Over the past two years Exformatics A/S, a Danish provider of Electronic Case Management systems, has been cooperating...... with researchers at IT University of Copenhagen (ITU) to create tools for the declarative workflow language Dynamic Condition Response Graphs (DCR Graphs) and incorporate them into their products and in teaching at ITU. In this paper we give a status report over the work. We start with an informal introduction...
Sfasciotti, Gian Luca; Marini, Roberta; Bossù, Maurizio; Ierardo, Gaetano; Annibali, Susanna
This paper reports the management of two clinical cases, in which the upper right central incisor was fused with a supernumerary tooth and the upper left central incisor was macrodontic. A radiographic examination revealed that the fused teeth had two separate roots. Hemisectioning of the fused teeth was performed, the supernumerary portion was extracted and the remaining part was reshaped to remove any sharp margins and to achieve a normal morphology. The macrodontic central incisors were not treated. At 12-months post-surgery there were no periodontal problems and no hypersensitivity. Orthodontic treatment was performed to appropriately align the maxillary teeth and to correct the malocclusion.
Radha Bai Prabhu T
Full Text Available Theca lutein cysts can occur in 20-25% of molar pregnancies. These cysts can undergo complications such as torsion, rupture, and haemorrhage. As these are functional cysts, when there are complications such as torsion they can be managed conservatively by aspirating the cysts under ultrasound guidance or by detorsion at the time of laparoscopy. By simple detorsion, ovaries can be preserved in 80-90% of cases. In order to prevent recurrence adnexal fixation can be undertaken by plicating the ovarian ligament.
Beichl, Lisa; Craig, Kathy
This article identifies three categories of case management (CM), in-country, international, and micro, that are poised to serve as the quality proxy for the international medical patient in the rapidly emerging globalized healthcare marketplace. The content concentrates on describing in-country CM and international CM (ICM). Because CM professionals are the providers of patient-centered quality and safety improvements, they are capable of filling the chasm between the travel industry and the regulators who specialize in accrediting hospital systems. In-country and ICM case managers are equipped to perform surveillance and intervention at the level of the international patient's bedside, activate network connections, and use culture-sensitive communication skills to safeguard patients in their individual sojourns abroad. The article discusses useful concepts and sources, including an algorithmic tool under development that is geared to identify and quantify risks for lay and business individuals who seek to engage the global medical market. The article's information is provided for front-line and front-office healthcare practitioners to understand or enter the worldwide medical marketplace. Content is targeted to CM generalists, specialists, and business developers interested in learning about safeguarding the patients who travel internationally to receive medical care. It can also be applied by those within and outside the healthcare practice arena, particularly those interested in the development of quality initiatives. All research and syntheses were executed by the authors. Sources included scholarly treatises, business correspondence, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. International health insurance, economics, and financing expertise stems from one author (L.B.). Clinical competencies stem from the international practice experiences of one author (K.C.). This
Full Text Available Obstructing lesions of the central airways present with a variety of symptoms and are often associated with pneumonia or asthma-like states. Anesthesia to these patients often presents challenges right from the preoperative stabilization of underlying lung condition, mask ventilation in the supine position to maintaining oxygenation and ventilation in the intraoperative and postoperative period. We present here a case of a young woman with a central bronchial tumor with significant airway obstruction with potential for major bleeding and subsequent anesthetic management without lung sacrificing measures and cardiopulmonary bypass assistance.
Woollam, P.B.; Cameron, H.M.; Davies, A.R.; Hiscox, A.W.
Probabilistic safety assessment methodology has been applied by Nuclear Electric plc (NE) to the development of comprehensive safety cases for the radioactive waste management processing and accumulation facilities associated with its 26 reactor systems. This paper describes the methodology and the safety case assessment criteria employed by NE. An overview of the results is presented, together with more detail of a specific safety analysis: storage of fuel element debris. No risk to the public greater than 10 -6 /y has been identified and the more significant risks arise from the potential for radioactive waste fires. There are no unacceptable risks from external hazards such as flooding, aircrash or seismic events. Some operations previously expected to have significant risks in fact have negligible risks, while the few faults with risks exceeding the assessment criteria were only identified as a result of this study
Probabilistic safety assessment methodology is being applied by Nuclear Electric plc (NE) to the development of comprehensive safety cases for the radioactive waste management processing and accumulation facilities associated with its 26 reactor systems. This paper describes the methodology and the safety case assessment criteria employed by NE. An overview of the results from facilities used by the first 16 reactors is presented, together with more detail of a specific safety analysis: storage of fuel element debris. No risk to the public greater than 10 -6 /y has been identified and the more significant risks arise from the potential for radioactive waste fires. There are no unacceptable risks from external hazards such as flooding, aircrash or seismic events. Some operations previously expected to have significant risks in fact have negligible risks, while the few faults with risks exceeding the assessment criteria were only identified as a result of this study
Shakra, Karam Abu
Failure of eruption of primary teeth can be considered rare, especially in maxillary anterior teeth. The problem can be either mechanical obstruction of eruption or a failure of the eruption mechanism. This case report presents failure of eruption of the maxillary right deciduous central incisor in a 4-year-old girl. The unerupted primary tooth was removed surgically. The histological finding revealed fibroma with reactive giant cells. Periodic follow-up visits were advised to monitor the developing dentition and to ensure enough space for the permanent incisor. How to cite this article: Shakra KA. Management of Unerupted Maxillary Deciduous Central Incisor: A Case Report. Int J Clin Pediatr Dent 2014;7(1):58-60.
Weidema, F.C.; Molewijk, A.C.; Kamsteeg, F.; Widdershoven, G.A.M.
Aims: Providing management insights regarding moral case deliberation (MCD) from the experiential perspective of nursing managers. Background: MCD concerns systematic group-wise reflection on ethical issues. Attention to implementing MCD in health care is increasing, and managers' experiences
Joo, J Y; Liu, M F
This qualitative systematic review aimed to identify and synthesize recent qualitative studies to improve understanding of the experiences and perceptions of case management interventions that individuals with chronic illnesses and their caregivers have. Case management has been shown to be effective at improving quality of care and lowering costs for individuals with chronic illnesses. However, no qualitative review has been synthesized with recent qualitative studies about case management experiences by individual with chronic illnesses. This qualitative systematic review uses a thematic synthesis method to review 10 qualitative studies published within the last 10 years, from 2007 to 2016, thereby identifying and discussing the understandings that individuals with chronic illnesses and their caregivers have about case management. From this synthesis, three themes were identified as facilitators of case management (access to healthcare resources, health status supports and emotional aid) and two themes were identified as barriers to it (low information about case management and time constraints). This is the first qualitative systematic review of the perceptions and experiences that individuals with chronic illnesses and their caregivers have about case management. The facilitators of case management can be employed to inform patients about the benefits of case management and to improve population health. The findings about barriers to case management can be used to reform case management for populations with chronic illnesses. These factors should be considered by nursing researchers and healthcare policymakers when implementing case management. © 2018 International Council of Nurses.
Full Text Available Suicidal behavior is a common psychiatric emergency and is associated with psychiatric illness and history of prior suicide attempts. Neuropsychiatric manifestations related to theophylline toxicity are well described in literature. We report a case of theophylline toxicity manifesting as suicidal ideation in a patient with no prior psychiatric illness.
Surendra Kumar Sethi
Full Text Available Plunging ranula is a mucous retention cyst found on the floor of mouth which arises from the submandibular and sublingual salivary glands extending to lateral aspect of neck, which may often cause potential airway obstruction leading to difficulty in airway management. A forty year old female patient was admitted to our hospital with large, painless swelling in the floor of mouth extending to the lateral part of body of mandible and neck. This intraoral swelling distorted the normal airway anatomy thus making airway management difficult as the patient was planned for excision of swelling under general anaesthesia. So we present a case of successful management of a difficult airway by using awake fibre optic intubation in a patient posted for excision of a large plunging ranula under general anaesthesia.
Full Text Available This is a case study of a conflict management intervention in two secondary schools in post-apartheid South Africa. The feature of the intervention that we examine is the use of play as an educational strategy. The literature attests that play can facilitate change by allowing learners freedom to change their behaviour and opportunities to explore their new identities. The context of the case revealed that conflicts had become deeply entrenched over time. The literature on conflict management suggests that such situations can change if approached in the right way. In the article we describe the intervention and evaluate it with the help of feedback received from participants and facilitators. In the evaluation we found that the participants were able to overcome prejudices and develop democratic approaches to conflict. The evaluation was repeated several months later, when it was found that the benefits of the workshop had been maintained, with the result that the participants were engaging in healthier relationships.
Vitaliy V. Kabernik
Full Text Available The following paper is the first in the series dedicated to review and analysis of cases of centralization of public diplomacy affairs management for better promoting the agenda of the state. Introduction focuses on the erosion of traditional diplomatic practices shifting towards the stark attraction of soft power and public diplomacy. The evolution of modern public diplomacy in new media and the ways of its practical implementation reviewed, stating the raising power of non-government actors and mass media with their greater influence developing political agenda. The shift is analyzed on temporal basis bearing in mind inception of web 2.0 happening almost simultaneously with theoretical basis of soft power and the role of public diplomacy in propagating it. The case outlined in the first part reviews the evolution of Israeli's Hasbara - public diplomacy apparatus implemented in Jewish State. This evolution demonstrates the shift from decentralized management and coordination paradigm towards structured complex of measures led by government bodies. The sources and reasons for such a shift are being analyzed while national specifics for public diplomacy coordination is outlined. Results of the study underline the deficiencies of the chosen centralization paradigm via government bodies' control. The approach is being compared with the current practices implemented in Russia, outlining the best practices and mistakes to avoid that could be deducted from Israeli experience.
Full Text Available Paraneoplastic pemphigus is a rare immunobullous disorder commonly associated with lymphoproliferative neoplasms and less commonly in carcinomas with a poor prognosis. The neoplasms produce autoantibodies that react with members of plakin family to produce a suprabasilar split and varied clinical presentations in the skin and mucous membrane. Oral erosions are the first manifestation most resistant to treatment and persist even after the underlying tumour has been resected or treated. We report here a rare case of paraneoplastic pemphigus with an underlying squamous cell carcinoma of the oesophagus that constitutes only 8% of the neoplasms associated with this condition. It was successfully managed by a multidisciplinary approach involving the Departments of Dermatology, Surgical Oncology and Oral Medicine. The oral erosions were resistant to treatment however, a patient-tailored treatment was advocated using professionally administered debridement with hydrogen peroxide diluted with hypotonic saline, high potency topical steroids, analgesic oral rinses and topical anaesthetics with systemically administered immunomodulators. Hence, management of such cases exhibiting systemic and oral manifestations require a multidisciplinary team approach to improve the quality of life of the patients.
Tahan, Hussein M; Watson, Annette C; Sminkey, Patrice V
The purpose of this national role and function study was to identify the essential activities and necessary knowledge areas for effective case manager practice from the perspective of those currently functioning in various care settings and across diverse professional disciplines. The national study covered all case management practices and/or work settings across the full continuum of health care. This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of case managers, in which 52,370 individuals received an invitation to participate. Data collection completed over a 4-week period, resulting in 7,668 useable survey responses (nearly a 15% response rate). The study identified the common activities and knowledge areas necessary for competent and effective performance of case managers, as is highlighted in this article, which is the first of a 2-part series on the role and function study. The results informed the needed update of the test specifications for the Certified Case Manager (CCM) certification examination, as will be delineated in Part 2 of the article series, to ensure that it continues to be substantiated in current practice. Of special note are the emergence of specific activity and knowledge domains in the area of case management ethical, legal, and practice standards, and an increase in the number of employers requiring certified case managers to fill vacant positions and compensating them financially for such qualifications. This study helps keep the CCM credentialing examination evidence-based and maintain its validity for evaluating competency of case managers. Specifically, the study identified essential activities and knowledge domains that define competent case management practice. Findings can be used for developing programs and curricula for the training and development of case managers. The study instrument also can be used for further research of case
Full Text Available The present paper addresses quality management from the specific perspective of project management consulting service providers, in the framework of large infrastructure projects. Because of their supposed superiority in knowledge and experience, project management consultants have an ultimate responsibility for the proper implementing of the project. Therefore, quality management in consulting organizations should focus on critical success factors. As there is no consensus yet regarding the most important aspects of the consulting activity on which depend the achievement of the project aims, there is scope for further investigating this subject. Here, the case of a project management consulting organization involved in large infrastructure projects in Romania, Bulgaria, Moldova, Ukraine and Serbia is analyzed. Data collected through a questionnaire-based survey among international consultants and support personnel suggest that factors related to leadership style and communication skills are more closely tied to the success of the project than more technical aspects. The results constitute an empirical evidence of main success factors for specialized consulting services in project management and can be useful in improving business and project performance and achieving business excellence.
Rusnak, James E.
Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.
Full Text Available Chylothorax is the most common cause of pleural effusion in neonates. It is usually idiopathic. Neonatal chylothorax successfully respond to octreotide treatment and can reduce the duration of hospitalization. A number of therapeutic interventions have been used to reduce chyle production and promote resolution of a chylothorax. Initial management typically includes restriction or temporary cessation of enteral feedings. Enteral feedings high in medium-chain triglycerides (MCT or parenteral nutrition may be used. These strategies alone are not successful in all patients. In the last several years, octreotide has become another option for management of patients with chylothorax. octreotide has a number of effects on the gastrointestinal system, including a decrease in splanchnic blood flow and inhibition of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide. We report an infant who had spontaneous chylothorax with patent ductus arteriosus that was managed primarily as congenital heart disease. Our case was treated successfully with octreotide without the need to insertion of chest tube.
Araujo, Juliano; Lima, Marcelo; Leitao, Gustavo; Guedes, Luiz Affonso [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil); Branco, Nicolau; Coelho, Robson; Elias, Gustavo Passos; Nunes, Marcelo [Transportadora Brasileira Gasoduto Bolivia-Brasil (TBG), Rio de Janeiro, RJ (Brazil)
In order to improve the requirements of industrial processes, many decision support systems have been introduced in recent years. In this context, the alarm management systems have great relevance. On the other hand, the informatics revolution allowed a great increase of information concerning the operation of the industrial processes. Currently, process operators handle an excessive number of about 1.500 alarms per day. Thus, this overdose of information implies in the discredit of alarms. Then, in order to improve the operation activities of industrial processes, it is mandatory to incorporate procedures to evaluate and rationalize alarms. Since the EMMUA191 Standard is the reference guide to alarm management, but it does not specify how to execute an alarm management procedure, in this paper, a systematic procedure to evaluate alarms configurations in industrial processes is proposed. This procedure is in line with EMMUA191 and is composed by the following steps: to use statistics analyses to identify problematic alarms, such as occurrence, intermittency, correlation, and flooding calculation; to indicate problematic alarm group; and to propose a set of actions to be implemented. To validate our proposal, we present a case study in a gas pipeline plant using the BR-AlarmExpert software. (author)
Liang Sai; Zhang Tianzhu
Managing urban energy system is vital for energy conservation and CO 2 reduction. Integrating energy input-output model with carbon emission pinch analysis, we propose a framework for managing urban energy system. This framework could analyze current energy demands and CO 2 emissions, predict their future possibilities and optimize energy mix of key sectors under CO 2 emission constraints. Key sectors are identified by the energy input-output table from both direct and accumulative perspectives. Moreover, taking Suzhou, a typical manufacturing center and export-oriented city in China, as a case example, energy metabolism of Suzhou in 2020 is predicted using energy input-output model. And three sectors named Coking, Smelting and pressing of metals and Production and supply of electric power are identified to have big effects on CO 2 emissions. Subsequently, energy mix of three identified key sectors is optimized under CO 2 emission constraints by the carbon emission pinch analysis. According to the results, clean energy sources will occupy a great position in Suzhou's future energy demands. And the reuse of wastes as energy sources should be limited to achieve CO 2 mitigation targets. Finally, policy implications of results and future work are discussed. - Research highlights: → We construct a framework for sustainable energy system management. → We apply the framework in a typical manufacturing center named Suzhou in China. → Key sectors for CO 2 emissions are identified, and energy mix is optimized. → Policy implications of results and future work are discussed.
Full Text Available Zika virus is an RNA virus belonging to the Flaviviridae family, and is primarily transmitted by Aedes mosquitoes. Only a small number of cases had been described until 2007 when the first major Zika virus outbreak occurred on Yap Island, Micronesia. Approximately 80% of people infected with Zika virus do not exhibit any symptoms. Symptomatic infections are generally moderate and characterized by acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. The virus has recently attracted a broad interest due to the emerging cases of microcephaly that are possibly associated with mothers infected by the Zika virus during pregnancy, and the regional increases in the incidence of Guillain-Barre syndrome during the epidemic periods. Although the relationship between Zika virus infection and these abnormalities is not obviously understood yet, Zika virus testing is recommended for infants with microcephaly or intracranial calcifications whose mothers were potentially infected with the Zika virus during pregnancy. Every day, new reports are being published about the outbreaks associated with this virus; nevertheless, no new cases of this virus have been reported in Turkey. Despite this, we cannot currently exclude the possibility of the encounter with the virus because of the presence of Aedes mosquitoes, which are responsible for the spread of the virus, are prevalent in Turkey, and an increasing number of travel-related cases are being reported from different countries. In the light of the current knowledge on this virus, this review aims to discuss the course of Zika virus infections in detail, especially congenital infection, and presenting current information about the case management and preventive measures. [Cukurova Med J 2016; 41(1.000: 143-151
Rusnak, James E.
Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The h...
Santos, Joao Regis dos
The present study investigated and analyzed the importance of a system of integrated safety manage, environment and health in a nuclear installation, having as perspective, the fire protection manage. The inquiry was made using a qualitative research involving a case study, where the considered environment was the Reconversion and UO 2 Plant of the Industrias Nucleares do Brasil (INB), located in Resende, Rio de Janeiro and the studied population, the managers and the staff directly involved with the aspects related to the safety of the industrial complex of the related company. The motivation for the research was the search of a bigger interaction of the questions related to the safety, environment and health in the nuclear industry having, as axle of the investigation, the fire protection. As a result, it was observed that in a nuclear installation, although dealing with diversified safety processes, integration is possible and necessary, since there are more reasons for integration than otherwise. (author)
Comparison of intramuscular olanzapine, orally disintegrating olanzapine tablets, oral risperidone solution, and intramuscular haloperidol in the management of acute agitation in an acute care psychiatric ward in Taiwan.
Hsu, Wen-Yu; Huang, Si-Sheng; Lee, Bo-Shyan; Chiu, Nan-Ying
The purpose of this study was to compare efficacy and safety among intramuscular olanzapine, intramuscular haloperidol, orally disintegrating olanzapine tablets, and oral risperidone solution for agitated patients with psychosis during the first 24 hours of treatment in an acute care psychiatric ward. Forty-two inpatients from an acute care psychiatric ward of a medical center in central Taiwan were enrolled. They were randomly assigned to 1 of the 4 treatment groups (10-mg intramuscular olanzapine, 10-mg olanzapine oral disintegrating tablet, 3-mg oral risperidone solution, or 7.5-mg intramuscular haloperidol). Agitation was measured by using the excited component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation-Calmness Evaluation Scale, and the Clinical Global Impression--Severity Scale during the first 24 hours. There were significant differences in the PANSS-EC total scores for the 4 intervention groups at 15, 30, 45, 60, 75, and 90 minutes after the initiation of treatment. More significant differences were found early in the treatment. In the post hoc analysis, the patients who received intramuscular olanzapine or orally disintegrating olanzapine tablets showed significantly greater improvement in PANSS-EC scores than did patients who received intramuscular haloperidol at points 15, 30, 45, 60, 75, and 90 minutes after injection. These findings suggest that intramuscular olanzapine, orally disintegrating olanzapine tablets, and oral risperidone solution are as effective treatments as intramuscular haloperidol for patients with acute agitation. Intramuscular olanzapine and disintegrating olanzapine tablets are more effective than intramuscular haloperidol in the early phase of the intervention. There is no significant difference in effectiveness among intramuscular olanzapine, orally disintegrating olanzapine tablets, and oral risperidone solution.
Eduardo Barbin Zuccolotto
Full Text Available Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.
Mannion, Russell; Brown, Sally; Beck, Matthias; Lunt, Neil
The National Health Service (NHS) Local Improvement Finance Trust (LIFT) programme was launched in 2001 as an innovative public-private partnership to address the historical under-investment in local primary care facilities in England. The organisations from the public and private sector that comprise a local LIFT partnership each have their own distinctive norms of behaviour and acceptable working practices - ultimately different organisational cultures. The purpose of this article is to assess the role of organisational culture in facilitating (or impeding) LIFT partnerships and to contribute to an understanding of how cultural diversity in public-private partnerships is managed at the local level. The approach taken was qualitative case studies, with data gathering comprising interviews and a review of background documentation in three LIFT companies purposefully sampled to represent a range of background factors. Elite interviews were also conducted with senior policy makers responsible for implementing LIFT policy at the national level. Interpreting the data against a conceptual framework designed to assess approaches to managing strategic alliances, the authors identified a number of key differences in the values, working practices and cultures in public and private organisations that influenced the quality of joint working. On the whole, however, partners in the three LIFT companies appeared to be working well together, with neither side dominating the development of strategy. Differences in culture were being managed and accommodated as partnerships matured. As LIFT develops and becomes the primary source of investment for managing, developing and channelling funding into regenerating the primary care infrastructure, further longitudinal work might examine how ongoing partnerships are working, and how changes in the cultures of public and private partners impact upon wider relationships within local health economies and shape the delivery of patient care
Shri Gopal Goyal
Full Text Available Context: Previous studies have reported high psychiatric comorbidity with physical illness. However, referral rate to consultation-liaison (C-L psychiatry from other departments is very low. There is a paucity of literature from India in this subspecialty of psychiatry. Aims: This study was conducted to assess the sociodemographic profile and psychiatric diagnosis of patients referred to C-L psychiatric services at a tertiary care center. Settings and Design: This was a descriptive cross-sectional study conducted in a tertiary care multispecialty teaching institution. Patients and Methods: The study population comprised all the patients who were referred for psychiatric consultation from other departments to C-L services of psychiatry department for 2 months. Information was collected using semi-structured pro forma, and diagnosis was made based on the International Classification of Diseases-10 criteria. Results: A total of 160 patients were referred for C-L psychiatric services. Majority of the patients were in the age group of 31–45 years, married, educated matriculation or beyond, belonged to Hindu religion, nuclear family, and residing in urban area. The maximum referrals were from internal medicine department (17.5 followed by nephrology (15.0% and neurology (10.6%. The most common psychiatric diagnosis was depression (12% followed by delirium (8%. The most common reason for seeking psychiatric consultation was psychiatric clearance of prospective kidney donor and bone marrow transplant/stem cell transplant recipient. Conclusions: Psychiatric comorbidity may present with chronic physical illness. The C-L psychiatry would play a major role in the management of psychiatric comorbidity.
van der Plas Annicka G M
Full Text Available Abstract Background Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. Methods A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. Results Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. Conclusions Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent.
Full Text Available The purpose of this paper is to provide a background to and guide for mainstreaming Disaster Risk Management (DRM into higher education and training institutions in Small Island Developing States (SIDS, with the aim of increasing awareness and understanding of the complexity of DRM issues in business and management, based on their general and specific vulnerabilities. SIDS are considered a special category within the discussion on DRM, given a number of vulnerabilities generally and specifically. Furthermore, little attention has been paid to the business impact of disasters in such settings. It is proposed that one major route to improving this situation is through the educational and training institutions, which play a major role in shaping thinking and practices in such settings.
All the health care facilities examined in the case studies addressed several important organizational issues before and during the installation of their systems. All the facilities examined employee commitment. The prudent managers considered how easily their employees adapt to changes in their jobs and work environment. They considered how enthusiastic cooperation can be fostered in the creation of a liberated and reengineered office. This was determined not only by each individual's reaction to change, but also by the health care facility's track record with other system installations. For example, document image, diagnostic image, and coded data processing systems allow the integration of divergent health care information systems within complex institutions. Unfortunately, many institutions are currently struggling with how to create an information management architecture that will integrate their mature systems, such as their patient care and financial systems. Information managers must realize that if optical storage technology-based systems are used in a strategic and planned fashion, these systems can act as focal points for systems integration, not as promises to further confuse the issue. Another issue that needed attention in all the examples was the work environment. The managers considered how the work environment was going to affect the ability to integrate optical image and data systems into the institution. For example, many of these medical centers have created alliances with clinics, HMOs, and large corporate users of medical services. This created a demand for all or part of the health information outside the confines of the original institution. Since the work environment is composed of a handful of factors such as merged medical services, as many work environment factors as possible were addressed before application of the optical storage technology solution in the institutions. And finally, the third critical issue was the organization of work
Tinnitus is an auditory phantom phenomenon characterized by the sensation of sounds without objectively identifiable sound sources. To date, its causes are not well understood. The perceived severity of tinnitus correlates more closely to psychological and general health factors than to audiometric parameters. Together with limbic structures in the ventral striatum, the prefrontal cortex forms an internal "noise cancelling system", which normally helps to block out unpleasant sounds, including the tinnitus signal. If this pathway is compromised, chronic tinnitus results. Patients with chronic tinnitus show increased functional connectivity in corticolimbic pathways. Psychiatric comorbidities are common in patients who seek help for tinnitus or hyperacusis. Clinicians need valid screening tools in order to identify patients with psychiatric disorders and to tailor treatment in a multidisciplinary setting.
Frederiksen, Julie Elisabeth Nordgaard; Sass, Louis A; Parnas, Josef
interview. We address the ontological status of pathological experience, the notions of symptom, sign, prototype and Gestalt, and the necessary second-person processes which are involved in converting the patient's experience (originally lived in the first-person perspective) into an "objective" (third......There is a glaring gap in the psychiatric literature concerning the nature of psychiatric symptoms and signs, and a corresponding lack of epistemological discussion of psycho-diagnostic interviewing. Contemporary clinical neuroscience heavily relies on the use of fully structured interviews...... person), actionable format, used for classification, treatment, and research. Our central thesis is that psychiatry targets the phenomena of consciousness, which, unlike somatic symptoms and signs, cannot be grasped on the analogy with material thing-like objects. We claim that in order to perform...
Margariti, M; Kontaxakis, V; Ploumpidis, D
The reform and development of psychiatric services require, in addition to financial resources, reserves in specialized human resources. The role of psychiatrists in this process, and at reducing the consequences of mental morbidity is evident. Psychiatrists are required to play a multifaceted role as clinicians, as experts in multidisciplinary team environments and as advisors in the recognition of public needs in mental health issues, as teachers and mentors for students and other health professionals, as researchers in order to enrich our knowledge in the scientific field of psychiatry, and as public health specialists in the development of the mental health services system. This multifaceted role requires the continuous education of modern psychiatrists, but above all a broad, substantial and comprehensive training regime in the initial stage of their professional career, that is to say during specialization. Training in Psychiatry, as indeed has happened in all other medical specialties, has evolved considerably in recent decades, both in the content of education due to scientific advances in the fields of neurobiology, cognitive neuroscience, genetics, psychopharmacology, epidemiology and psychiatric nosology, and also because of advances in the educational process itself. Simple apprenticeship next to an experienced clinician, despite its importance in the clinical training of young psychiatrists, is no longer sufficient to meet the increased demands of the modern role of psychiatrists, resulting in the creation of educational programs defined by setting and pursuing minimum, though comprehensive educational objectives. This development has created the global need to develop organizations intended to supervise training programs. These organizations have various forms worldwide. In the European Union, the competent supervising body for medical specialties is the UEMS (European Union of Medical Specialities) and particularly in the case of the psychiatric
Lewis-Fernández, Roberto; Aggarwal, Neil Krishan
Since the publication of DSM-IV in 1994, neurobiologists and anthropologists have criticized the rigidity of its diagnostic criteria that appear to exclude whole classes of alternate illness presentations, as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis - composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress - as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning. Copyright © 2013 APA*
Dehghan, Azad; Kovacevic, Aleksandar; Karystianis, George; Keane, John A; Nenadic, Goran
De-identification of clinical narratives is one of the main obstacles to making healthcare free text available for research. In this paper we describe our experience in expanding and tailoring two existing tools as part of the 2016 CEGS N-GRID Shared Tasks Track 1, which evaluated de-identification methods on a set of psychiatric evaluation notes for up to 25 different types of Protected Health Information (PHI). The methods we used rely on machine learning on either a large or small feature space, with additional strategies, including two-pass tagging and multi-class models, which both proved to be beneficial. The results show that the integration of the proposed methods can identify Health Information Portability and Accountability Act (HIPAA) defined PHIs with overall F 1 -scores of ∼90% and above. Yet, some classes (Profession, Organization) proved again to be challenging given the variability of expressions used to reference given information. Copyright © 2017. Published by Elsevier Inc.
Christianson, J B; Applebaum, R; Carcagno, G; Phillips, B
This article discusses issues relating to the design and internal administration of a case-management agency for community based home care for the elderly. Included in the article are issues relating to screening procedures, assessment and case management activities, cost controls, automated management information systems, and personnel matters. The analysis is based on the experience of the National Long Term Care Demonstration ("Channeling") which established and evaluated ten case management projects nationwide under federal funding.
AlSamh, Duaa Abo; Endo, Cert End
The aim of this case report was to emphasize the value of preforming patient's treatment plan into phases of treatment and encouraging colleagues to apply such phases in the clinical practice for the management of complex restorative cases. Traditional approach to treatment planning has certain merits. However, new treatment approach should improve oral health rather than react to presenting problems and therefore, dentists should aim to convert their irregular attendee to a regular attendee with treatment plan directed to enhance oral health, prevent disease, improve esthetic and free the patient from pain and discomfort. In this report, a complex restorative case of a 16-year-old female patient was managed for comprehensive dental therapy in the form of treatment plan which was divided into phases by way of a ''staircase'' approach with one clinical step being dependent on the previous step. The whole treatment was completed in three months and the results were satisfactory and patient became a highly motivated person with more self-confidence. (author)
Walsh, Anne; Bearden, Eithne
Despite the plethora of methods and tools available to support strategic management, the challenge for health executives in the next century will relate to their ability to access and interpret data from multiple and intricate communication networks. Integrated digital networks and satellite systems will expand the scope and ease of sharing information between business divisions, and networked systems will facilitate the use of virtual case discussions across universities. While the internet is frequently used to support clinical decisions in the healthcare industry, few executives rely upon the internetfor strategic analysis. Although electronic technologies can easily synthesize data from multiple information channels, research as well as technical issues may deter their application in strategic analysis. As digital models transform access to information, online models may become increasingly relevant in designing strategic solutions. While there are various pedagogical models available to support the strategic management process, this framework was designed to enhance strategic analysis through the application of technology and electronic research. A strategic analysis framework, which incorporated internet research and case analysis in a strategic managementcourse, is described alongwith design and application issues that emerged during the case analysis process.
Srivatsa, Uma N; Ebrahimi, Ramin; El-Bialy, Adel; Wachsner, Robin Y
Electrical storm is defined as a recurrent episode of hemodynamically destabilizing ventricular tachyarrhythmia that usually requires electrical cardioversion or defibrillation. We describe three cases presenting with electrical storm under differing circumstances: (1) a 57-year-old man with ST-elevation myocardial infarction within 1 week of a posterior circulation stroke who developed refractory sustained ventricular tachycardia 10 days after an acute myocardial infarction; (2) a 65-year-old man who developed polymorphic ventricular tachycardia and ventricular fibrillation following dobutamine echocardiography; and (3) a 20-year-old woman who developed intractable ventricular fibrillation following an overdose of a weight-reduction pill. The management of electrical storm is discussed, and evolving literature supporting the routine use of intravenous amiodarone and beta-blockers in place of intravenous lidocaine is critically examined.
Suardi Wekke, Ismail; Yandra, Alexander; Hamuddin, Budianto
This article is a research conducted with qualitative approach with various case studies underlining a strategy that becomes the basis for classroom management. The article discusses and links to the learning revolution that becomes today’s demands, including a discussion that analyses the condition of learners. The article based its data preliminary study conducted in Manado in the province of North Sulawesi in Indonesia. This region has its own characteristics with the encounter of Muslims and the Protestant community for century. Due to its uniqueness 3 Moslem schools and 3 Protestant schools in Manado were selected to study. Data collection was conducted for a year, from May 2016 to April 2017. The study employ four stages research steps: identification, data collection, data validity checking, and directed discussion. The stages include observation and in-depth interviews and conducting focus group discussions. Two important thought about the essence of learning strategy and learning revolution in class were shared briefly within this article.
Gerber, Leah R; Costello, Christopher; Gaines, Steven D
Although market-based incentives have helped resolve many environmental challenges, conservation markets still play a relatively minor role in wildlife management. Establishing property rights for environmental goods and allowing trade between resource extractors and resource conservationists may offer a path forward in conserving charismatic species like whales, wolves, turtles, and sharks. In this paper, we provide a conceptual model for implementing a conservation market for wildlife and evaluate how such a market could be applied to three case studies for whales (minke [Balaenoptera acutorostrata], bowhead [Balaena mysticetus], and gray [Eschrictius robustus]). We show that, if designed and operated properly, such a market could ensure persistence of imperiled populations, while simultaneously improving the welfare of resource harvesters.
Silverman, Enid; Ebright, Linda; Kwiatkowski, Marianne; Cullina, Joanne
Bronchiectasis is the abnormal, irreversible dilatation of diseased bronchi. Permanently dilated airways, usually in the medium-sized bronchi, are inflamed and often obstructed with thick, purulent secretions. Known causative factors include postinfection bronchial damage, postinhalation injury, hypersensitivity reactions, and congenital airway obstructive disorders. Typical symptoms include sputum overproduction, fever, pleurisy, dyspnea, and chronic cough. Diagnosis involves radiographic studies and pulmonary function testing. Treatment includes oral, aerosolized, or intravenous antibiotic therapy according to the severity of the exacerbation, and mucus clearance by means of bronchial hygiene assistive devices, chest physiotherapy, postural drainage, and high-frequency chest compression. We present a review of bronchiectasis and offer 3 case studies illustrating current management of different presentations, including use of aerosolized antibiotics for patients infected with Pseudomonas aeruginosa. Although an adjunctive program of pulmonary rehabilitation may be useful for patients with bronchiectasis, no confirming studies have been performed to date, and additional research in this area is warranted.
Many types of dental abnormality can be observed in the anterior sectors, where they can cause genuine esthetic problems for our patients. While conventional prosthetic treatments offer the best solutions in terms of esthetic result and durability, they involve the sacrifice of significant quantities of mineralized dental material and cannot be undertaken before the periodontal tissues are mature. Other less invasive alternatives should be envisaged as transitional, or sometimes even permanent, solutions for the management of these anomalies in children and adolescents. This article discusses these options and presents a clinical case where composite resin veneers and microabrasion of the enamel were used to treat dental agenesis and enamel dysplasia. Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.
: the notations in which the processes are defined. Traditional process notations are flow-based: control of the process flows from one activity to the next. This paradigm inherently encourages modellers to think in terms of strict orderings instead of supporting flexibility. Flow-based models that do try...... of the process and techniques for runtime adaptation. This dissertation reports on the results of the Technologies for Flexible Cross-organizational Case Management Systems (FLExCMS) research project which was started in cooperation between ITU and the company Exformatics A/S. The goals of the project were...... to strengthen the industrial adoption of constraintbased notations and techniques by further developing DCR Graphs to be industrially applicable, with a particular focus on guaranteeing safety for cross-organizational processes. We will show how DCR Graphs have been extended with new dimensions such as time...
Esfahanizade, Katayoun; Mahdavi, Ali Reza; Ansari, Ghassem; Fallahinejad Ghajari, Masoud; Esfahanizadeh, Abdolreza
Epidermolysis bullosa (EB) is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist.
Rahm, B.; Woods, F.; Hwang, S.; Walter, M. T.; Grantham, D. G.; Riha, S. J.
On-site wastewater treatment systems (OWTS) are used in 20-25% of homes in the United States and can be an efficient and cost-effective alternative to conventional centralized systems. However, OWTS also represent a source of non-point nutrient, pathogen, and micro-contaminant pollution to surface and groundwater if they are poorly designed, sited and/or maintained. Despite their ubiquity and potential to negatively impact water resources, the contribution of OWTS to local and regional water contamination issues is poorly understood. There are no federal regulations or uniform standards for the operation, maintenance, and management of these systems. The effectiveness of educational programs and best management practices developed by the US Environmental Protection Agency, along with local and regional governments, remains uncertain. Here we describe attempts to increase our knowledge of the state of OWTS in relation to water resources and their management. Specifically, we summarize 1) efforts to modernize a NY State-wide inventory of residential OWTS using GIS-based tools; 2) research aimed at better understanding the impact of OWTS on surface and ground water in 5 upstate NY counties across a gradient of land uses; 3) lessons learned from 13 case studies of municipal OWTS management programs across the US; and 4) observations on the roles of data, education and policy in creating and evaluating successful municipal OWTS management programs. Initial results show that total numbers of OWTS in NY State continue to grow, particularly in areas associated with ex-urban migration. Research into the relationship between OWTS and nutrient and pathogen contamination in ground and surface waters, respectively, suggests location-specific variation. This has implications for management approaches: preventing failure of any individual OWTS may be just as effective as programs attempting to bring all OWTS up to a high level of performance. Case studies of management programs
Yousafzai, A.W.; Kazim, M.; Jehangiri, A.U.R.
Very few studies from Pakistan have examined the profile of patients seen by psychiatrists in general hospital. The aim of this research is to describe the clinical and demographic characteristics of patients referred to the psychiatric unit of a general hospital over a one year period. Methods: This cross-sectional study was conducted at the Ayub Teaching Hospital, Abbottabad, from January 1st to December 31st 2012. All patients being referred to psychiatry were included in the study over one year period. The information was recorded on a structured questionnaire and analysed the data using SPSS-19.0. Results: Out of the 105 patients referred to the psychiatric unit, 74 (72.3%) were females. A total of 69 (68.5%) patients were married. More than half were uneducated and only number 4 (3%) patients had university qualification. Housewives made up 64.4% of the patient population followed by students (11%). Majority 55 (53%) had less than Rs. 5000/ monthly income. About 30% patients were shifted to psychiatry ward while, nearly one tenth were discharged. In 35% cases the psychiatrist was asked to help in the management, while in 50% cases only opinion was sought. Aggressive and threatening behaviour was source of concern in majority of patients for the primary team while 34% exhibited suicidal behaviour. Depression was most frequent diagnosis in 45 43% patients, followed by conversion disorder 19 (17%) and delirium 16 (14%). Conclusion: The rate of psychiatric referrals is dismal with only one third of the patients being transferred to the psychiatric ward. The major psychiatric diagnosis was depression. Patients with aggressive and threatening behaviour were more frequently referred. (author)
Dr. Amalendu Bhunia; Islam Uddin Khan
Liquidity management is of crucial importance in financial management decision. The optimalof liquidity management is could be achieve by company that manage the trade-off between profitability and liquidity management. The paper analyses the association between the liquidity management and profitability of 230 Indian private sector steel companies obtained from CMIE database. Liquidity management indicators and profitability indicator over the period from 2002 to 2010 are modeled as a linear...
Claver, Enrique; López, María D; Molina, José F; Tarí, Juan J
This study has as its aim to help to clarify the relationship between environmental management and economic performance by integrating it into a wider framework that includes the relationship between environmental strategy and firm performance, the latter being understood as the combination of environmental performance, competitive advantage and economic performance. A case study of the COATO farming cooperative showed us that its environmental management, focused on prevention logic, has had a positive net effect on its environmental performance. Besides, the order in which these practices were adopted favoured the development of new organisational capabilities that have contributed to the appearance of advantages derived from the greater accumulated experience of employees in creating new projects that are designed to reduce residues and pollution. COATO has also obtained a competitive advantage in differentiation thanks to an improved brand image and to its increased credibility in business relationships. Finally, a positive correlation exists between the pioneering proactive strategy adopted by this cooperative and the improvement of its firm performance with respect to the other firms in its sector.
Tatum, William O; Al-Saadi, Sam; Orth, Thomas L
Case management (CM) has been shown to improve the medical care of patients in several paradigms of general medicine. This study was undertaken to assess the impact of CM on low-income patients with epilepsy. From 2002 to 2003, 737 epilepsy patients had CM provided by a non-profit, state-supported, epilepsy service subserving a four county region in southeastern Florida. Standardized survey forms distributed by the Florida Department of Health were completed by 159 consecutive patients at program admission. Follow-up information regarding seizure frequency, antiepileptic drugs, and quality of life self-rating was performed after 1 year of CM. The patients evaluated were composed of 58.5% men, with a mean age of 41.0 years. After CM, an increase in self-reported seizure control was seen in 40.2% of patients (preduction of ED visits per patient from 1.83 per patient per year before CM to 0.14 per patient per year after CM (p<0.0001, Wilcoxon matched-pairs test). Following CM, fewer patients reported difficulty with friends, employers, problems socializing, and feelings of anger (p<0.05, Fisher's exact test). CM of low-income patients with epilepsy resulted in self-reported improvement in seizure control, QoL, and significantly reduced ED visitation. CM in epilepsy is feasible and represents a cost-effective improvement in outpatient epilepsy management.
Ekwunife, O H; Ugwu, J O; Modekwe, V
Prune belly syndrome (PBS) is a rare congenital malformation of unclear etiology. The disease progress and outcome in developing countries are not clear as most reports are isolated case reports. A review of 9 patients managed for PBS in 5 years. There were 7 males and 2 females, aged 30 min-11 days (median = 5 days) at the time of presentation (a child presented as neonate, defaulted from follow-up and represented at 10 years of life). Their weights on admission were 2.5-4.2 kg (median = 3 kg). Maternal age range was 26-37 years (median = 32 years), with five mothers being above 30 years. Seven mothers had febrile illness in the first trimester and took antimalarial drugs or antibiotics. Intestinal malrotation was the most common associated anomaly. The degree of the anterior abdominal wall and the urinary tract morphology varies from patient to patient. Urinary tract anomalies were initially managed conservatively. Two infants however later had cutaneous ureterostomy due to worsening renal function and recalcitrant urinary tract infection (UTI). Four infants had abdominoplasty at the 2 nd week, 6 th week, 3 rd year and 10 th year of life. Seven orchiopexies were done. Four were done by Fowler-Stephen's method while the rest were via the inguinal route. Of the former, 3 testicles have normal volume 6 months after, whereas one atrophied. Post abdominoplasty, there was a significant reduction in the frequency of respiratory tract infection (RTI), UTI and post void urine volume in three infants. In addition, there was improved peer interaction and academic performance in the 10-year-old child. One infant died of pulmonary hypoplasia and two others from worsening urosepsis and progressive renal failure. PBS presents with a spectrum of features. Initial conservative management of the urinary tract was beneficial. Abdominoplasty and orchiopexy have both physiological and improved quality of life benefits. Early Parental education helped in reducing defaults from follow-up.
Newnam, Sharon; Petersen, Alan; Keleher, Helen; Collie, Alex; Vogel, Adam; McClure, Rod
Case managers within injury compensation systems are confronted with various emotional demands. Employing the concept of emotional labour, this paper explores distinctive aspects of these demands. The findings are drawn from focus groups with 21 Australian case managers. Case managers work was characterised by extra-role commitments, emotional control, stress and balancing tensions arising from differing stakeholder expectations about outcomes related to compensation and return to work. By examining the experiences of case managers, the findings add to the literature on the emotional labour of front line service workers, especially with respect to the demands involved in managing the conflicting demands of work.
Balard, Frédéric; Gely-Nargeot, Marie-Christine; Corvol, Aline; Saint-Jean, Olivier; Somme, Dominique
In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006-2010). People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users' (old people and their informal caregivers) and case managers' first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19), their informal caregivers (11) and the case managers (5) who participated in the program during the first 6 months. Thematic analysis of the data was carried out. The analysis revealed that each group of people generated its own representations of the case manager's role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual's projected expectations of this social service. Analyzing the first representations
Full Text Available Reiter's syndrome is a clinical syndrome of arthritis, urethritis, conjunctivitis, and mucocutaneous lesions. Skin and mucosal involvement is observed in about 10% of the cases. A 34-year-old male was brought in severe condition. He had red colored foul smelling maculopapular skin lesions all over body, swollen and painful knee and shoulder joints. History revealed that he was suffering from Reiter's syndrome since 2003. He used to get admitted between the months of February and May every year due to aggravation of symptoms. Every time he was treated with systemic antibiotics, corticosteroids, immunosuppressants and non-steroidal anti-inflammatory drugs. He was successfully treated with external application and internal medication with tikta (bitter and kaṣāya (astringent drugs. He got significant relief in skin lesions as well as joint pain and his quality of life was markedly improved. This case study demonstrates that Reiter's syndrome can be well managed with Ayurvedic medicines.
Arnautovska, Urska; McPhedran, Samara; De Leo, Diego
Farmers constitute an occupation group at a heightened suicide risk compared to the general population. To date, research has tried to explain this peculiarity by identifying suicide risk factors that are common to the whole of the farming population. There are, however, indications that risk factors may be different for different sub-populations of farmers, such as younger/older farmers or farm managers/farm labourers. This study compared the characteristics of suicides by farm managers and farm labourers, while controlling for the effect of age. A review of two datasets, the Queensland Suicide Register and the National Coroners Information System, was conducted in which a total of 78 cases of farm managers and 69 cases of farm labourers were identified as a suicide during 2000-2009, Queensland, Australia. The main outcome measures included various demographic characteristics, circumstances related to death, health and mental health variables, and history of stressful life events. The two groups differed in marital status, living arrangements, ethnicity, physical and mental illness, alcohol and drug abuse, contact with a health professional prior to death, and specific life events such as relationship breakdown and recent/pending unemployment. The majority of these differences were not statistically significant once age was accounted for. However, differences in psychiatric variables and experience of a recent/pending unemployment remained significant. This study contributes towards better understanding of suicide among farmers in different job positions, and highlights the need for tailored suicide prevention initiatives that consider a combination of age- and job-specific suicide risk and protective factors among farmers.
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Case tracking, data management, and reporting... Accreditation and Approval Responding to Complaints and Records and Reports Management § 96.43 Case tracking, data management, and reporting. (a) When acting as the primary provider, the agency or person maintains...
Leskens, Johannes; Brugnach, Marcela
New policies on flood management called Multi-Level Safety (MLS), demand for an integral and collaborative approach. The goal of MLS is to minimize flood risks by a coherent package of protection measures, crisis management and flood resilience measures. To achieve this, various stakeholders, such as water boards, municipalities and provinces, have to collaborate in composing these measures. Besides the many advances this integral and collaborative approach gives, the decision-making environment becomes also more complex. Participants have to consider more criteria than they used to do and have to take a wide network of participants into account, all with specific perspectives, cultures and preferences. In response, sophisticated models are developed to support decision-makers in grasping this complexity. These models provide predictions of flood events and offer the opportunity to test the effectiveness of various measures under different criteria. Recent model advances in computation speed and model flexibility allow stakeholders to directly interact with a hydrological hydraulic model during meetings. Besides a better understanding of the decision content, these interactive models are supposed to support the incorporation of stakeholder knowledge in modelling and to support mutual understanding of different perspectives of stakeholders To explore the support of interactive modelling in integral and collaborate policies, such as MLS, we tested a prototype of an interactive flood model (3Di) with respect to a conventional model (Sobek) in two cases. The two cases included the designing of flood protection measures in Amsterdam and a flood event exercise in Delft. These case studies yielded two main results. First, we observed that in the exploration phase of a decision-making process, stakeholders participated actively in interactive modelling sessions. This increased the technical understanding of complex problems and the insight in the effectiveness of various
Lightfoot, Elizabeth B; LaLiberte, Traci L
This exploratory study examines the delivery of child protection services by county child protection agencies involving cases with a family member with a disability. Telephone surveys were conducted with the directors or their designees of 89% of the child protection agencies in a Midwestern state. Respondents were asked about the policies and/or procedures for approaching cases involving a person with a disability and the barriers and strengths agencies have in serving people with disabilities. Only 6.7% of respondents reported their agency had a written policy related to serving persons with a disability. There were 18 different approaches to serving clients with a disability within child protection, with the most common being informally teaming for information, dual case assignment, and teaming with an outside consultant. Five counties had specialty workers who were experts in both child protection and disability. Barriers reported varied between rural and non-rural counties, with the most important barriers being lack of resources, lack of knowledge regarding disabilities, systems conflicts, and rural issues, such as lack of providers and lack of transportation. Strengths included accessing and coordinating services, individualizing services, good collaboration and creativity. While few county agencies had any written policies, both formal and informal collaboration is happening at the individual level. The lack of standardization in providing services indicates a need for more attention to issues regarding disability within child protection, including more training for workers, the development of models of collaborative case management and the removal of systemic barriers.
Full Text Available The purpose of the article is to present the importance of project management for the functioning of public administration, and its contribution to the realization of the developmental goals of the government. For this, integration of strategic management and project management is of vital importance. The methodology used is a combination of literature review, a case study of project management in public administration of the Republic of Slovenia, and development of a maturity model of project management in public administration, with its verifi cation on the case of Slovenia. The main contribution of the study is development of TPM – Total Project Management maturity model for public administration. Upon the TPM maturity model, project management in Slovene public administration is assessed and discussed. Out of fi ve maturity levels, the results for project management in Slovene public administration are: management of projects – level 2 (initiated, management of programs of projects – level 2 (initiated, management of portfolios of projects – level 3 (implemented, organizational support for project management – level 3 (implemented, HRM for project management – level 2 (initiated, and integration of project management and strategic management – level 3 (implemented. General fi ndings and recommendations in this respect are drawn, together with indicated areas for possible further research and investigation.
Hoffmann, Jens; Allwinn, Mirko
Three cases of rampage killings at German schools by adult outsiders were identified and analyzed. The cases took place between 1913 and 1983. To what extent do psychiatric aspects play a role and are there risk factors that can be identified und used for prevention? For the identification of risk factors the warning behavior typology was utilized which covers eight behavioral factors. Severe mental problems were found in all three cases. The factors of the warning behavior typology were present in different relevance: Pathway (100 %), Fixation (100 %), Identification (33 %), novel aggression (33 %), energy burst (33 %), Leakage (66 %), last resort (66 %), directly communicated threat (0 %). The prevention of such cases seems to be most promising installing a regional and interdisciplinary threat management model. The field of threat management offers a scientific frame with evidence based tools and methods.
Full Text Available Case: A shy, depressed 30 year old male discussed his frequent ego-syntonic indoor prostitution consumption in small peer groups. Several distinctive non-sexual functions of this paid sex habit were identified. Design and method: The patient had 40 hourly psychiatric sessions in the private practice setting over 14 months. The Arizona Sexual Experience Scale was applied to compare the subjective appraisal of both paid sex and sex in a relationship. The informal Social Atom elucidates social preferences and the Operationalized Psychodynamic Diagnostic-procedure was applied to describe a dominant relationship pattern. Results: The paid sex consumption functioned as a proud male life style choice to reinforce the patients fragile identity. The effect on self esteem was a release similar to his favorite past-time of kick-boxing. With paid sex asserted as a group ritual, it was practiced even with frequent erectile dysfunction and when sex with a stable romantic partner was more enjoyable and satisfying. The therapeutic attitude of the female psychiatrist, with her own ethical values, is put in to context with two opposing theories about prostitution: the ‘Sex-Work-model’ and the ‘Oppression-model’. The therapist’s reaction to the patients’ information was seen as a starting point to understanding the intrapsychic function of paid sex as a coping mechanism against depressive feelings. Conclusions: Exploring and understanding prostitution consumption patterns in young men can benefit the treatment of psychiatric disorders in the private practice setting. It is the psychiatrists task to investigate the patients hidden motives behind paid sex use to help patients achieve a greater inner and relational freedom.
Pan, Shiyang; Mu, Yuan; Wang, Hong; Wang, Tong; Huang, Peijun; Ma, Jianfeng; Jiang, Li; Zhang, Jie; Gu, Bing; Yi, Lujiang
To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.