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Sample records for therapy implementation intercomparacao

  1. Dosimetric intercomparison between protons and electrons therapies applied to retinoblastoma; Intercomparacao dosimetrica entre terapias de protons e eletrons aplicada ao retinoblastoma

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    Braga, Flavia Vieira

    2008-07-01

    In this work we propose a construction of a simple human eye model in order to simulate the dosimetric response for a treatment with protons and electrons in a retinoblastoma cancer. The computational tool used in this simulation was the Geant4 code, in the version 4.9.1, all these package are free and permit simulate the interaction of radiation with matter. In our simulation we use a box with 4 cm side, with water, for represent the human eye. The simulation was performed considering mono energetics beams of protons and electrons with energy range between 50 and 70 MeV for protons and 2 and 10 MeV for electrons. The simulation was based on the advanced hadron therapy example of the Geant 4 code. In these example the phantom is divided in voxels with 0.2 mm side and it is generated the energy deposited in each voxel. The simulation results show the energy deliver in each voxel, with these energie we can calculate the dose deposited in that region. We can see the dose profile of, proton and electron, and we can see in both cases that for protons the position of delivered dose is well know, that happen in the position where the proton stop, for electrons the energies is delivered along the way and pass the desired position for high dose deposition. (author)

  2. Multileaf collimator intercomparison for intensity modulated radiation therapy implementation; Intercomparacao de colimadores de multiplas laminas para implementacao de terapia de feixes de intensidade modulada

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    Viteri, Juan Fernando Delgado

    2006-07-01

    In this work a dosimetric comparison between three multileaf collimator systems is presented: a Varian Millennium with 120 leaves, Brainlab mMLC m3 and Varian Mark II both with 52 leaves. The width projection at isocenter level in field's central region are: 0,5 cm; 0,35 cm and 1,0 cm respectively. Common dosimetric characteristics for the three systems in static mode and dynamic capabilities for the two first were compared. In dynamic mode, tests validating proper MLC function through film irradiation were done, such MLC stability, MU linearity, treatment interruptions sensitivity, stability of MLC in dynamic mode, leaf speed stability, were found within {+-}3% deviation in all cases. Dose rate linearity showed differences when this parameter decreases in dynamic mode. Average dose errors for fixed width gaps moving at constant speed were found to be proportional to gap errors and inversely proportional to the gap width. Output factors differences delivered through a sweeping gap were found less than {+-}1% when the gantry was in a lateral position. For the three MLC systems, when comparing beam profiles for the same field was observed that for mMLC presents the sharpest dose gradient region. In the output factors small differences where observed in every MLC system. Dosimetric leaf gap was determined for MLC 120, mMLC and MLC 52, obtained values for a 6 MV beam are: (0,202 {+-} 0,054) cm; (0,157 {+-} 0,070) cm and (0,189 {+-} 0,081) cm respectively. The transmission showed an increase with depth and field width for 6 MV in all the three systems. Average values obtained with ionization chamber for this energy were: (1,630 {+-} 0,018)% for MLC 120; (1,291 {+-} 0,029)% for mMLC and (1,638 {+-} 0,010)% for MLC 52. When obtained through film irradiation, inter and intra leaf transmission showed an off axis dependent behavior for MLC 120 and mMLC. Scatter produced by MLC as a 6 MV open reference field ratio was: (0,297 {+-} 0,024)% for MLC 120; (0,239 {+-} 0,052)% for mMLC and (0,202 {+-} 0,028)% for MLC 52. It was verified that penumbra width (80-20%) as a function of off axis leaf position do not showed significant differences in all systems. As a function of field width defined by MLC leaves, penumbra width presented an increasing behavior. When tests as a depth function in a 6 MV field, penumbra showed the smallest value for the mMLC at d{sub max}: 2,59 mm and the biggest was 6,74 mm for the MLC Mark II AT 10 cm depth. Penumbra dependence with leaf movement axis showed that for 10 deg, the mMLC presented a 3,74 mm value, for larger angles, the higher values were obtained for MLC Mark 11. Described series of tests described in the present investigation allows to establish a commissioning routine for MLC systems, that could be applied in a Radiotherapy Department that will commission those systems for dynamic IMRT. Obtained results allow to characterize every MLC studied system. It is not possible to establish which system is better, but when one is chosen it is feasible to identify vantages and disadvantages that everyone will present. (author)

  3. Implementation of Behavioral Marital Therapy.

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    Lester, Gregory W.; And Others

    1980-01-01

    Implementing behavioral marital therapy is discussed with emphasis on techniques of problem solving, communications training, behavioral contracting, and homework assignments. The therapist's intervention style and the aspects of treatment which aid in generalization and maintenance of therapeutic gains are also described, and a typical treatment…

  4. Implementation and qualification of MCNP 5 through the intercomparison with the benchmark for the calculation of critical systems Godiva and Jezebel; Implementacao e qualificacao do MCNP5 atraves da intercomparacao com o benchmark para o calculo dos sistemas criticos Godiva e Jezebel

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    Lara, Rafael G.; Maiorino, Jose R., E-mail: rafael.lara@aluno.ufabc.edu.br, E-mail: joserubens.maiorino@ufabc.edu.br [Universidade Federal do ABC (UFABC), Santo Andre, SP (Brazil). Centro de Engenharia, Modelagem e Ciencias Sociais Aplicadas

    2013-07-01

    This work aimed at the implementation and qualification of MCNP code in a supercomputer of the Universidade Federal do ABC, so that may be available a next-generation simulation tool for precise calculations of nuclear reactors and systems subject to radiation. The implementation of this tool will have multidisciplinary applications, covering various areas of engineering (nuclear, aerospace, biomedical), radiation physics and others.

  5. Challenges in implementing and maintaining osteoporosis therapy

    Directory of Open Access Journals (Sweden)

    Modi A

    2014-08-01

    Full Text Available Ankita Modi,1 Shiva Sajjan,1 Sampada Gandhi2 1Center for Observational and Real-World Evidence, Merck & Co., Inc., Whitehouse Station, NJ, USA; 2School of Public Health, Rutgers University, Piscataway, NJ, USA Abstract: In the United States, an estimated 19% of older men and 30% of older women are at elevated risk of osteoporotic fracture and considered to be eligible for treatment. The burden of osteoporosis is similar in Europe and is projected to rise worldwide, with aging populations and increasing fracture rates accompanying urbanization. Notwithstanding its high prevalence, osteoporosis is often underdiagnosed and undertreated. Moreover, even when the diagnosis is made and the decision is taken to treat, there are remaining challenges in implementing therapy for osteoporosis. Several patient populations are particularly challenging for clinicians to treat and require further study with regard to osteoporosis therapy. These include the very elderly, who face challenges relating to adherence; men, in whom osteoporosis remains under-recognized; patients with glucocorticoid-induced osteoporosis or renal impairment, who are at increased risk of fracture; patients with preexisting gastrointestinal problems who cannot tolerate existing orally administered osteoporosis therapies; and high-risk patients who show inadequate response to therapy. Moreover, poor adherence and poor persistence with osteoporosis medications are common and result in an increased risk of fracture, higher medical costs, and increased hospitalizations. Once the decision to institute therapy is made, patient education about osteoporosis and fracture risk should be provided. This is particularly important for men, who may not be aware that osteoporosis can be a concern. Secondary prevention programs, including fracture liaison services and bone therapy groups, can help to improve adherence to therapy. Further study is needed to guide the treatment of men, the very elderly

  6. How to implement complementary therapies for laboring women.

    Science.gov (United States)

    Zwelling, Elaine; Johnson, Kitti; Allen, Jonell

    2006-01-01

    Complementary therapies have been a part of nursing practice for centuries and are supported today as a part of nursing practice by many state boards of nursing. Some of these modalities can be used by nurses as a part of their comprehensive plan of labor support for women during the childbirth experience. This article describes five complementary therapies (aromatherapy, massage, use of birth balls, music therapy, and hydrotherapy), and how one large Midwestern hospital system implemented an educational program for nurses that helped them integrate complementary therapies into their nursing care for laboring women.

  7. Implementing cognitive therapies into routine psychosis care: organisational foundations.

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    Dark, Frances; Whiteford, Harvey; Ashkanasy, Neal M; Harvey, Carol; Crompton, David; Newman, Ellie

    2015-08-05

    Treatment outcomes for people diagnosed with psychosis remain suboptimal due in part to the limited systematic application of evidence based practice (Adm Policy Ment Health, 36: 1-7, 2009) [1]. The Implementation science literature identifies a number of factors organisationally that need to be considered when planning to introduce a particular EBP. Profiling these organisational characteristics at baseline, prior to commencement of service reform can determine the focus of a subsequent implementation plan. This study examined the organisational baseline factors existing in two services promoting the routine use of cognitive interventions for psychosis. One of the services studied has since undertaken organisational structural reform to facilitate the greater uptake of Evidence Based Practice (EBP). The results of this study were used to design an implementation strategy to make cognitive therapies a part of routine psychosis care. One hundred-and-six mental health staff from two metropolitan mental health services in Australia was surveyed to ascertain their attitudes, competencies and interest in Cognitive Behavioural Therapy for psychosis (CBTp) and Cognitive Remediation Therapy (CRT). In addition perceptions of organisational values were profiled using the Organisational Culture Profile (OCP). Fifty five participants were excluded because they completed less than 50% of the survey. The final sample consisted of 51 participants. 48.1% of surveys were completed. Over 50% of staff were interested in CBTp and CRT approaches to psychosis. Staff were aware of existing CBTp and CRT programs but these were not uniformly available throughout the services. Fourteen percent of staff identified as CBT therapist and 35% were trained CRT facilitators. Only 12% of staff were receiving therapy specific supervision. The Organisational Culture Profile (OCP) at baseline revealed highest scores amongst leadership, planning, and humanistic workplace domains, with communication

  8. Implementation of spacer therapy for acute asthma in children.

    LENUS (Irish Health Repository)

    Vandeleur, M

    2009-09-01

    The aim was to develop and implement an evidence based guideline for the treatment of acute asthma using a metered dose inhaler and spacer combination. Children admitted to Cork University Hospital Paediatric Department with acute asthma were identified during two identical 2 month seasonal periods before (2005) and after (2006) implementation of the new guidelines in September 2006. Pre-intervention and post-intervention audits by case note review were performed to determine the impact of and compliance with this evidence-based guideline emphasising patient assessment, spacer delivered bronchodilator and specific discharge criteria. Patients had similar characteristics during the two study periods. There was a raised threshold for admission after guideline implementation with 11\\/52 patients having mild exacerbations in 2006, compared to 21\\/36 in 2005. Duration of admission was less in the post-implementation group for equivalent exacerbation severity e.g. for moderate severity; 28 hours in 2005, 23 hours in 2006. Duration of bronchodilator therapy was shorter in 2006 and more likely to be given by spacer device earlier for equivalent levels of severity e.g. for moderate exacerbations, in 2006 the average length of salbutamol therapy was 18 hours with 12 hours by spacer device, in 2005 the average length of therapy was 25 hours with 3 hours by spacer. There was earlier initiation of oral corticosteroids; the average time to administration was 56 minutes in 2006 and 227 minutes in 2005. There was an improved documentation of asthma education in 2006 e.g. inhaler technique was reviewed in 37\\/52 in 2006, 21\\/35 in 2005 and better use of written action plans.

  9. Multisystemic Therapy(®) : Clinical Overview, Outcomes, and Implementation Research.

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    Henggeler, Scott W; Schaeffer, Cindy M

    2016-09-01

    Multisystemic therapy (MST) is an evidence-based treatment originally developed for youth with serious antisocial behavior who are at high risk for out-of-home placement and their families; and subsequently adapted to address other challenging clinical problems experience by youths and their families. The social-ecological theoretical framework of MST is presented as well as its home-based model of treatment delivery, defining clinical intervention strategies, and ongoing quality assurance/quality improvement system. With more than 100 peer-reviewed outcome and implementation journal articles published as of January 2016, the majority by independent investigators, MST is one of the most extensively evaluated family based treatments. Outcome research has yielded almost uniformly favorable results for youths and families, and implementation research has demonstrated the importance of treatment and program fidelity in achieving such outcomes. © 2016 Family Process Institute.

  10. A method for implementation of nutritional therapy in hospitals

    DEFF Research Database (Denmark)

    Rasmussen, Henrik Højgaard; Kondrup, Jens; Staun, Michael

    2006-01-01

    Background & aims: Many barriers make implementation of nutritional therapy difficult in hospitals. In this study we investigated whether, a targeted plan made by the staff in different departments could improve nutritional treatment within selected quality goals based on the ESPEN screening...... guidelines. Methods: The project was carried out as a continuous quality improvement project. Four different specialities participated in the study with a nutrition team of both doctors, nurses, and a dietician, and included the following methods: (1) Premeasurement: assessment of quality goals prior...... to study including the use of screening of nutritional risk (NRS-2002), whether a nutrition plan was made, and monitoring was documented in the records. (2) Intervention: multidisciplinary meeting for the ward staff using a PC-based meeting system for detecting barriers in the department concerning...

  11. Clinical Implementation of Intensity Modulated Proton Therapy for Thoracic Malignancies

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    Chang, Joe Y., E-mail: jychang@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Li, Heng; Zhu, X. Ronald [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing; Zhao, Lina [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liu, Amy [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Li, Yupeng [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Applied Research, Varian Medical Systems, Palo Alto, California (United States); Sahoo, Narayan; Poenisch, Falk [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gomez, Daniel R. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wu, Richard; Gillin, Michael [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhang, Xiaodong, E-mail: xizhang@mdanderson.org [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-11-15

    Purpose: Intensity modulated proton therapy (IMPT) can improve dose conformality and better spare normal tissue over passive scattering techniques, but range uncertainties complicate its use, particularly for moving targets. We report our early experience with IMPT for thoracic malignancies in terms of motion analysis and management, plan optimization and robustness, and quality assurance. Methods and Materials: Thirty-four consecutive patients with lung/mediastinal cancers received IMPT to a median 66 Gy(relative biological equivalence [RBE]). All patients were able to undergo definitive radiation therapy. IMPT was used when the treating physician judged that IMPT conferred a dosimetric advantage; all patients had minimal tumor motion (<5 mm) and underwent individualized tumor-motion dose-uncertainty analysis and 4-dimensional (4D) computed tomographic (CT)-based treatment simulation and motion analysis. Plan robustness was optimized by using a worst-case scenario method. All patients had 4D CT repeated simulation during treatment. Results: IMPT produced lower mean lung dose (MLD), lung V{sub 5} and V{sub 20}, heart V{sub 40}, and esophageal V{sub 60} than did IMRT (P<.05) and lower MLD, lung V{sub 20}, and esophageal V{sub 60} than did passive scattering proton therapy (PSPT) (P<.05). D{sub 5} to the gross tumor volume and clinical target volume was higher with IMPT than with intensity modulated radiation therapy or PSPT (P<.05). All cases were analyzed for beam-angle-specific motion, water-equivalent thickness, and robustness. Beam angles were chosen to minimize the effect of respiratory motion and avoid previously treated regions, and the maximum deviation from the nominal dose-volume histogram values was kept at <5% for the target dose and met the normal tissue constraints under a worst-case scenario. Patient-specific quality assurance measurements showed that a median 99% (range, 95% to 100%) of the pixels met the 3% dose/3 mm distance criteria for the

  12. Implementing Cognitive Behavioral Therapy for Chronic Fatigue Syndrome in a Mental Health Center: A Benchmarking Evaluation

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    Scheeres, Korine; Wensing, Michel; Knoop, Hans; Bleijenberg, Gijs

    2008-01-01

    Objective: This study evaluated the success of implementing cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) in a representative clinical practice setting and compared the patient outcomes with those of previously published randomized controlled trials (RCTs) of CBT for CFS. Method: The implementation interventions were the…

  13. Randomized Controlled Trials in Music Therapy: Guidelines for Design and Implementation.

    Science.gov (United States)

    Bradt, Joke

    2012-01-01

    Evidence from randomized controlled trials (RCTs) plays a powerful role in today's healthcare industry. At the same time, it is important that multiple types of evidence contribute to music therapy's knowledge base and that the dialogue of clinical effectiveness in music therapy is not dominated by the biomedical hierarchical model of evidence-based practice. Whether or not one agrees with the hierarchical model of evidence in the current healthcare climate, RCTs can contribute important knowledge to our field. Therefore, it is important that music therapists are prepared to design trials that meet current methodological standards and, equally important, are able to respond appropriately to those design aspects that may not be feasible in music therapy research. To provide practical guidelines to music therapy researchers for the design and implementation of RCTs as well as to enable music therapists to be well-informed consumers of RCT evidence. This article reviews key design aspects of RCTs and discusses how to best implement these standards in music therapy trials. A systematic presentation of basic randomization methods, allocation concealment strategies, issues related to blinding in music therapy trials and strategies for implementation, the use of treatment manuals, types of control groups, outcome selection, and sample size computation is provided. Despite the challenges of meeting all key design demands typical of an RCT, it is possible to design rigorous music therapy RCTs that accurately estimate music therapy treatment benefits.

  14. Implementation of MRI gel dosimetry in radiation therapy

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    Baeck, S.Aa.J

    1998-12-01

    Gel dosimetry was used together with magnetic resonance imaging (MRI) to measure three-dimensional absorbed dose distributions in radiation therapy. Two different dosimeters were studied: ferrous- and monomer gel, based on the principles of radiation-induced oxidation and polymerisation, respectively. Single clinical electron and photon beams were evaluated and gel dose distributions were mainly within 2% of conventional detector results. The ferrous-gel was also used for clinical proton beams. A decrease in signal per absorbed dose was found close to the end of the range of the protons (15-20%). This effect was explained as a linear energy transfer dependence, further supported with Monte Carlo simulations. A method for analysing and comparing data from treatment planning system (TPS) and gel measurements was developed. The method enables a new pixel by pixel evaluation, isodose comparison and dose volume histogram verification. Two standard clinical radiation therapy procedures were examined using the developed TPS verification method. The treatment regimes included several beams of different radiation qualities. The TPS calculated data were in very good agreement with the dose distribution measured by the ferrous-gel. However, in a beam abutment region, larger dose difference was found. Beam adjustment errors and a minor TPS underestimation of the lateral scatter contribution outside the primary electron beam may explain the discrepancy. The overall uncertainty in the ferrous-gel dose determination was considerably reduced using an optimised MRI acquisition protocol and a new MRI scanner. The relative dose uncertainty was found to be better than 3.3% for all dose levels (95% confidence level). Using the method developed for comparing measured gel data with calculated treatment plans, the gel dosimetry method was proven to be a useful tool for radiation treatment planning verification 103 refs, 20 figs, 6 tabs

  15. Filling potholes on the implementation highway: Evaluating the implementation of Parent-Child Interaction Therapy in Los Angeles County.

    Science.gov (United States)

    Timmer, Susan G; Urquiza, Anthony J; Boys, Deanna K; Forte, Lindsay A; Quick-Abdullah, Daphne; Chan, Sam; Gould, William

    2016-03-01

    In October 2012, first 5 LA funded a unique collaboration between Los Angeles County Department of Mental Health (DMH) and UC Davis PCIT Training Center (UCD PCIT) to train county-contracted agencies to provide Parent-Child Interaction Therapy (PCIT). This $20 million dollar, 5-year grant represented the largest implementation effort of an empirically based treatment to date. The purpose of this paper was to describe the first 2 years of the implementation process of this project, beginning with project start up and pre-implementation phases, and to present agency training and client performance outcomes from our first year of training. Results presented in this evaluation suggest that it is possible to train LA County providers in PCIT, and that PCIT is an effective intervention for DMH-contracted providers in LA County. This evaluation also discusses challenges to successful implementation. Barriers to progress included unanticipated delays building county infrastructure, trainee attrition, and insufficient client referrals. We discuss the results of the current implementation with respect to theory, research, and others' training models, with the aim of evaluating and prioritizing different implementation drivers, noting the ongoing competition between knowing what to do and the need for action. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Implementation of methadone therapy for opioid use disorder in Russia - a modeled cost-effectiveness analysis.

    Science.gov (United States)

    Idrisov, Bulat; Murphy, Sean M; Morrill, Tyler; Saadoun, Mayada; Lunze, Karsten; Shepard, Donald

    2017-01-20

    Opioid agonist therapy using methadone, an effective treatment of opioid use disorders (OUD) for people who inject drugs (PWID), is recommended by the World Health Organization as essential to curtail the growing HIV epidemic. Yet, despite increasing prevalence of OUD and HIV, methadone therapy has not yet been implemented in Russia. The aim of this modeling study was to estimate the cost-effectiveness of methadone therapy for Russian adults with a diagnosed OUD. We modeled the projected program implementation costs and estimated disability-adjusted life years (DALYs) averted over a 10-year period, associated with the provision of methadone therapy for a hypothetical, unreplenished cohort of Russian adults with an OUD (n = 249,000), in comparison to the current therapies at existing addiction treatment facilities. Our model compared four distinct scenarios of treatment coverage in the cohort ranging from 3.1 to 55%. Providing methadone therapy to as few as 3.1% of adults with an OUD amounted to an estimated almost 50,000 DALYs averted over 10 years at a cost of just over USD 17 million. Further expanding service coverage to 55% resulted in an estimated almost 900,000 DALYs averted, at a cost of about USD 308 million. Our study indicated that implementing opioid agonist therapy with methadone to treat OUD at existing facilities in Russia is highly cost-effective.

  17. A real world dissemination and implementation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders.

    Science.gov (United States)

    Gros, Daniel F; Szafranski, Derek D; Shead, Sarah D

    2017-03-01

    Dissemination and implementation of evidence-based psychotherapies is challenging in real world clinical settings. Transdiagnostic Behavior Therapy (TBT) for affective disorders was developed with dissemination and implementation in clinical settings in mind. The present study investigated a voluntary local dissemination and implementation effort, involving 28 providers participating in a four-hour training on TBT. Providers completed immediate (n=22) and six-month follow-up (n=12) training assessments and were encouraged to collect data on their TBT patients (delivery fidelity was not investigated). Findings demonstrated that providers endorsed learning of and interest in using TBT after the training. At six-months, 50% of providers reported using TBT with their patients and their perceived effectiveness of TBT to be very good to excellent. Submitted patient outcome data evidenced medium to large effect sizes. Together, these findings provide preliminary support for the effectiveness of a real world dissemination and implementation of TBT. Published by Elsevier Ltd.

  18. Implementing Cognitive Behavioral Therapy in the real world: A case study of two mental health centers

    Directory of Open Access Journals (Sweden)

    Burns Barbara J

    2008-02-01

    Full Text Available Abstract Background Behavioral health services for children and adolescents in the U.S. are lacking in accessibility, availability and quality. Evidence-based interventions for emotional and behavioral disorders can improve quality, yet few studies have systematically examined their implementation in routine care settings. Methods Using quantitative and qualitative data, we evaluated a multi-faceted implementation strategy to implement cognitive-behavioral therapy (CBT for depressed adolescents into two publicly-funded mental healthcare centers. Extent of implementation during the study's duration and variables influencing implementation were explored. Results Of the 35 clinicians eligible to participate, 25 (71% were randomized into intervention (n = 11 or usual care (n = 14. Nine intervention clinicians completed the CBT training. Sixteen adolescents were enrolled in CBT with six of the intervention clinicians; half of these received at least six CBT manually-based sessions. Multiple barriers to CBT adoption and sustained use were identified by clinicians in qualitative interviews. Conclusion Strategies to implement evidence-based interventions into routine clinical settings should include multi-method, pre-implementation assessments of the clinical environment and address multiple barriers to initial uptake as well as long-term sustainability.

  19. The implementation and evaluation of cognitive milieu therapy for dual diagnosis inpatients: A pragmatic clinical trial

    DEFF Research Database (Denmark)

    Lykke, Jørn; Oestrich, Irene; Austin, Stephen

    2010-01-01

    milieu therapy (CMT) among a group of dual diagnosis inpatients. CMT is an integrated treatment for both mental illness and substance abuse based on cognitive behavioral principles and carried out within a supportive inpatient environment. A convenience sample of dual diagnosis inpatients (N = 136......Dual diagnosis is chronic psychiatric condition involving serious mental illness and substance abuse. Experts recommend the integration of treatment for concurrent substance abuse and serious psychiatric problems. The following pragmatic trial examined the implementation and outcomes of cognitive...

  20. Clinicians' perspectives on cognitive therapy in community mental health settings: implications for training and implementation.

    Science.gov (United States)

    Stirman, Shannon Wiltsey; Gutiérrez-Colina, Ana; Toder, Katherine; Esposito, Gregory; Barg, Frances; Castro, Frank; Beck, Aaron T; Crits-Christoph, Paul

    2013-07-01

    Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings.

  1. Reduction of the inappropriate ICD therapies by implementing a new fuzzy logic-based diagnostic algorithm.

    Science.gov (United States)

    Lewandowski, Michał; Przybylski, Andrzej; Kuźmicz, Wiesław; Szwed, Hanna

    2013-09-01

    The aim of the study was to analyze the value of a completely new fuzzy logic-based detection algorithm (FA) in comparison with arrhythmia classification algorithms used in existing ICDs in order to demonstrate whether the rate of inappropriate therapies can be reduced. On the basis of the RR intervals database containing arrhythmia events and controls recordings from the ICD memory a diagnostic algorithm was developed and tested by a computer program. This algorithm uses the same input signals as existing ICDs: RR interval as the primary input variable and two variables derived from it, onset and stability. However, it uses 15 fuzzy rules instead of fixed thresholds used in existing devices. The algorithm considers 6 diagnostic categories: (1) VF (ventricular fibrillation), (2) VT (ventricular tachycardia), (3) ST (sinus tachycardia), (4) DAI (artifacts and heart rhythm irregularities including extrasystoles and T-wave oversensing-TWOS), (5) ATF (atrial and supraventricular tachycardia or fibrillation), and 96) NT (sinus rhythm). This algorithm was tested on 172 RR recordings from different ICDs in the follow-up of 135 patients. All diagnostic categories of the algorithm were present in the analyzed recordings: VF (n = 35), VT (n = 48), ST (n = 14), DAI (n = 32), ATF (n = 18), NT (n = 25). Thirty-eight patients (31.4%) in the studied group received inappropriate ICD therapies. In all these cases the final diagnosis of the algorithm was correct (19 cases of artifacts, 11 of atrial fibrillation and 8 of ST) and fuzzy rules algorithm implementation would have withheld unnecessary therapies. Incidence of inappropriate therapies: 3 vs. 38 (the proposed algorithm vs. ICD diagnosis, respectively) differed significantly (p fuzzy logic based algorithm seems to be promising and its implementation could diminish ICDs inappropriate therapies. We found FA usefulness in correct diagnosis of sinus tachycardia, atrial fibrillation and artifacts in comparison with tested ICDs.

  2. CPAP therapy in patients with mild OSA: implementation and treatment outcome.

    Science.gov (United States)

    Rosenthal; Gerhardstein; Lumley; Guido; Day; Syron; Roth

    2000-07-01

    Objectives: To determine continuous positive airway pressure (CPAP) treatment compliance and reversal of excessive daytime sleepiness in patients with mild OSA.Background: CPAP therapy is the most widely accepted and used intervention in patients with a diagnosis of obstructive sleep apnea (OSA). There are, however, no widely accepted protocols to help guide the rational use of CPAP therapy. Patients with mild OSA (respiratory event index (REI) >5 or CPAP implementation needs to be evaluated.Methods: This is a retrospective study of 740 consecutive patients evaluated for sleep apnea in 1996. Mild OSA was documented in 241 patients, of whom, 41 opted for CPAP therapy. Implementation of CPAP treatment included an education session and an overnight clinical polysomnography (CPSG) for titration purposes. Patients returned for follow-ups after 1 week and 1 year of CPAP use. During each appointment, compliance and response to treatment were evaluated.Results: Of the initial 41 patients nine were lost to follow-up, 16 discontinued CPAP use during the first week, and 16 were still using CPAP after 1 year. For the 16 still using CPAP after one year, hours of use the first week was correlated to hours of use the first year (r=0.81). Patients using CPAP more than 4 h/night experienced a marked improvement in daytime sleepiness after 1 year (PCPAP discontinuation. Those patients who manifested good compliance during the first week of treatment continued using CPAP for the entire first year. These patients experienced improved alertness during the day. A 1 week trial on CPAP therapy is warranted to identify patients who benefit from this form of therapy.

  3. The systematic implementation of acceptance & commitment therapy (ACT) in Dutch multidisciplinary chronic pain rehabilitation.

    Science.gov (United States)

    Trompetter, Hester R; Schreurs, Karlein M G; Heuts, Peter H T G; Vollenbroek-Hutten, Miriam M

    2014-08-01

    This study evaluates the implementation of Acceptance & Commitment Therapy (ACT) in Dutch chronic pain rehabilitation centers. Changes in multidisciplinary professionals' self-perceived competencies in working with ACT were evaluated and corroborated with patients' ratings of treatment adherence. To inform subsequent implementation efforts, relevant determinants of implementation success were monitored and the relationship with self-perceived competencies over time was explored. Data was gathered from 111 professionals, 9 managers and 79 patients using questionnaires at the start (T0), halfway (T1) and end (T2) of implementation, and at the end of treatment. All professionals adhered to ACT, improved significantly in self-perceived competencies over time and rated competence in working with ACT ≥ adequate at T2. Determinants of success were evaluated extremely positive by professionals and management. Professionals' self-perceived competencies at T2 were most strongly related to ratings of more workload (b=-.43), and experienced difficulties in working with ACT (b=-.38) at T0 and T1. Multidisciplinary chronic pain rehabilitation professionals rated their improvement in working with ACT positively during the implementation period. Impeding and facilitating factors were explored successfully. A multi-faceted, long-term, educational, train-the-trainer approach may help to guide systematic changes in multidisciplinary treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Implementation of practice guidelines for antifungal therapy in a surgical intensive care unit and its impact on use and costs.

    Science.gov (United States)

    Swoboda, Stefanie; Lichtenstern, Christoph; Ober, Michael Christoff; Taylor, Lenka Alexandra; Störzinger, Dominic; Michel, André; Brobeil, Angelika; Mieth, Markus; Hofer, Stefan; Sonntag, Hans-Günther; Hoppe-Tichy, Torsten; Weigand, Markus Alexander

    2009-01-01

    Considering the complexity of diagnosis, high costs of therapy and high morbidity and mortality of systemic fungal infections, antifungal therapy of intensive care patients should follow clearly defined guidelines. We outline the impact of a standardised practice of antifungal treatment in an interdisciplinary surgical intensive care unit of a university hospital. Therapy was intended to be optimised by implementation of standardised practice guidelines supported by the clinical pharmacist. Costs for antifungal agents during a period of 18 months before and after implementation of the practice guidelines were compared, respectively. The intervention was associated with a significant decrease in use of antifungal agents. Analysis of data revealed a reduction in costs by 50%. This could substantially be attributed to the implementation of the practice guidelines. The implementation of standardised practice guidelines for antifungal therapy in intensive care units decreased the use of selected antifungal agents and resulted in substantial reduction in expenditure on antifungal agents. Copyright 2009 S. Karger AG, Basel.

  5. Designing and implementing a physiology course for a new doctoral occupational therapy program with student feedback.

    Science.gov (United States)

    Goodman, Barbara E; Ikiugu, Moses N

    2017-09-01

    Recently, the Occupational Therapy Department requested a custom-designed medical physiology course for the students in the new occupational therapy doctoral program. The first author, a physiologist with extensive experience in teaching both undergraduate preprofessional and medical students in human physiology, was recruited to design and implement the course. The course was designed to be consistent with the constructivist philosophy that guides the occupational therapy curriculum. The course was offered for the first time during fall/spring 2015/2016 and included both first- and second-year occupational therapy doctoral students. A number of anonymous assessment tools were used to evaluate students' perceptions regarding the effectiveness of various pedagogies used in the course in enhancing their learning. A summative course assessment survey with comments was used at the end of the course. This paper describes the model of course design and the student feedback, which generated some suggestions for improvement of the course. This approach in designing a new course for a new disciplinary group of students should be helpful to other faculty involved in developing courses for health career programs populated by students with variable physiology backgrounds and different educational needs. The final relevant feedback from the course would be to have the students evaluate the usefulness of the course to their future careers immediately following their certification examinations in a year or two and during their subsequent clinical experiences; however, that information will likely be more difficult to obtain. Copyright © 2017 the American Physiological Society.

  6. [Quality of vocational education in speech therapy - development and implementation of a quality assurance programme].

    Science.gov (United States)

    Ullrich, A; Kawski, S; Koch, U; Härter, M

    2014-12-01

    The provision of high-quality health-services is only possible if it is based on vocational education of corresponding quality. To promote the quality of vocational education in speech therapy, a quality assurance programme was developed in a scientifically supervised multi-step process. The main goals of the quality assurance programme include: (i) external review of the quality of education by means of well-defined criteria, (ii) certification of schools that meet the requirements, and (iii) provision of feedback to schools about their results. A total of 208 quality indicators cover the essential aspects of vocational education in speech therapy, and apply to the structural, process and outcome quality. These indicators are based on a literature survey as well as on expert opinion, and are calibrated by data. The data are collected by using questionnaires (school management, teachers in speech therapy, students, consecutive patient sample) and are validated by specific document analyses and telephone audits. Each school receives an individual quality report of its achieved results benchmarked to other schools. Since the initial implementation in 2008, a total of 50 schools participated in the quality assurance programme and 41 achieved certification. Therefore, the defined set of quality criteria has been disseminated and utilized by about half of all German schools for vocational education in speech therapy. The evaluation of the data on quality collected across all schools highlights the strengths and weaknesses of vocational education as well as the demands for quality improvement. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Challenges in implementing individualized medicine illustrated by antimetabolite therapy of childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Nersting, Jacob; Borst, Louise; Schmiegelow, Kjeld

    2011-01-01

    ABSTRACT: Predicting the response to medical therapy and subsequently individualizing the treatment to increase efficacy or reduce toxicity has been a longstanding clinical goal. Not least within oncology, where many patients fail to be cured, and others are treated to or beyond the limit...... of acceptable toxicity, an individualized therapeutic approach is indicated. The mapping of the human genome and technological developments in DNA sequencing, gene expression profiling, and proteomics have raised the expectations for implementing genotype-phenotype data into the clinical decision process......, but also multiplied the complex interaction of genetic and other laboratory parameters that can be used for therapy adjustments. Thus, with the advances in the laboratory techniques, post laboratory issues have become major obstacles for treatment individualization. Many of these challenges have been...

  8. A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial

    NARCIS (Netherlands)

    Dopp, C.M.E.; Graff, M.J.L.; Teerenstra, S.; Adang, E.M.M.; Nijhuis-Van der Sanden, R.; Olde Rikkert, M.G.M.; Vernooij-Dassen, M.J.F.J.

    2011-01-01

    BACKGROUND: Even effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD) program was not implemented optimally due to various barriers. To decrease

  9. Implementation of outpatient schema therapy for borderline personality disorder: study design

    Directory of Open Access Journals (Sweden)

    van Asselt Thea

    2009-10-01

    Full Text Available Abstract Background Schema Therapy (ST is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis. Methods/Design Patient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%. Discussion The study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value. Trial Registration The Dutch Cochrane Center, NTR (TC = 1781.

  10. Implementation of outpatient schema therapy for borderline personality disorder: study design.

    Science.gov (United States)

    Nadort, Marjon; Arntz, Arnoud; Smit, Johannes H; Giesen-Bloo, Josephine; Eikelenboom, Merijn; Spinhoven, Philip; van Asselt, Thea; Wensing, Michel; van Dyck, Richard

    2009-10-06

    Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD) in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis. Patient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%. The study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value. The Dutch Cochrane Center, NTR (TC = 1781).

  11. Family therapy for schizophrenia: cultural challenges and implementation barriers in the South African context.

    Science.gov (United States)

    Asmal, L; Mall, S; Kritzinger, J; Chiliza, B; Emsley, R; Swartz, L

    2011-11-01

    Family therapy is an effective, evidence based intervention for schizophrenia. This literature review explores the impact of culture on family therapy as a treatment model for schizophrenia and examines how cultural beliefs impact on access to care. Although there is a good deal of evidence to suggest that certain principles of family therapy such as empathy and psycho-education are universal, there is a paucity of literature about the role of culture in designing family interventions for people living with schizophrenia in a culturally diverse setting such as South Africa. It is well acknowledged that cultural ideologies influence families' belief systems of schizophrenia, expected expressed emotion, and levels of stigma in relation to mental illness. Additionally, in adapting models designed for first-world settings, consideration needs to be given to aspects such as language, educational level and accessibility of mental health care facilities. Family therapists are increasingly recognising the need for the study and implementation of evidence based culture-relevant and culture-responsive therapeutic techniques. These techniques need to be cost-effective and will require training, supervision, staff support, and management input in order to become generally available.

  12. Implementing lifestyle medicine with medication therapy management services to improve patient-centered health care.

    Science.gov (United States)

    Lenz, Thomas L; Monaghan, Michael S

    2011-01-01

    To describe a patient-centered medication therapy management (MTM) program that focuses on lifestyle medicine. Community pharmacy in Omaha, NE, from August 2008 to September 2010. Traditional MTM services are combined with lifestyle medicine interventions for employees of a self-insured organization who have dyslipidemia, hypertension, and/or diabetes. Program participants meet one-on-one with a pharmacist 12 times during the first year of the program to ensure proper drug therapy and modify lifestyle behaviors (physical activity, nutrition, weight control, sleep, stress, and alcohol and tobacco use) through individualized programming. Several patient-centered activities have been developed for the program with an emphasis on modifying lifestyle behaviors in conjunction with medications to manage participants' chronic condition. In addition, a new specialty position in health care is being developed (the ambulatist) that focuses on maintaining the ambulatory status of individuals with chronic medical conditions through appropriate drug therapy, lifestyle medicine, and care coordination. Biometric data collection and participant survey data at baseline and after 12 months. Pilot data for 15 participants showed improvements in all measurements, including blood cholesterol, low-density lipoprotein cholesterol, blood glucose, body weight, physical activity level, fruit and vegetable intake, risk for myocardial infarction, risk for any cardiovascular disease event, self-reported unhealthy days, and qualitative survey data. Pharmacists are in an ideal position to implement lifestyle medicine strategies in combination with MTM services to enhance patient-centered health care in a community pharmacy setting.

  13. Staff training and outreach support for Cognitive Stimulation Therapy and its implementation in practice: a cluster randomised trial.

    Science.gov (United States)

    Streater, Amy; Spector, Aimee; Hoare, Zoe; Aguirre, Elisa; Russell, Ian; Orrell, Martin

    2017-12-01

    There is evidence that Cognitive Stimulation Therapy and maintenance Cognitive Stimulation Therapy are effective in mild to moderate dementia. There is, however, little evidence available for its implementation in practice and the impact of outreach support on the sustainability of the programme. Two hundred and forty-one staff members were randomised from 63 dementia care settings between outreach support including an online forum, email, and telephone support, compared to usual Cognitive Stimulation Therapy control group. The primary outcome was average number of attendees to the Cognitive Stimulation Therapy and maintenance Cognitive Stimulation Therapy programmes. There was no difference in average number of attendees between the intervention and usual Cognitive Stimulation Therapy control groups for the Cognitive Stimulation Therapy (p = 0.82) or the maintenance Cognitive Stimulation Therapy programme (p = 0.97). Outreach support does not affect the average number of people with dementia attending the Cognitive Stimulation Therapy or maintenance Cognitive Stimulation Therapy programme. Irrespective of outreach support, the programmes remain widely implemented and yield perceived benefits for people with dementia. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  14. Implementing a hospital-based animal therapy program for children with cancer: a descriptive study.

    Science.gov (United States)

    Gagnon, Johanne; Bouchard, France; Landry, Marie; Belles-Isles, Marthe; Fortier, Martine; Fillion, Lise

    2004-01-01

    Children living with cancer must cope with the disease, frequent hospitalizations, aggressive treatments and numerous treatment side effects. Combined, these stressors can lead to adverse biopsychosocial effects. An animal therapy program called "A Magical Dream" was instituted for children hospitalized in pediatric oncology to promote their well-being during hospitalization and facilitate their adaptation to the therapeutic process. The main goal of this preliminary study was to complete a descriptive assessment of the program implementation using Donabedian's quality model. This study aims more specifically at documenting the observed connection between participating in the program, quality of care and satisfaction of participating parents and nurses. A total of 16 parents of children and 12 nurses took part in the implementation study and composed the sample. Data were collected through two self-administered questionnaires intended for parents and one questionnaire for nurses. Evaluating the quality of the animal therapy program includes issues related to user profiles, animal therapy intervention process, organizational structure and client outcomes. It appears that dog-assisted therapy may contribute to alleviate psychological distress in children and parents, facilitate their adaptation to the therapeutic process, and promote their well-being while hospitalized. The goal of a second phase to the project will be to verify the effectiveness of the animal therapy intervention by targeting more specifically children hospitalized with solid tumours. Stemming from a nursing initiative started in 1999, this project aims to promote the well-being of children living with cancer during their hospitalization, reduce their emotional distress and facilitate their adaptation to the therapeutic (psychological, physical and social) process by promoting the emergence of special bonds between children and animals. The animal therapy program at CHUQ allows children accompanied

  15. Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study

    Directory of Open Access Journals (Sweden)

    Blevins Dean

    2010-10-01

    Full Text Available Abstract Background Although for more than a decade healthcare systems have attempted to provide evidence-based mental health treatments, the availability and use of psychotherapies remains low. A significant need exists to identify simple but effective implementation strategies to adopt complex practices within complex systems of care. Emerging evidence suggests that facilitation may be an effective integrative implementation strategy for adoption of complex practices. The current pilot examined the use of external facilitation for adoption of cognitive behavioral therapy (CBT in 20 Department of Veteran Affairs (VA clinics. Methods The 20 clinics were paired on facility characteristics, and 23 clinicians from these were trained in CBT. A clinic in each pair was randomly selected to receive external facilitation. Quantitative methods were used to examine the extent of CBT implementation in 10 clinics that received external facilitation compared with 10 clinics that did not, and to better understand the relationship between individual providers' characteristics and attitudes and their CBT use. Costs of external facilitation were assessed by tracking the time spent by the facilitator and therapists in activities related to implementing CBT. Qualitative methods were used to explore contextual and other factors thought to influence implementation. Results Examination of change scores showed that facilitated therapists averaged an increase of 19% [95% CI: (2, 36] in self-reported CBT use from baseline, while control therapists averaged a 4% [95% CI: (-14, 21] increase. Therapists in the facilitated condition who were not providing CBT at baseline showed the greatest increase (35% compared to a control therapist who was not providing CBT at baseline (10% or to therapists in either condition who were providing CBT at baseline (average 3%. Increased CBT use was unrelated to prior CBT training. Barriers to CBT implementation were therapists' lack of

  16. A framework for implementation of organ effect models in TOPAS with benchmarks extended to proton therapy

    Science.gov (United States)

    Ramos-Méndez, J.; Perl, J.; Schümann, J.; Shin, J.; Paganetti, H.; Faddegon, B.

    2015-07-01

    The aim of this work was to develop a framework for modeling organ effects within TOPAS (TOol for PArticle Simulation), a wrapper of the Geant4 Monte Carlo toolkit that facilitates particle therapy simulation. The DICOM interface for TOPAS was extended to permit contour input, used to assign voxels to organs. The following dose response models were implemented: The Lyman-Kutcher-Burman model, the critical element model, the population based critical volume model, the parallel-serial model, a sigmoid-based model of Niemierko for normal tissue complication probability and tumor control probability (TCP), and a Poisson-based model for TCP. The framework allows easy manipulation of the parameters of these models and the implementation of other models. As part of the verification, results for the parallel-serial and Poisson model for x-ray irradiation of a water phantom were compared to data from the AAPM Task Group 166. When using the task group dose-volume histograms (DVHs), results were found to be sensitive to the number of points in the DVH, with differences up to 2.4%, some of which are attributable to differences between the implemented models. New results are given with the point spacing specified. When using Monte Carlo calculations with TOPAS, despite the relatively good match to the published DVH’s, differences up to 9% were found for the parallel-serial model (for a maximum DVH difference of 2%) and up to 0.5% for the Poisson model (for a maximum DVH difference of 0.5%). However, differences of 74.5% (in Rectangle1), 34.8% (in PTV) and 52.1% (in Triangle) for the critical element, critical volume and the sigmoid-based models were found respectively. We propose a new benchmark for verification of organ effect models in proton therapy. The benchmark consists of customized structures in the spread out Bragg peak plateau, normal tissue, tumor, penumbra and in the distal region. The DVH’s, DVH point spacing, and results of the organ effect models are provided

  17. Implementation of internet-delivered cognitive behavior therapy within community mental health clinics: a process evaluation using the consolidated framework for implementation research.

    Science.gov (United States)

    Hadjistavropoulos, H D; Nugent, M M; Dirkse, D; Pugh, N

    2017-09-12

    Depression and anxiety are prevalent and under treated conditions that create enormous burden for the patient and the health system. Internet-delivered cognitive behavior therapy (ICBT) improves patient access to treatment by providing therapeutic information via the Internet, presented in sequential lessons, accompanied by brief weekly therapist support. While there is growing research supporting ICBT, use of ICBT within community mental health clinics is limited. In a recent trial, an external unit specializing in ICBT facilitated use of ICBT in community mental health clinics in one Canadian province (ISRCTN42729166; registered November 5, 2013). Patient outcomes were very promising and uptake was encouraging. This paper reports on a parallel process evaluation designed to understand facilitators and barriers impacting the uptake and implementation of ICBT. Therapists (n = 22) and managers (n = 11) from seven community mental health clinics dispersed across one Canadian province who were involved in implementing ICBT over ~2 years completed an online survey (including open and closed-ended questions) about ICBT experiences. The questions were based on the Consolidated Framework for Implementation Research (CFIR), which outlines diverse constructs that have the potential to impact program implementation. Analyses suggested ICBT implementation was perceived to be most prominently facilitated by intervention characteristics (namely the relative advantages of ICBT compared to face-to-face therapy, the quality of the ICBT program that was delivered, and evidence supporting ICBT) and implementation processes (namely the use of an external facilitation unit that aided with engaging patients, therapists, and managers and ICBT implementation). The inner setting was identified as the most significant barrier to implementation as a result of limited resources for ICBT combined with greater priority given to face-to-face care. The results contribute to understanding

  18. The implementation and evaluation of cognitive milieu therapy for dual diagnosis inpatients: A pragmatic clinical trial

    DEFF Research Database (Denmark)

    Lykke, Jørn; Oestrich, I.; Austin, Stephen

    2010-01-01

    ) was assessed pre- and post-intervention from an inpatient setting where CMT was the mode of treatment. Psychopathology was measured using the Brief Psychiatric Rating Scale and substance abuse measured with the DrugCheck scale, breath/urine samples, and the Severity of Dependence Scale. Functioning......Dual diagnosis is chronic psychiatric condition involving serious mental illness and substance abuse. Experts recommend the integration of treatment for concurrent substance abuse and serious psychiatric problems. The following pragmatic trial examined the implementation and outcomes of cognitive...... milieu therapy (CMT) among a group of dual diagnosis inpatients. CMT is an integrated treatment for both mental illness and substance abuse based on cognitive behavioral principles and carried out within a supportive inpatient environment. A convenience sample of dual diagnosis inpatients (N = 136...

  19. Implementation of indicators through balanced scorecards in a nutritional therapy company.

    Science.gov (United States)

    de Matos Nasser, Emanuele; Reis da Costa, Stella Regina

    2013-01-01

    The Balanced Scorecard (BSC) is a tool that helps in strategic management under the four following perspectives: the financial one, the client s, the internal processes of the company's, the growth and learning processes. In order to measure the performance of the entities, the BSC uses as a basis financial and non-financial indicators. To implement the BSC in a nutrional therapy company. This research deals with a case study that took place in a nutrional therapy company from January to November 2010. For analysis of the learning and growth perspective all 45 of the company's collaborators were considered and for client analysis 124 home-care clients were considered. The study sample consisted of 39 collaborators and 44 clients participating in the research. Material was elaborated for collection of data and verification of perspective tendencies through analysis of the main processes of the company, questionnaires of client's satisfaction, questionnaires of collaborator s satisfaction and spread sheets for the verification of net renvenue and percentage of disallowances. The data was launched in the spread sheet of the Excel Application Program. The indicators were chosen conforming to the strategic objectives and organizational profiles. Learning perspectives and personal growth: efficacy in capacitaion 94%, participation 77%, fidelity/retention 93%, satisfaction 75%, organizational environment 88%, well being 100%, process perspective: microbiological analysis 100%, internal auditing 100%, productivity 100%, nutritional evaluation 81%, nutritional support 100%, indication for domicile hospital care 94%, home-care visits 98%, client perspective: company perception 97%, prioritizating 94%, retention 59%, insatisfaction 24%, logistics 94%, customers ervice (SAC) 88%, motivation: trust, financial perspectives, disallowances 5% and positive company net revenue. The implementation of indicators under the four perspectives of the Balanced Scorecard were favourable in

  20. Implementation of transdiagnostic cognitive therapy in community behavioral health: The Beck Community Initiative.

    Science.gov (United States)

    Creed, Torrey A; Frankel, Sarah A; German, Ramaris E; Green, Kelly L; Jager-Hyman, Shari; Taylor, Kristin P; Adler, Abby D; Wolk, Courtney B; Stirman, Shannon W; Waltman, Scott H; Williston, Michael A; Sherrill, Rachel; Evans, Arthur C; Beck, Aaron T

    2016-12-01

    Progress bringing evidence-based practice (EBP) to community behavioral health (CBH) has been slow. This study investigated feasibility, acceptability, and fidelity outcomes of a program to implement transdiagnostic cognitive therapy (CT) across diverse CBH settings, in response to a policy shift toward EBP. Clinicians (n = 348) from 30 CBH programs participated in workshops and 6 months of consultation. Clinician retention was examined to assess feasibility, and clinician feedback and attitudes were evaluated to assess implementation acceptability. Experts rated clinicians' work samples at baseline, mid-, and end-of-consultation with the Cognitive Therapy Rating Scale (CTRS) to assess fidelity. Feasibility was demonstrated through high program retention (i.e., only 4.9% of clinicians withdrew). Turnover of clinicians who participated was low (13.5%) compared to typical CBH turnover rates, even during the high-demand training period. Clinicians reported high acceptability of EBP and CT, and self-reported comfort using CT improved significantly over time. Most clinicians (79.6%) reached established benchmarks of CT competency by the final assessment point. Mixed-effects hierarchical linear models indicated that CTRS scores increased significantly from baseline to the competency assessment (p < .001), on average by 18.65 points. Outcomes did not vary significantly between settings (i.e., outpatient vs. other). Even clinicians motivated by policy-change rather than self-nomination may feasibly be trained to deliver a case-conceptualization driven EBP with high levels of competency and acceptability. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  1. Feasibility and acceptability of two incentive-based implementation strategies for mental health therapists implementing cognitive-behavioral therapy: a pilot study to inform a randomized controlled trial.

    Science.gov (United States)

    Beidas, Rinad S; Becker-Haimes, Emily M; Adams, Danielle R; Skriner, Laura; Stewart, Rebecca E; Wolk, Courtney Benjamin; Buttenheim, Alison M; Williams, Nathaniel J; Inacker, Patricia; Richey, Elizabeth; Marcus, Steven C

    2017-12-15

    Informed by our prior work indicating that therapists do not feel recognized or rewarded for implementation of evidence-based practices, we tested the feasibility and acceptability of two incentive-based implementation strategies that seek to improve therapist adherence to cognitive-behavioral therapy for youth, an evidence-based practice. This study was conducted over 6 weeks in two community mental health agencies with therapists (n = 11) and leaders (n = 4). Therapists were randomized to receive either a financial or social incentive if they achieved a predetermined criterion on adherence to cognitive-behavioral therapy. In the first intervention period (block 1; 2 weeks), therapists received the reward they were initially randomized to if they achieved criterion. In the second intervention period (block 2; 2 weeks), therapists received both rewards if they achieved criterion. Therapists recorded 41 sessions across 15 unique clients over the project period. Primary outcomes included feasibility and acceptability. Feasibility was assessed quantitatively. Fifteen semi-structured interviews were conducted with therapists and leaders to assess acceptability. Difference in therapist adherence by condition was examined as an exploratory outcome. Adherence ratings were ascertained using an established and validated observational coding system of cognitive-behavioral therapy. Both implementation strategies were feasible and acceptable-however, modifications to study design for the larger trial will be necessary based on participant feedback. With respect to our exploratory analysis, we found a trend suggesting the financial reward may have had a more robust effect on therapist adherence than the social reward. Incentive-based implementation strategies can be feasibly administered in community mental health agencies with good acceptability, although iterative pilot work is essential. Larger, fully powered trials are needed to compare the effectiveness of

  2. Multidimensional Family Therapy: Evidence Base for Transdiagnostic Treatment Outcomes, Change Mechanisms, and Implementation in Community Settings.

    Science.gov (United States)

    Liddle, Howard A

    2016-09-01

    This article summarizes the 30+-year evidence base of Multidimensional Family Therapy (MDFT), a comprehensive treatment for youth substance abuse and antisocial behaviors. Findings from four types of MDFT studies are discussed: hybrid efficacy/effectiveness randomized controlled trials, therapy process studies, cost analyses, and implementation trials. This research has evaluated various versions of MDFT. These studies have systematically tested adaptations of MDFT for diverse treatment settings in different care sectors (mental health, substance abuse, juvenile justice, and child welfare), as well as adaptations according to treatment delivery features and client impairment level, including adolescents presenting with multiple psychiatric diagnoses. Many published scientific reviews, including meta-analyses, national and international government publications, and evidence-based treatment registries, offer consistent conclusions about the clinical effectiveness of MDFT compared with standard services as well as active treatments. The diverse and continuing MDFT research, the favorable, multi-source independent evaluations, combined with the documented receptivity of youth, parents, community-based clinicians and administrators, and national and international MDFT training programs (U.S.-based organization is MDFT International, www.mdft.org; and Europe-based organization is www.mdft.nl) all support the potential for continued transfer of MDFT to real-world clinical settings. © 2016 Family Process Institute.

  3. A Randomized Implementation Study of Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Teens in Residential Treatment Facilities

    OpenAIRE

    Cohen, Judith A.; Mannarino, Anthony P.; Jankowski, Kay; Rosenberg, Stanley; Kodya, Suzanne; Wolford, George L.

    2016-01-01

    Adjudicated youth in residential treatment facilities (RTFs) have high rates of trauma exposure and post-traumatic stress disorder (PTSD). This study evaluated strategies for implementing trauma-focused cognitive behavioral therapy (TF-CBT) in RTF. Therapists (N = 129) treating adjudicated youth were randomized by RTF program (N = 18) to receive one of the two TF-CBT implementation strategies: (1) web-based TF-CBT training + consultation (W) or (2) W + 2 day live TF-CBT workshop + twice month...

  4. Barriers in the implementation of isoniazid preventive therapy for people living with HIV in Northern Ethiopia: a mixed quantitative and qualitative study

    NARCIS (Netherlands)

    Teklay, Gebrehiwot; Teklu, Tsigemariam; Legesse, Befikadu; Tedla, Kiros; Klinkenberg, Eveline

    2016-01-01

    Isoniazid preventive therapy is a key public health intervention for the prevention of tuberculosis disease among people living with HIV. Despite the confirmed efficacy of isoniazid preventive therapy and global recommendations existing for decades, its implementation remains limited. In resource

  5. Electron arc therapy: design, implementation and evaluation of a dynamic multi-vane collimator system.

    Science.gov (United States)

    Leavitt, D D; Stewart, J R; Moeller, J H; Lee, W L; Takach, G A

    1989-11-01

    Innovative techniques in motion control technology have been applied to the design and implementation of a portable computer-controlled multi-vane collimator for use in electron arc therapy. The collimator, consisting of 18 independently controlled vanes, is inserted into the standard accessory mount assembly of a linear accelerator, in the same fashion as standard field shaping blocks. Power is supplied to the collimator vane motors via a self-contained battery system. The range of motion of the vanes, symmetrically mounted nine on each side, provides a variable aperture width projected to isocenter of 2 cm minimum to 8 cm maximum. The projected length of the aperture at isocenter is 38 cm. The transition time between vane positions is less than 1 second, corresponding to gantry movement of less than 1 degree. The movement of each of the 18 vanes is monitored and controlled by six individually addressed three axis processors that are shielded from the electron beam. A table of collimator vane positions versus gantry angle, as determined by dose optimization calculations, is stored in a data file. The desired collimator vane position corresponding to the current arc segment is conveyed from the control console to each vane controller via packets within a token passing network. Communication between the computer in the console area and the vane controllers is accomplished through encoded infra-red pulse transmission, eliminating the need for additional communication lines between the console and the accelerator. This dynamic collimator offers improved dose uniformity while simplifying the delivery of electron arc therapy.

  6. Dialectical Behavior Therapy of borderline patients with and without substance use problems - Implementation and long-term effects

    NARCIS (Netherlands)

    van den Bosch, Louisa M. C.; Verheul, Roel; Schippers, Gerard M.; van den Brink, Wim

    2002-01-01

    Objective: The aim of this article is to examine whether standard Dialectical Behavior Therapy (DBT) (1) can be successfully implemented in a mixed population of borderline patients with or without comorbid substance abuse (SA), (2) is equally efficacious in reducing borderline symptomatology among

  7. Implementing Precision Antimicrobial Therapy for the Treatment of Bovine Respiratory Disease: Current Limitations and Perspectives

    Science.gov (United States)

    Lhermie, Guillaume; Toutain, Pierre-Louis; El Garch, Farid; Bousquet-Mélou, Alain; Assié, Sébastien

    2017-01-01

    treatment, accounting for more than 90% of the antimicrobial amount in the herds implementing prophylaxis. The higher number of treatments in the groups treated on the basis of ruminal temperature monitoring, the accuracy of the detection method, and the necessary conditions to implement precision antimicrobial therapy in the field are discussed in this article. PMID:28900616

  8. Implementing Precision Antimicrobial Therapy for the Treatment of Bovine Respiratory Disease: Current Limitations and Perspectives

    Directory of Open Access Journals (Sweden)

    Guillaume Lhermie

    2017-08-01

    antimicrobial treatment, accounting for more than 90% of the antimicrobial amount in the herds implementing prophylaxis. The higher number of treatments in the groups treated on the basis of ruminal temperature monitoring, the accuracy of the detection method, and the necessary conditions to implement precision antimicrobial therapy in the field are discussed in this article.

  9. [Implementation of interdisciplinary multimodal pain therapy according to OPS 8‑918 : Recommendations of the ad hoc commission for interdisciplinary multimodal pain therapy of the German Pain Association].

    Science.gov (United States)

    Arnold, B; Böger, A; Brinkschmidt, T; Casser, H-R; Irnich, D; Kaiser, U; Klimczyk, K; Lutz, J; Pfingsten, M; Sabatowski, R; Schiltenwolf, M; Söllner, W

    2018-02-01

    With the implementation of the German diagnosis-related groups (DRG) reimbursement system in hospitals, interdisciplinary multimodal pain therapy was incorporated into the associated catalogue of procedures (OPS 8‑918). Yet, the presented criteria describing the procedure of interdisciplinary multimodal pain therapy are neither precise nor unambiguous. This has led to discrepancies in the interpretation regarding the handling of the procedure-making it difficult for medical services of health insurance companies to evaluate the accordance between the delivered therapy and the required criteria. Since the number of pain units has increased in recent years, the number of examinations by the medical service of health insurance companies has increased. This article, published by the ad hoc commission for interdisciplinary multimodal pain therapy of the German Pain Association, provides specific recommendations for correct implementation of interdisciplinary multimodal pain therapy in routine care. The aim is to achieve a maximum level of accordance between health care providers and the requirements of the medical examiners from health insurance companies. More extensive criteria regarding interdisciplinary multimodal pain treatment in an in-patient setting, especially for patients with chronic and complex pain, are obviously needed. Thus, the authors further discuss specific aspects towards further development of the OPS-code. However, the application of the OPS-code still leaves room regarding treatment intensity and process quality. Therefore, the delivery of pain management in sufficient quantity and quality still remains the responsibility of each health care provider.

  10. Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience.

    Science.gov (United States)

    Nuffer, Wesley; Gilliam, Eric; Thompson, Megan; Vande Griend, Joseph

    2017-03-25

    Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students' self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services.

  11. Implementation of a training program for low-literacy promotoras in oral rehydration therapy.

    Science.gov (United States)

    Amerson, Roxanne; Hall-Clifford, Rachel; Thompson, Beti; Comninellas, Nicholas

    2015-01-01

    The purpose of this study was to ascertain the effectiveness of a culturally appropriate promotora training program related to oral rehydration therapy and diarrheal management. Factors that influenced the development, implementation, and evaluation of the program provided to low-literacy women in Guatemala are explored. Promotora training was conducted with 15 Mayan women from a rural community in the highlands of Guatemala. Women were selected by leaders of the community to participate in the program. Quantitative data were collected and analyzed to determine descriptive statistics and reliability coefficients for the pretests and posttests. A nonparametric Wilcoxon test for paired-samples was conducted. The qualitative data from the program evaluations were analyzed for themes. Mean scores increased from 41.73 (SD = 9.65) to 70.33 (SD = 21.29) on the pretest and posttest. The Cronbach's alpha was 0.54 on the pretest with 0.65 on the posttest. The Wilcoxon test demonstrated a significant difference between the pretest and posttest scores (Z = 3.040, p < .05). Extremely low-literacy levels played a major role in the ability of the women to successfully complete the requirements of the training program. The curriculum demonstrated effectiveness, but will benefit from replication with a larger sample. © 2014 Wiley Periodicals, Inc.

  12. Implementing evidence-based patient and family education on oral anticoagulation therapy: a community-based participatory project.

    Science.gov (United States)

    Shaha, Maya; Wüthrich, Erika; Stauffer, Yvonne; Herczeg, Franziska; Fattinger, Karin; Hirter, Kathrin; Papalini, Marianne; Herrmann, Luzia

    2015-06-01

    This study aimed at developing and implementing evidence-based patient and family education on oral anticoagulation therapy. The number of persons with chronic diseases who live at home is increasing. They have to manage multiple diseases and complex treatments. One such treatment is oral anticoagulation therapy, a high risk variable dose medication. Adherence to oral anticoagulation therapy is jeopardised by limited information about the medications, their risk and complications, the impact of individual daily routine and the limited inclusion of family members in education. Hence, improved and tailored education is essential for patients and families to manage oral anticoagulation therapy at home. A community-based participatory research design combined with the Precede-Proceed model was used including a systematic literature review, posteducation analysis, an online nurse survey, a documentation analysis and patient/family interviews. The study was conducted between April 2010-December 2012 at a department of general internal medicine in a teaching hospital in Switzerland. Participants were the department's nursing and medical professionals including the patients and their families. The evidence-based patient and family education on oral anticoagulation therapy emerged comprising a learning assessment, teaching units, clarification of responsibilities of nurse professionals and documentation guidelines. The inclusion of the whole department has contributed to the development and implementation of this evidence-based patient family education on oral anticoagulation therapy, which encompasses local characteristics and patient preferences. This education is now being used throughout the department. © 2015 John Wiley & Sons Ltd.

  13. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.

    Science.gov (United States)

    Cully, Jeffrey A; Armento, Maria E A; Mott, Juliette; Nadorff, Michael R; Naik, Aanand D; Stanley, Melinda A; Sorocco, Kristen H; Kunik, Mark E; Petersen, Nancy J; Kauth, Michael R

    2012-07-11

    Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews

  14. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design

    Directory of Open Access Journals (Sweden)

    Cully Jeffrey A

    2012-07-01

    Full Text Available Abstract Background Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. Methods This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1 to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases primary care patients and (2 to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200 or usual care (n = 120. Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points and

  15. Adapting and implementing an evidence-based treatment with justice-involved adolescents: the example of multidimensional family therapy.

    Science.gov (United States)

    Liddle, Howard A

    2014-09-01

    For over four decades family therapy research and family centered evidence-based therapies for justice-involved youths have played influential roles in changing policies and services for these young people and their families. But research always reveals challenges as well as advances. To be sure, demonstration that an evidence-based therapy yields better outcomes than comparison treatments or services as usual is an accomplishment. But the extraordinary complexity embedded in that assertion feels tiny relative to what we are now learning about the so-called transfer of evidence-based treatments to real world practice settings. Today's family therapy studies continue to assess outcome with diverse samples and presenting problems, but research and funding priorities also include studying particular treatments in nonresearch settings. Does an evidence-based intervention work as well in a community clinic, with clinic personnel? How much of a treatment has to change to be accepted and implemented in a community clinic? Perhaps it is the setting and existing procedures that have to change? And, in those cases, do accommodations to the context compromise outcomes? Thankfully, technology transfer notions gave way to more systemic, dynamic, and frankly, more family therapy-like conceptions of the needed process. Implementation science became the more sensible, as well as the theoretically and empirically stronger overarching framework within which the evidence-based family based therapies now operate. Using the example of Multidimensional Family Therapy, this article discusses treatment development, refinement, and implementation of that adapted approach in a particular clinical context-a sector of the juvenile justice system-juvenile detention. © 2014 FPI, Inc.

  16. A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial

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    Adang Eddy

    2011-03-01

    Full Text Available Abstract Background Even effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD program was not implemented optimally due to various barriers. To decrease these barriers and make implementation of the program more effective a combined implementation (CI strategy was developed. In our study we will compare the effectiveness of this CI strategy with the usual educational (ED strategy. Methods In this cluster randomized, single-blinded, controlled trial, each cluster consists of at least two occupational therapists, a manager, and a physician working at Dutch healthcare organizations that deliver community occupational therapy. Forty-five clusters, stratified by healthcare setting (nursing home, hospital, mental health service, have been allocated randomly to either the intervention group (CI strategy or the control group (ED strategy. The study population consists of the professionals included in each cluster and community-dwelling people with dementia and their caregivers. The primary outcome measures are the use of community OT, the adherence of OTs to the COTiD program, and the cost effectiveness of implementing the COTiD program in outpatient care. Secondary outcome measures are patient and caregiver outcomes and knowledge of managers, physicians and OTs about the COTiD program. Discussion Implementation research is fairly new in the field of occupational therapy, making this a unique study. This study does not only evaluate the effects of the CI-strategy on professionals, but also the effects of professionals' degree of implementation on client and caregiver outcomes. Clinical trials registration NCT01117285

  17. Operational barriers to the implementation of multidrug therapy and leprosy elimination in Cameroon

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    Nsagha Dickson

    2009-01-01

    Full Text Available Background: The World Health Organization targeted to eliminate leprosy from the world with multidrug therapy (MDT by 2000. But, leprosy remains a problem in Essimbiland of Menchum Division of Cameroon, with a prevalence of 1.7/10,000 and high rate of case detection in children. Aims: To assess knowledge and practices on the cure of leprosy, treatment duration, drug availability and problems faced by leprosy patients acquiring drugs in order to enhance MDT implementation and leprosy elimination in Menchum and Boyo divisions. Methods: Observational study in which a structured questionnaire was administered to leprosy patients, their contacts and a control group. Results: 480 respondents were interviewed and 405 (84.8% (95% confidence interval [CI]: 81.6-87.2% knew that leprosy can be cured. These respondents comprised 166 (92.2% of 180 contacts, 129 (93.5% of 138 patients and 110 (67.9% of 162 controls. Two hundred and fourteen (44.6% (95% CI: 40.1-48.9% respondents knew that leprosy treatment is free, comprising of 110 (51.4% patients, 99 (46.3% contacts and five (2.3% controls. A statistically significant difference in the knowledge on free treatment of leprosy was found to exist between leprosy patients, contacts and controls, with leprosy patients having a better knowledge (79.71% (95% CI: 73-86.42%, followed by contacts (55.0% (95% CI: 47.73-62.26% and controls (3.1% (95% CI: 0.43-5.77% (P = 0.00. Pertinent problems faced by patients in getting MDT included distant health facilities and poor road network (91[19.0%], lack of confidence in treatment (56 [11.7%], MDT shortage (45 [9.4%], few health facilities (52 [10.8%], gratification demands (25 [5.2%], disturbance from other illnesses (24 [5.0], ignorance (21 [4.4%] and poor relationship with nurses (24 [5.0%]. Conclusion: Patients still face problems in getting free MDT. Better MDT implementation and leprosy elimination strategies are proposed.

  18. Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities.

    Science.gov (United States)

    Sempértegui, Gabriela A; Karreman, Annemiek; Arntz, Arnoud; Bekker, Marrie H J

    2013-04-01

    Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Young's schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery

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    Lakshmi Kumar

    2015-01-01

    Full Text Available Background and Aims: Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT targeting cardiac index (CI and oxygen extraction ratio (O 2 ER on outcomes of high-risk patients undergoing abdominal surgery. Methods: In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8-10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT, in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m 2 and O 2 ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment. Results: Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (P < 0.05. The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (P < 0.05. There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days between Group A and B. Conclusions: Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation.

  20. Barriers in the implementation of isoniazid preventive therapy for people living with HIV in Northern Ethiopia: a mixed quantitative and qualitative study

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    Gebrehiwot Teklay

    2016-08-01

    Full Text Available Abstract Background Isoniazid preventive therapy is a key public health intervention for the prevention of tuberculosis disease among people living with HIV. Despite the confirmed efficacy of isoniazid preventive therapy and global recommendations existing for decades, its implementation remains limited. In resource constrained settings, few have investigated why isoniazid preventive therapy is not implemented on full scale. This study was designed to investigate the level of isoniazid preventive therapy implementation and reasons for suboptimal implementation in Tigray region of Ethiopia. Methods A review of patient records combined with a qualitative study using in-depth interviews and focus group discussions was conducted in 11 hospitals providing isoniazid preventive therapy in the Tigray Region. The study participants were health providers working in the HIV clinics of the 11 hospitals in the province. Health providers were interviewed about their experience of providing isoniazid preventive therapy and challenges faced during its implementation. All conversations were audio-recorded. Record review of 16,443 HIV patients registered for care in these hospitals between September 2011 and April 2014 was done to determine isoniazid preventive therapy utilization. Data were collected from April to August 2014. Results Fifty health providers participated in the study. Overall isoniazid preventive therapy coverage of the region was estimated to be 20 %. Isoniazid stock out, fear of creating isoniazid resistance, problems in patient acceptance, and lack of commitment of health managers to scale up the program were indicated by health providers as the main barriers hindering implementation of isoniazid preventive therapy. Conclusion Implementation of isoniazid preventive therapy in Tigray region of Ethiopia had low coverage. Frequent interruption of isoniazid supplies raises the concern of interrupted therapy resulting in creation of isoniazid

  1. Intravenous therapy for women in labor: implementation of a practice change.

    Science.gov (United States)

    Tourangeau, A; Carter, N; Tansil, N; McLean, A; Downer, V

    1999-03-01

    Intravenous therapy for women in labor has been routinely administered in many North American hospitals since the 1950s. The purpose of this study was to evaluate a change in intravenous therapy practice. The evaluation study, using a posttest, quasi-experimental design, examined the responses of women in labor and nurses to a questionnaire. Proxy prestudy cohort data were used for comparison of some patient outcomes. The convenience sample comprised 219 women admitted to the labor and delivery unit of a community hospital in Toronto, Ontario, between August and October 1997. Under the new intravenous therapy protocol, 26 percent of the women in labor did not receive intravenous therapy compared with 100 percent under the old protocol. The primary reasons for therapy were to enable administration of prescribed medication and bolus intravenous administration associated with epidural anesthesia. At the first after-delivery void, 61 percent of study women-65 percent of those who received intravenous therapy and 50 percent of those who received no intravenous therapy-tested negative for ketonuria. All 119 comments from nurses indicated comfort with their judgments related to the initiation of intravenous therapy. The change in the intravenous therapy protocol was supported by the study findings. Nurses should increase patient education about drinking and eating adequately throughout labor if appropriate, and resuming adequate fluid and food intake as quickly as possible after childbirth.

  2. Implementation of Remote 3-Dimensional Image Guided Radiation Therapy Quality Assurance for Radiation Therapy Oncology Group Clinical Trials

    Energy Technology Data Exchange (ETDEWEB)

    Cui Yunfeng [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Galvin, James M. [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, Pennsylvania (United States); Parker, William [Department of Medical Physics, McGill University Health Center, Montreal, QC (Canada); Breen, Stephen [Department of Radiation Physics, Princess Margaret Hospital, Toronto, ON (Canada); Yin Fangfang; Cai Jing [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Papiez, Lech S. [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Bednarz, Greg [Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Chen Wenzhou [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Xiao Ying, E-mail: ying.xiao@jefferson.edu [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, Pennsylvania (United States)

    2013-01-01

    Purpose: To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Methods and Materials: Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. Results: The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. Conclusion: This first experience indicated that remote review for 3D IGRT as part of QA

  3. Facilitating the use of COBRA combination therapy in early rheumatoid arthritis: a pilot implementation study.

    NARCIS (Netherlands)

    Tuyl, L.H.D. van; Plass, A.M.C.; Lems, W.F.; Voskuyl, A.E.; Kerstens, P.J.S.M.; Dijkmans, B.A.C.; Boers, M.

    2009-01-01

    OBJECTIVE: COBRA combination therapy is well known and has uncontested efficacy in the treatment of rheumatoid arthritis (RA). However, it is infrequently applied in Dutch clinical practice. Based on qualitative research on opinions of physicians and patients towards COBRA therapy, our study

  4. Implementation of outpatient schema therapy for borderline personality disorder: study design

    NARCIS (Netherlands)

    Nadort, M.; Arntz, A.; Smit, J.H.; Giesen-Bloo, J.; Eikelenboom, M.J.; Spinhoven, P.; Asselt, van T.; Wensing, M.; Dyck, van R.

    2009-01-01

    ABSTRACT: BACKGROUND: Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality

  5. Implementation of outpatient schema therapy for borderline personality disorder: study design

    NARCIS (Netherlands)

    Nadort, M.; Arntz, A.; Smit, J.H.; Giesen-Bloo, J.; Eikelenboom, M.; Spinhoven, P.; Asselt, T. van; Wensing, M.J.P.; Dyck, R. van

    2009-01-01

    BACKGROUND: Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders.

  6. Implementation of antiretroviral therapy guidelines for under-five children in Tanzania: translating recommendations into practice

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    Harriet Nuwagaba-Biribonwoha

    2015-12-01

    Full Text Available Introduction: Paediatric antiretroviral therapy (ART guidelines have been updated several times in recent years. We assessed implementation of ART guidelines among under-five children to inform the transition to universal paediatric ART in Tanzania. Methods: We conducted a retrospective cohort analysis of infants (0 to 11 months and children (12 to 59 months enrolled between 2010 and 2012 using routinely collected data. Infants and children were initiated on ART according to the 2008 World Health Organization (WHO recommendations/2009 Tanzania guidelines (universal ART for infants. Cumulative ART initiation incidence and correlates of ART initiation were examined using competing risk methods accounting for attrition (death or loss to follow-up. Kaplan-Meier methods and Cox regression models were used to examine attrition on ART and its correlates. Results: A total of 1679 children were enrolled at 69 clinics: 469 (28% infants and 1210 (74% children. Infant cumulative ART initiation incidence was 59.6, 71.3 and 78.0% at one, three and six months of follow-up. Infants were more likely to start ART if enrolled in 2012 [adjusted sub-hazard ratio (AsHR=2.2, 95% confidence interval (CI: 1.7 to 2.8] or 2011 (AsHR=1.8, 95% CI: 1.4 to 2.3 compared to 2010; they were more likely to start ART from prevention of mother-to-child HIV transmission (AsHR=1.6, 95% CI: 1.3 to 2.1 and inpatient wards (AsHR=1.5, 95% CI: 1.2 to 2.0 versus being enrolled from voluntary counselling and testing centres. Attrition at 12 months on ART was 33.9% and was more likely among infants with WHO Stage 4 [adjusted hazard ratio (AHR=3.1. 95% CI: 1.8 to 5.2] and severe malnutrition (AHR=1.4, 95% CI: 1.0 to 1.9.Among 599 children eligible for ART at enrolment, cumulative ART initiation incidence was 51.8, 68.6 and 76.1% at one, three, and six months. Children were more likely to start ART if enrolled in 2012 (AsHR=1.8, 95% CI: 1.4 to 2.3 or 2011 (AsHR=1.5, 95% CI: 1.2 to 1.8 compared

  7. Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: therapist and patient outcomes.

    Science.gov (United States)

    Walser, Robyn D; Karlin, Bradley E; Trockel, Mickey; Mazina, Barbara; Barr Taylor, C

    2013-09-01

    The U.S. Department of Veterans Affairs has implemented a national dissemination and training initiative to promote the availability of Acceptance and Commitment Therapy for depression (ACT-D). This paper reports on therapist and patient outcomes associated with competency-based training in and implementation of ACT-D. Therapist and patient outcomes were assessed on eleven cohorts of therapists (n = 391) and their patients (n = 745). Three-hundred thirty four therapists successfully completed all requirements of the Training Program. Ninety-six percent of therapists achieved competency by the end of training, compared to 21% at the outset of training. Mixed effects model analysis indicated therapists' overall ACT-D competency scores increased from 76 to 112 (conditional SD = 6.6), p therapy. Mixed effects model analysis revealed that mean BDI-II scores decreased from 30 at baseline assessment to 19 (conditional SD = 5.6) at final assessment, t(367) = -20.3, p < 0.001. Quality of life scores also increased. Training in and implementation of ACT-D in the treatment of Veterans is associated with significant increases in therapist competency and robust improvements in patient outcomes. Published by Elsevier Ltd.

  8. Implementation of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit.

    Science.gov (United States)

    Lavrentieva, A; Kontou, P; Soulountsi, V; Kioumis, J; Chrysou, O; Bitzani, M

    2015-09-30

    The purpose of this study was to examine the hypothesis that an algorithm based on serial measurements of procalcitonin (PCT) allows reduction in the duration of antibiotic therapy compared with empirical rules, and does not result in more adverse outcomes in burn patients with infectious complications. All burn patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections were eligible. Patients were assigned to either a procalcitonin-guided (study group) or a standard (control group) antibiotic regimen. The following variables were analyzed and compared in both groups: duration of antibiotic treatment, mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score (days 1-28), length of ICU and hospital stay. A total of 46 Burn ICU patients receiving antibiotic therapy were enrolled in this study. In 24 patients antibiotic therapy was guided by daily procalcitonin and clinical assessment. PCT guidance resulted in a smaller antibiotic exposure (10.1±4 vs. 15.3±8 days, p=0.034) without negative effects on clinical outcome characteristics such as mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score, length of ICU and hospital stay. The findings thus show that use of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit may contribute to the reduction of antibiotic exposure without compromising clinical outcome parameters.

  9. Clinical Pharmacogenetics Implementation Consortium guidelines for cytochrome P450 2D6 genotype and codeine therapy: 2014 update.

    Science.gov (United States)

    Crews, K R; Gaedigk, A; Dunnenberger, H M; Leeder, J S; Klein, T E; Caudle, K E; Haidar, C E; Shen, D D; Callaghan, J T; Sadhasivam, S; Prows, C A; Kharasch, E D; Skaar, T C

    2014-04-01

    Codeine is bioactivated to morphine, a strong opioid agonist, by the hepatic cytochrome P450 2D6 (CYP2D6); hence, the efficacy and safety of codeine are governed by CYP2D6 activity. Polymorphisms are a major cause of CYP2D6 variability. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for codeine based on CYP2D6 genotype. This document is an update to the 2012 Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for CYP2D6 genotype and codeine therapy.

  10. First clinical implementation of audiovisual biofeedback in liver cancer stereotactic body radiation therapy

    Science.gov (United States)

    Tse, Regina; Martin, Darren; McLean, Lisa; Cho, Gwi; Hill, Robin; Pickard, Sheila; Aston, Paul; Huang, Chen‐Yu; Makhija, Kuldeep; O'Brien, Ricky; Keall, Paul

    2015-01-01

    Summary This case report details a clinical trial's first recruited liver cancer patient who underwent a course of stereotactic body radiation therapy treatment utilising audiovisual biofeedback breathing guidance. Breathing motion results for both abdominal wall motion and tumour motion are included. Patient 1 demonstrated improved breathing motion regularity with audiovisual biofeedback. A training effect was also observed. PMID:26247520

  11. Implementing Adlerian Sand Tray Therapy with Adult Male Substance Abuse Offenders: A Phenomenological Inquiry

    Science.gov (United States)

    Monakes, Sarah; Garza, Yvonne; Wiesner, Van, III; Watts, Richard E.

    2011-01-01

    The purpose of this phenomenological study was to understand the perceptions of adult male substance offenders who experienced sand tray therapy as an adjunct to their cognitive behavioral rehabilitative treatment. Results indicate a positive experience for participants. Implications for counselors are discussed. (Contains 1 table.)

  12. [Multisystemic Therapy (MST) for youths with severe conduct disorders - economic evaluation of the implementation in a German-speaking environment].

    Science.gov (United States)

    Rehberg, Walter; Fürstenau, Ute; Rhiner, Bruno

    2011-01-01

    Multisystemic Therapy (MST) was adapted for implementation in a German-speaking environment. The study evaluates the possible economic effects of MST. Professionals who recommended MST for youths with severe conduct disorders were asked to evaluate the probability of other forms of interventions if MST had not been used. We investigated the costs of those other forms of treatment and compared them to the costs that had actually been incurred with MST. Implementation of MST in a German-speaking environment showed a significant potential of cost savings compared to other intervention methods. The costs of MST per case were between 40 % and 64 % lower than these of standard interventions. MST is not only an effective, but also a cost-efficient form of evidence-based treatment for youths with severe conduct disorders.

  13. Implementation and Acceptability of Mindful Awareness in Body-Oriented Therapy in Women's Substance Use Disorder Treatment

    Science.gov (United States)

    Wells, Elizabeth A.; Donovan, Dennis M.; Brooks, Marissa

    2012-01-01

    Abstract Objectives The purpose of this study was to examine the implementation and acceptability of Mindful Awareness in Body-oriented Therapy (MABT), a novel adjunctive approach to substance use disorder (SUD) treatment. The primary aims of the study were to examine implementation of MABT as an adjunct to addiction treatment, and MABT acceptability to study participants and treatment staff. Methods MABT was delivered to participants randomly assigned to the intervention in a larger ongoing trial. This study focuses only on the implementation and acceptability of the intervention, as outcomes are not yet available. MABT was delivered once weekly for 8 weeks (1.5-hour sessions) and spanned inpatient and outpatient programs at a women-only treatment facility. Descriptive statistics were used to examine participant recruitment and retention to the intervention. To measure MABT acceptability, survey and written questionnaires were administered; analysis involved descriptive statistics and content analysis using Atlas.ti software. Results Thirty-one (31) of the women enrolled in the study were randomized to MABT. Eighteen (18) participants completed 75%–100% of the MABT sessions. Intervention implementation required flexibility on the part of both the researchers and the clinic staff, and minor changes were made to successfully implement MABT as an adjunct to usual care. MABT was perceived to increase emotional awareness and provide new tools to cope with stress, and to positively influence SUD treatment by facilitating emotion regulation. Conclusions It was feasible to implement MABT and to recruit and retain women to MABT in women's chemical-dependency treatment. MABT acceptability and perceived benefit was high. PMID:22524991

  14. Implementation of isoniazid preventive therapy in an HIV clinic in Cambodia: high rates of discontinuation when combined with antiretroviral therapy.

    Science.gov (United States)

    van Griensven, Johan; Choun, Kimcheng; Chim, Bopha; Thai, Sopheak; Lorent, Natalie; Lynen, Lutgarde

    2015-12-01

    Data on feasibility and completion rates of isoniazid preventive therapy (IPT) in HIV-infected patient in Asia are limited. Within a hospital-based HIV programme in Phnom Penh, Cambodia, we determined the proportion completing IPT and reasons for non-completion. Retrospective cohort study using HIV/IPT programme data, including all adults starting IPT (300 mg/day self-administered for 24 weeks) from February 2011 to March 2013. All patients underwent symptom screening and further investigations as indicated. After ruling out tuberculosis (TB), IPT was started, with monthly follow-up visits. As per national guideline, IPT was only prescribed for ART-naïve patients. IPT completion was defined as taking IPT for at least 22 of the planned 24 weeks. Stavudine/lamivudine/nevirapine was the preferential first-line ART regimen. Among 445 ART-naïve patients starting IPT (median age: 35 years (IQR: 31-43), median CD4 count 354 cells/μl (IQR 215-545) and 288 (65%) were female), 214 (48%) started ART after a median of 4 weeks (IQR 2-6) on IPT ('concurrent ART'). Overall, 348 (78%) completed IPT. Among individuals with concurrent ART, the completion rate was 73% (157/214). Those without concurrent ART had a higher completion rate (83%; 191/231; P 0.017). The main reason for non-completion with concurrent ART was drug toxicity (mainly hepatotoxicity/rash), occurring in 22% (48/214). Without concurrent ART, the main reason for non-completion was loss to follow-up (16/231; 7%). Fourteen (3%) patients were diagnosed with TB while on IPT, of whom three had a positive TB culture at baseline. An additional 14 TB cases were diagnosed after IPT completion; four were bacteriologically confirmed. Although overall completion rates were acceptable, IPT discontinuation due to drug toxicity was common in patients subsequently initiating ART. Future studies should evaluate whether this relates to IPT, ARVs or both, and whether the increased toxicity would justify delaying IPT initiation

  15. A Randomized Implementation Study of Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Teens in Residential Treatment Facilities.

    Science.gov (United States)

    Cohen, Judith A; Mannarino, Anthony P; Jankowski, Kay; Rosenberg, Stanley; Kodya, Suzanne; Wolford, George L

    2016-05-01

    Adjudicated youth in residential treatment facilities (RTFs) have high rates of trauma exposure and post-traumatic stress disorder (PTSD). This study evaluated strategies for implementing trauma-focused cognitive behavioral therapy (TF-CBT) in RTF. Therapists (N = 129) treating adjudicated youth were randomized by RTF program (N = 18) to receive one of the two TF-CBT implementation strategies: (1) web-based TF-CBT training + consultation (W) or (2) W + 2 day live TF-CBT workshop + twice monthly phone consultation (W + L). Youth trauma screening and PTSD symptoms were assessed via online dashboard data entry using the University of California at Los Angeles PTSD Reaction Index. Youth depressive symptoms were assessed with the Mood and Feelings Questionnaire-Short Version. Outcomes were therapist screening; TF-CBT engagement, completion, and fidelity; and youth improvement in PTSD and depressive symptoms. The W + L condition resulted in significantly more therapists conducting trauma screening (p = .0005), completing treatment (p = .03), and completing TF-CBT with fidelity (p = .001) than the W condition. Therapist licensure significantly impacted several outcomes. Adjudicated RTF youth receiving TF-CBT across conditions experienced statistically and clinically significant improvement in PTSD (p = .001) and depressive (p = .018) symptoms. W + L is generally superior to W for implementing TF-CBT in RTF. TF-CBT is effective for improving trauma-related symptoms in adjudicated RTF youth. Implementation barriers are discussed. © The Author(s) 2016.

  16. Building a Community-Academic Partnership: Implementing a Community-Based Trial of Telephone Cognitive Behavioral Therapy for Rural Latinos

    Directory of Open Access Journals (Sweden)

    Eugene Aisenberg

    2012-01-01

    Full Text Available Concerns about the appropriate use of EBP with ethnic minority clients and the ability of community agencies to implement and sustain EBP persist and emphasize the need for community-academic research partnerships that can be used to develop, adapt, and test culturally responsive EBP in community settings. In this paper, we describe the processes of developing a community-academic partnership that implemented and pilot tested an evidence-based telephone cognitive behavioral therapy program. Originally demonstrated to be effective for urban, middle-income, English-speaking primary care patients with major depression, the program was adapted and pilot tested for use with rural, uninsured, low-income, Latino (primarily Spanish-speaking primary care patients with major depressive disorder in a primary care site in a community health center in rural Eastern Washington. The values of community-based participatory research and community-partnered participatory research informed each phase of this randomized clinical trial and the development of a community-academic partnership. Information regarding this partnership may guide future community practice, research, implementation, and workforce development efforts to address mental health disparities by implementing culturally tailored EBP in underserved communities.

  17. Motion-Compensated Estimation of Delivered Dose during External BeamRadiation Therapy: Implementation in Philips’ Pinnacle3 Treatment Planning System

    NARCIS (Netherlands)

    Bharat, S.; Parikh, P.; Noel, C.; Meltsner, M.; Bzdusek, K.; Kaus, M.

    2012-01-01

    Purpose: Recent research efforts investigating dose escalation techniques for three-dimensional conformal radiation therapy (3D CRT) andintensity modulated radiation therapy (IMRT) have demonstrated great benefit when high-dose hypofractionated treatment schemes are implemented16,21. The use of

  18. Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care.

    Science.gov (United States)

    Nadort, Marjon; van Dyck, Richard; Smit, Johannes H; Giesen-Bloo, Josephine; Eikelenboom, Merijn; Wensing, Michel; Spinhoven, Philip; Dirksen, Carmen; Bleecke, Jeroen; van Milligen, Bianca; van Vreeswijk, Michiel; Arntz, Arnoud

    2009-11-01

    Three studies were conducted to prepare for the implementation of Schema Therapy (ST) for Borderline Personality Disorder (BPD) in general mental healthcare settings. Two were surveys to detect promoting and hindering factors, one was a preliminary test of a training program in ST. In 2004, a diagnostic analysis of factors promoting and hindering implementation of a new treatment for BPD was conducted among both managers (n = 23) and therapists (n = 49) of 29 Dutch mental healthcare institutes through a written survey (Study 1). Next, a training program, including a set of DVDs displaying the major therapeutic techniques, was developed and tested among eight therapists. The training program was evaluated by the participants. After the training, three independent raters evaluated therapists' adherence and competence, viewing videos of the therapists completing structured role-plays (Study 2). In 2008, a second written survey was conducted in 22 mental health institutes to study factors for future nationwide implementation of ST (Study 3). Both surveys indicated that the situation in most institutes was favorable for implementing a new effective treatment, as participants were not satisfied with the existing treatments, had suitable professional backgrounds, worked in settings with (B)PD-oriented care programs, and expressed a need for change. The surveys yielded clear results for promoting or hindering successful implementation of ST. Promoting factors included scientific evidence for the effectiveness of the treatment, structural changes in the patient's personality, rapidly noticeable effects for the patient, low drop-out rates and a favorable cost-effectiveness. Possible barriers included implementation mandated unilaterally by management, choosing ST based on financial or organizational needs, extending implementation over a lengthy period of time and providing telephone support by therapists beyond office hours. The eight-day training program received very

  19. The Implementation of Modified Parent-Child Interaction Therapy for Youth with Separation Anxiety Disorder

    Science.gov (United States)

    Pincus, Donna B.; Santucci, Lauren C.; Ehrenreich, Jill T.; Eyberg, Sheila M.

    2008-01-01

    Separation Anxiety Disorder (SAD) is the most prevalent anxiety disorder experienced by children, and yet empirical treatment studies of SAD in young children are virtually nonexistent. This paper will describe the development and implementation of an innovative treatment for SAD in young children. First, we will highlight the rationale for…

  20. Online Adaptive Radiation Therapy: Implementation of a New Process of Care.

    Science.gov (United States)

    Lamb, James; Cao, Minsong; Kishan, Amar; Agazaryan, Nzhde; Thomas, David H; Shaverdian, Narek; Yang, Yingli; Ray, Suzette; Low, Daniel A; Raldow, Ann; Steinberg, Michael L; Lee, Percy

    2017-08-27

    Onboard magnetic resonance imaging (MRI) guided radiotherapy is now clinically available in nine centers in the world. This technology has facilitated the clinical implementation of online adaptive radiotherapy (OART), or the ability to alter the daily treatment plan based on tumor and anatomical changes in real-time while the patient is on the treatment table. However, due to the time sensitive nature of OART, implementation in a large and busy clinic has many potential obstacles as well as patient-related safety considerations. In this work, we have described the implementation of this new process of care in the Department of Radiation Oncology at the University of California, Los Angeles (UCLA). We describe the rationale, the initial challenges such as treatment time considerations, technical issues during the process of re-contouring, re-optimization, quality assurance, as well as our current solutions to overcome these challenges. In addition, we describe the implementation of a coverage system with a physician of the day as well as online planners (physicists or dosimetrists) to oversee each OART treatment with patient-specific 'hand-off' directives from the patient's treating physician. The purpose of this effort is to streamline the process without compromising treatment quality and patient safety. As more MRI-guided radiotherapy programs come online, we hope that our experience can facilitate successful adoption of OART in a way that maximally benefits the patient.

  1. In incontinence developing after radical prostatectomy the role of nurses on implementing behavioral therapy

    OpenAIRE

    Aylin Aydın Sayılan

    2016-01-01

    Developing after radical prostatectomy urinary incontinence (UI) is a major health problem affecting the quality of life of men. Urinary incontinence patients in their care and treatment purpose is to provide continence. In the treatment of urinary incontinence surgery, medication and behavioral treatments are used. For the purposes of behavioral therapy; increasing the capacity of the bladder function and is aimed at promoting bladder control. Behavioral treatments for incontinence; diet...

  2. The implementation of computerized cognitive behavioural therapies in a service user-led, third sector self help clinic.

    Science.gov (United States)

    Cavanagh, Kate; Seccombe, Nick; Lidbetter, Nicky

    2011-07-01

    The efficacy and effectiveness of a computerized cognitive behavioural therapy (CCBT) package, Beating the Blues, has been demonstrated in a large randomized controlled trial and several pragmatic studies in the National Health Service (NHS). The current study tests the generalizability of this finding to the implementation of CCBT in a service user-led, third sector Self Help Clinic. 510 referrals for the Beating the Blues program were received over a 16 month period in routine care. The Patient Health Questionnaire Depression (PHQ-9) and Anxiety (GAD-7) Scales were administered pre-treatment and during each treatment session. The 10-item Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), Work and Social Adjustment Scale and Patient Experience Questionnaire were also administered pre-treatment and immediately on completing treatment. More than two-thirds of referrals were suitable for treatment and completed a baseline assessment; 84% of these started the Beating the Blues program. Two-hundred and twenty-six people meeting caseness criteria at baseline completed at least two sessions of CCBT. Of these, 50% met recovery criteria at their final point of measurement. Completer and intention-to-treat analysis also demonstrated statistically and clinically significant improvements on key outcome measures. CCBT can be effectively implemented in a service user-led, third sector Self Help Clinic, increasing access to psychological therapies to meet local needs for tier two interventions for depression and anxiety.

  3. Rapid implementation of the repair-misrepair-fixation (RMF) model facilitating online adaption of radiosensitivity parameters in ion therapy

    Science.gov (United States)

    Kamp, F.; Carlson, D. J.; Wilkens, J. J.

    2017-07-01

    Introduction: Treatment planning for ion therapy must account for physical properties of the beam as well as differences in the relative biological effectiveness (RBE) of ions compared to photons. In this work, we present a fast RBE calculation approach, based on the decoupling of physical properties and the αx / βx ratio commonly used to describe the radiosensitivity of irradiated cells or organs. Material and methods: In the framework of the mechanistic repair-misrepair-fixation (RMF) model, the biological modeling can be decoupled from the physical dose. This was implemented into a research treatment planning system for carbon ion therapy. Results: The presented implementation of the RMF model is very fast, allowing online changes of αx / βx . For example, a change of αx / βx including a complete biological modeling and a recalculation of RBE for 2.9\\cdot 105 voxel takes 4 ms on a 4 CPU, 3.2 GHz workstation. Discussion and conclusion: The derived decoupling within the RMF model allows fast changes in αx / βx , facilitating online adaption by the user. This provides new options for radiation oncologists, facilitating online variations of the radiobiological input parameters during the treatment plan evaluation process as well as uncertainty and sensitivity analyses.

  4. Implementing cognitive behavior therapy for chronic fatigue syndrome in mental health care: a costs and outcomes analysis

    Directory of Open Access Journals (Sweden)

    Scheeres Korine

    2008-08-01

    Full Text Available Abstract Background This study investigated the costs and outcomes of implementing cognitive behavior therapy (CBT for chronic fatigue syndrome (CFS in a mental health center (MHC. CBT is an evidence-based treatment for CFS that was scarcely available until now. To investigate the possibilities for wider implementation, a pilot implementation project was set up. Method Costs and effects were evaluated in a non-controlled before- and after study with an eight months time-horizon. Both the costs of performing the treatments and the costs of implementing the treatment program were included in the analysis. The implementation interventions included: informing general practitioners (GPs and CFS patients, training therapists, and instructing the MHC employees. Given the non-controlled design, cost outcome ratios (CORs and their acceptability curves were analyzed. Analyses were done from a health care perspective and from a societal perspective. Bootstrap analyses were performed to estimate the uncertainty around the cost and outcome results. Results 125 CFS patients were included in the study. After treatment 37% had recovered from CFS and the mean gained QALY was 0.03. Costs of patients' health care and productivity losses had decreased significantly. From the societal perspective the implementation led to cost savings and to higher health states for patients, indicating dominancy. From the health care perspective the implementation revealed overall costs of €5.320 per recovered patient, with an acceptability curve showing a 100% probability for a positive COR at a willingness to pay threshold of €6.500 per recovered patient. Conclusion Implementing CBT for CFS in a MHC appeared to have a favorable cost outcome ratio (COR from a societal perspective. From a health care perspective the COR depended on how much a recovered CFS patient is being valued. The strength of the evidence was limited by the non-controlled design. The outcomes of this study

  5. Implementation of shared decision making in physical therapy: observed level of involvement and patient preference.

    Science.gov (United States)

    Dierckx, Katreine; Deveugele, Myriam; Roosen, Philip; Devisch, Ignaas

    2013-10-01

    Shared decision making (SDM) reduces the asymmetrical power between the therapist and the patient. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been previously considered. The objective of this study was to examine the status of SDM in physical therapy, patients' preferred levels of involvement, and the agreement between therapist perception and patient preferred level of involvement. This was an observational study of real consultations in physical therapy. In total, 237 consultations, undertaken by 13 physical therapists, were audiorecorded, and 210 records were analyzed using the Observing Patient Involvement (OPTION) instrument. Before the consultation, the patient and therapist completed the Control Preference Scale (CPS). Multilevel analysis was used to study the association between individual variables and the level of SDM. Agreement on preferences was calculated using kappa coefficients. The mean OPTION score was 5.2 (SD=6.8), out of a total score of 100. Female therapists achieved a higher OPTION score (b=-0.86, P=0.01). In total, 36.7% of the patients wanted to share decisions, and 36.2% preferred to give their opinion before delegating the decisions. In the majority of cases, therapists believed that they had to decide. The kappa coefficient for agreement was poor at .062 (95% confidence interval=-.018 to .144). Only 13 out of 125 therapists who were personally contacted agreed to participate. Shared decision making was not applied; although patients preferred to share decisions or at least provide their opinion about the treatment, physical therapists did not often recognize this factor. The participating physical therapists were more likely to make decisions in the best interest of their patients; that is, these therapists tended to apply a paternalistic approach rather than involving the patient.

  6. Clinical implementation of total skin electron beam (TSEB) therapy: a review of the relevant literature.

    Science.gov (United States)

    Diamantopoulos, S; Platoni, K; Dilvoi, M; Nazos, I; Geropantas, K; Maravelis, G; Tolia, M; Beli, I; Efstathopoulos, E; Pantelakos, P; Panayiotakis, G; Kouloulias, V

    2011-04-01

    Total skin electron beam therapy has been in medical service since the middle of the last century in order to confront rare skin malignancies. Since then various techniques have been developed, all aiming at better clinical results in conjunction with less post-irradiation complications. In this article every available technique is presented in addition to physical parameters of technique establishment and common dose fractionation. This study also revealed the preference of the majority of institutes the last 20 years in "six dual field technique" at a high dose rate, which is a safe and effective treatment. Copyright © 2010 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  7. Community-implemented trauma therapy for former child soldiers in Northern Uganda: a randomized controlled trial.

    Science.gov (United States)

    Ertl, Verena; Pfeiffer, Anett; Schauer, Elisabeth; Elbert, Thomas; Neuner, Frank

    2011-08-03

    The psychological rehabilitation of former child soldiers and their successful reintegration into postconflict society present challenges. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility and efficacy of mental health interventions for former child soldiers. To assess the efficacy of a community-based intervention targeting symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals. Randomized controlled trial recruiting 85 former child soldiers with PTSD from a population-based survey of 1113 Northern Ugandans aged 12 to 25 years, conducted between November 2007 and October 2009 in camps for internally displaced persons. Participants were randomized to 1 of 3 groups: narrative exposure therapy (n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28). Symptoms of PTSD and trauma-related feelings of guilt were measured using the Clinician-Administered PTSD Scale. The respective sections of the Mini International Neuropsychiatric Interview were used to assess depression and suicide risk, and a locally adapted scale was used to measure perceived stigmatization. Symptoms of PTSD, depression, and related impairment were assessed before treatment and at 3 months, 6 months, and 12 months postintervention. Treatments were carried out in 8 sessions by trained local lay therapists, directly in the communities. Change in PTSD severity, assessed over a 1-year period after treatment. Secondary outcome measures were depression symptoms, severity of suicidal ideation, feelings of guilt, and perceived stigmatization. PTSD symptom severity (range, 0-148) was significantly more improved in the narrative exposure therapy group than in the academic catch-up (mean change difference, -14.06 [95% confidence interval, -27.19 to -0.92]) and waiting-list (mean change difference, -13.04 [95% confidence interval, -26.79 to 0.72]) groups. Contrast analyses

  8. Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C19 Genotype and Clopidogrel Therapy: 2013 Update

    Science.gov (United States)

    Scott, S A; Sangkuhl, K; Stein, C M; Hulot, J-S; Mega, J L; Roden, D M; Klein, T E; Sabatine, M S; Johnson, J A; Shuldiner, A R

    2013-01-01

    Cytochrome P450 (CYP)2C19 catalyzes the bioactivation of the antiplatelet prodrug clopidogrel, and CYP2C19 loss-of-function alleles impair formation of active metabolites, resulting in reduced platelet inhibition. In addition, CYP2C19 loss-of-function alleles confer increased risks for serious adverse cardiovascular (CV) events among clopidogrel-treated patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary intervention (PCI). Guideline updates include emphasis on appropriate indication for CYP2C19 genotype–directed antiplatelet therapy, refined recommendations for specific CYP2C19 alleles, and additional evidence from an expanded literature review (updates at http://www.pharmgkb.org). PMID:23698643

  9. Medication therapy management goes hi-tech: implementing automated software improves pharmacy efficiency.

    Science.gov (United States)

    Giordano, Adrienne; Holden, Carrie; Misquitta, Cathrine

    2008-10-01

    With the Centers for Medicare & Medicaid Services mandate that all Medicare Part D benefit sponsors must offer members a medication therapy management program, pharmacists were facing new challenges of data collecting using software applications that had limited use for the new program. Health Net pharmacists initiated an automated software application to increase the efficiency of the medication therapy management program, the integrity of the member profiles, and the ability to provide accurate reporting of drug-related issues. Pharmacists were integral contributors to the automated software program; they developed the clinical algorithms, screen layout and transitions, and program functionality. Together with a programming company-Cognizant Technology Solutions-they created a web-based software application to accommodate an increasing number of eligible members and ensure accuracy of the information; they also performed testing of the final product. The new program includes member demographics and qualifying parameters that are uploaded monthly. All drug-related problems are now displayed and updated automatically by the software application. Assessment questions are answered and saved within the software, and reporting functions allow for quick and accurate results. Consequently, the number of drug regimen reviews and drug problems identified has increased by more than 300%. The automated software application is capable of maintaining and updating medication claims, sending and receiving faxes to physicians and pharmacies, and allows for documentation of patient-specific freeform text. Each profile is extensive and allows the pharmacist to get all necessary information from a single source.

  10. Design and Implementation of Markerless Augmented Reality Application for Cockroach Phobia Therapy Using Adaptive Threshold

    Directory of Open Access Journals (Sweden)

    Fiandra Fatharany

    2017-01-01

    Full Text Available Augmented reality (AR technology is useful for treating several psychological problems, including phobias such as fear of flying, agoraphobia, claustrophobia, and phobia to insects and small animals. However, the currently existing applications for therapy of cockroach phobia that uses AR technology are still very dependent towards the presence of markers, which might lessen the feeling of being in an actual scenario from everyday lives. In this paper, we created a system that is able to use everyday things as a replacement for markers for phobia therapy for cockroach. There are five main processes: getting the live streaming feed from camera, preprocessing, extracting the center point of the objects, tracking the marker-substitute objects, and lastly, instantiating cockroaches randomly after user lifts the objects according to the number and mode of the cockroaches, whether it is moving or not, that are predetermined by the user. The evaluation in this paper includes eight participants that are carefully selected based on their Fear of Spiders Questionnaire (FSQ score that is translated into Indonesian and modified to accommodate cockroaches instead of spiders. The results is that the system can induce anxiety level on participants with the highest score of 10, which is the highest score in Standard Unit of Discomfort scale (SUDs. While the presence and reality judgment of this paper has the highest score of 7 which is also the highest score in Slater-Usoh-Steed Questionnaire (SUS.

  11. Potential return on investment for implementation of perioperative goal-directed fluid therapy in major surgery: a nationwide database study.

    Science.gov (United States)

    Michard, Frederic; Mountford, William K; Krukas, Michelle R; Ernst, Frank R; Fogel, Sandy L

    2015-01-01

    Preventable postsurgical complications are increasingly recognized as a major clinical and economic burden. A recent meta-analysis showed a 17-29 % decrease in postoperative morbidity with goal-directed fluid therapy. Our objective was to estimate the potential economic impact of perioperative goal-directed fluid therapy. We studied 204,680 adult patients from 541 US hospitals who had a major non-cardiac surgical procedure between January 2011 and June 2013. Hospital costs (including 30-day readmission costs) in patients with and without complications were extracted from the Premier Inc. research database, and potential cost-savings associated with a 17-29 % decrease in postoperative morbidity were estimated. A total of 76,807 patients developed one or more postsurgical complications (morbidity rate 37.5 %). In patients with and without complications, hospital costs were US$27,607 ± 32,788 and US$15,783 ± 12,282 (p potential gross cost-savings of US$153-263 million for the study period, US$61-105 million per year, or US$754-1286 per patient. Potential savings per patient were highly variable from one surgical procedure to the other, ranging from US$354-604 for femur and hip-fracture repair to US$3515-5996 for esophagectomies. When taking into account the volume of procedures, the total potential savings per year were the most significant (US$32-55 million) for colectomies. Postsurgical complications occurred in more than one third of our study population and had a dramatic impact on hospital costs. With goal-directed fluid therapy, potential cost-savings per patient were US$754-1286. The highest cost-savings per year were observed for colectomies. These projections should help hospitals estimate the return on investment when considering the implementation of goal-directed fluid therapy.

  12. Implementation of a wedged-dynamic arc therapy technique for head and neck cancer.

    Science.gov (United States)

    Ibrahim, Mohamed S; Metwaly, Mohamed; El-Sayed, El-Sayed Mahmoud; Sallam, Abdel-Sattar M

    2014-01-01

    In this study, we designed and evaluated a wedged dynamic arc therapy (W-DAT) to provide the desirable concaved-shape dose distribution to cover the target in the treatment of head and neck sequence cell carcinoma. Eight patients were treated using W-DAT. The dose prescriptions were 70 Gy and 54 Gy, in 35 fractions, to the sites of the gross planning target volume (PTV1) and the microscopic (PTV2) diseases respectively. This technique consists of four wedged half-arcs of moving multi-leaf collimator leaves to fit PTV1 and shield brain stem at all gantry rotations. These were combined with two anterior-posterior conformal fields of different weighing to improve the dose uniformity. Another two anterior-posterior conformal fields were designed to cover the PTV2. All of the eight fields were half blocked by the normal jaws so there is no dose overlap at the interface between the two targets. Referring to radiation therapy oncology group protocol 0615, 95% of the PTV1 was covered by more than 95% (66.50 Gy) of the prescribed dose, with very low dose inhomogeneity index of 0.0670 ± 0.0007. The maximum dose to 1% of the planning organ at risk volumes-brainstem didn't exceed 56.10 ± 2.17 Gy while the two parotids were well spared as they received a mean dose of 21.97 ± 3.24 Gy. Isocentric ion chamber measurements showed good agreement with the treatment planning system calculated dose with the maximum deviation of 2.40% while film measurements yielded lesser than 4.20% of the pixels failed the acceptance gamma criteria of (3 mm, 3%). W-DAT technique was approved in our department as the standard choice for the radical treatment of head and neck sequence cell carcinoma.

  13. Measuring treatment differentiation for implementation research: the Therapy Process Observational Coding System for Child Psychotherapy Revised Strategies scale.

    Science.gov (United States)

    McLeod, Bryce D; Smith, Meghan M; Southam-Gerow, Michael A; Weisz, John R; Kendall, Philip C

    2015-03-01

    Observational measures to assess implementation integrity (the extent to which components of an evidence-based treatment are delivered as intended) are needed. The authors evaluated the reliability of the scores and the validity of the score interpretations for the Therapy Process Observational Coding System for Child Psychotherapy-Revised Strategies scale (TPOCS-RS; McLeod, 2010) and assessed the potential of the TPOCS-RS to assess treatment differentiation, a component of implementation integrity. The TPOCS-RS includes 5 theory-based subscales (Cognitive, Behavioral, Psychodynamic, Client-Centered, and Family). Using the TPOCS-RS, coders independently rated 954 sessions conducted with 89 children (M age = 10.56, SD = 2.00; age 7-15 years; 65.20% White) diagnosed with a primary anxiety disorder who received different treatments (manual-based vs. nonmanualized) across settings (research vs. practice). Coders produced reliable ratings at the item level (M intraclass correlation coefficient = .76, SD = .18). Analyses support the construct validity of the Cognitive and Behavioral subscale scores and, to a lesser extent, the Psychodynamic, Family, and Client-Centered subscale scores. Correlations among the TPOCS-RS subscale scores and between the TPOCS-RS subscale scores and observational ratings of the alliance and client involvement were moderate suggesting independence of the subscale scores. Moreover, the TPOCS-RS showed promise for assessing implementation integrity as the TPOCS-RS subscale scores, as hypothesized, discriminated between manual-guided treatment delivered across research and practice settings and nonmanualized usual care. The findings support the potential of the TPOCS-RS Cognitive and Behavioral subscales to assess treatment differentiation in implementation research. Results for the remaining subscales are promising, although further research is needed. 2015 APA, all rights reserved

  14. Measuring Treatment Differentiation for Implementation Research: The Therapy Process Observational Coding System for Child Psychotherapy Revised Strategies Scale

    Science.gov (United States)

    McLeod, Bryce D.; Smith, Meghan M.; Southam-Gerow, Michael A.; Weisz, John R.; Kendall, Philip C.

    2014-01-01

    Observational measures to assess implementation integrity (the extent to which components of an evidence-based treatment are delivered as intended) are needed. We evaluated the reliability of the scores and the validity of the score interpretations for the Therapy Process Observational Coding System for Child Psychotherapy – Revised Strategies scale (TPOCS-RS; McLeod, 2010) and assessed the potential of the TPOCS-RS to assess treatment differentiation, a component of implementation integrity. The TPOCS-RS includes five theory-based subscales (Cognitive, Behavioral, Psychodynamic, Client-Centered, Family). Using the TPOCS-RS, coders independently rated 954 sessions conducted with 89 children (M age = 10.56, SD = 2.00; aged 7–15 years; 65.20% Caucasian) diagnosed with a primary anxiety disorder who received different treatments (manual-based vs. non-manualized) across settings (research vs. practice). Coders produced reliable ratings at the item level (M ICC = .76, SD = .18). Analyses support the construct validity of the Cognitive and Behavioral subscale scores and, to a lesser extent, the Psychodynamic, Family, and Client-Centered subscale scores. Correlations among the TPOCS-RS subscale scores and between the TPOCS-RS subscale scores and observational ratings of the alliance and client involvement were moderate suggesting independence of the subscale scores. Moreover, the TPOCS-RS showed promise for assessing implementation integrity as the TPOCS-RS subscale scores, as hypothesized, discriminated between manual-guided treatment delivered across research and practice settings and non-manualized usual care. The findings support the potential of the TPOCS-RS Cognitive and Behavioral subscales to assess treatment differentiation in implementation research. Results for the remaining subscales are promising, although further research is needed. PMID:25346995

  15. Factors Influencing Acceptability and Perceived Impacts of a Mandatory ePortfolio Implemented by an Occupational Therapy Regulatory Organization.

    Science.gov (United States)

    Vachon, Brigitte; Foucault, Marie-Lyse; Giguère, Charles-Édouard; Rochette, Annie; Thomas, Aliki; Morel, Martine

    2017-12-19

    The use of ePortfolios has been implemented in several regulatory organizations to encourage clinicians' engagement in continuing professional development (CPD). However, their use has achieved mixed success, and multiple personal and contextual factors can influence their impacts on practice change. The aim of this study was to identify which factors influence the acceptability and perceived impacts of an ePortfolio implemented by an occupational therapy regulatory organization in one Canadian province. A cross-sectional online survey design was used. The survey was sent to registered occupational therapists in Quebec. Multiple regression analyses were conducted to identify factors influencing acceptability and outcomes: ease of use, satisfaction, impact on implementation of the CPD plan, and competence improvement. The survey was fully completed by 546 participants. Factors significantly influencing the ePortfolio acceptability and perceived impacts were attitude toward and familiarity with the portfolio, confidence in reflective skills, engagement in the CPD plan, and desire for feedback. Time spent completing the ePortfolio and the fact of completing it in teams were negatively associated with the outcomes. Shaping more favorable user attitudes, helping users recognize and experience the tool's benefits for their practice, and fostering confidence in their reflective skills are important factors that can be addressed to improve ePortfolio acceptability and outcomes. Contextual factors, such as time spent completing the ePortfolio and completing it in teams, seem to reflect greater difficulty with using the tool. Study findings can contribute to improving ePortfolio implementation in the CPD context.

  16. Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report.

    Science.gov (United States)

    Karlen, Emily; McCathie, Becky

    2015-12-01

    The current state of health care demands higher-value care. Due to many barriers, clinicians routinely do not implement evidence-based care even though it is known to improve quality and reduce cost of care. The purpose of this case report is to describe a theory-based, multitactic implementation of a quality improvement process aimed to deliver higher-value physical therapy for patients with low back pain. Patients were treated from January 2010 through December 2014 in 1 of 32 outpatient physical therapy clinics within an academic health care system. Data were examined from 47,755 patients (mean age=50.3 years) entering outpatient physical therapy for management of nonspecific low back pain, with or without radicular pain. Development and implementation tactics were constructed from adult learning and change management theory to enhance adherence to best practice care among 130 physical therapists. A quality improvement team implemented 4 tactics: establish care delivery expectations, facilitate peer-led clinical and operational teams, foster a learning environment focused on meeting a population's needs, and continuously collect and analyze outcomes data. Physical therapy utilization and change in functional disability were measured to assess relative cost and quality of care. Secondarily, charge data assessed change in physical therapists' application of evidence-based care. Implementation of a quality improvement process was measured by year-over-year improved clinical outcomes, decreased utilization, and increased adherence to evidence-based physical therapy, which was associated with higher-value care. When adult learning and change management theory are combined in quality improvement efforts, common barriers to implementing evidence-based care can be overcome, creating an environment supportive of delivering higher-value physical therapy for patients with low back pain. © 2015 American Physical Therapy Association.

  17. Overcoming obstacles to implementing methadone maintenance therapy for prisoners: Implications for policy and practice

    Science.gov (United States)

    McKenzie, Michelle; Nunn, Amy; Zaller, Nickolas D.; Bazazi, Alexander R.; Rich, Josiah D.

    2010-01-01

    More than 2.4 million people are currently incarcerated in the United States, many as a result of drug-related offenses. In addition, more than 200,000 active heroin addicts pass through the correctional system annually. New evidence suggests that both providing prisoners with referrals for community-based methadone programs and providing methadone prior to release reduces recidivism and adverse health and social consequences associated with drug use. This article reports the programmatic challenges associated with initiating methadone treatment in the Rhode Island correctional system. Significant obstacles to implementing methadone treatment include: stigma associated with pharmacological treatment, misconceptions regarding the nature of opioid addiction, logistics of control and storage of methadone, increased work load for nursing staff, and general safety and control concerns. The authors discuss strategies to address these barriers and conclude that providing methadone prior to inmate release is a feasible intervention with the potential to mitigate drug-related health and social harms. PMID:19736902

  18. Clinical Implementation of Intrafraction Cone Beam Computed Tomography Imaging During Lung Tumor Stereotactic Ablative Radiation Therapy

    Science.gov (United States)

    Li, Ruijiang; Han, Bin; Meng, Bowen; Maxim, Peter G.; Xing, Lei; Koong, Albert C.; Diehn, Maximilian; Loo, Billy W.

    2013-01-01

    Purpose To develop and clinically evaluate a volumetric imaging technique for assessing intrafraction geometric and dosimetric accuracy of stereotactic ablative radiation therapy (SABR). Methods and Materials Twenty patients received SABR for lung tumors using volumetric modulated arc therapy (VMAT). At the beginning of each fraction, pretreatment cone beam computed tomography (CBCT) was used to align the soft-tissue tumor position with that in the planning CT. Concurrent with dose delivery, we acquired fluoroscopic radiograph projections during VMAT using the Varian on-board imaging system. Those kilovolt projections acquired during megavolt beam-on were automatically extracted, and intrafraction CBCT images were reconstructed using the filtered backprojection technique. We determined the time-averaged target shift during VMAT by calculating the center of mass of the tumor target in the intrafraction CBCT relative to the planning CT. To estimate the dosimetric impact of the target shift during treatment, we recalculated the dose to the GTV after shifting the entire patient anatomy according to the time-averaged target shift determined earlier. Results The mean target shift from intrafraction CBCT to planning CT was 1.6, 1.0, and 1.5 mm; the 95th percentile shift was 5.2, 3.1, 3.6 mm; and the maximum shift was 5.7, 3.6, and 4.9 mm along the anterior-posterior, left-right, and superior-inferior directions. Thus, the time-averaged intrafraction gross tumor volume (GTV) position was always within the planning target volume. We observed some degree of target blurring in the intrafraction CBCT, indicating imperfect breath-hold reproducibility or residual motion of the GTV during treatment. By our estimated dose recalculation, the GTV was consistently covered by the prescription dose (PD), that is, V100% above 0.97 for all patients, and minimum dose to GTV >100% PD for 18 patients and >95% PD for all patients. Conclusions Intrafraction CBCT during VMAT can provide

  19. Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence

    Directory of Open Access Journals (Sweden)

    Gisel Viviana Osorio-Cuellar

    Full Text Available Abstract Given the context and the number of armed conflict victims in the Colombian Pacific coast and their difficulties to access psycho-social care, Narrative Community-based Group Therapy appears as a viable mental health intervention. The objective of this study is to describe the process of implementation and results of the intervention in Afro-Colombian victims of violence, in the municipalities of Buenaventura and Quibdó. More specifically, we will be looking at the perspectives of workers and supervisors, through evaluative case studies and individual in-depth interviews. The therapy allows us to identify support and coping systems through coexistence, communication and interaction. It requires an adaptation process to the diversity of knowledge and expressions of victims of Colombian violence, greater empathy from care providers and rigor in their profiles selection, facilities ensuring security and confidentiality, and links with other educational, employment and recreational organizations. It is important to include these results while improving current and future intervention processes.

  20. Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence.

    Science.gov (United States)

    Osorio-Cuellar, Gisel Viviana; Pacichana-Quinayáz, Sara Gabriela; Bonilla-Escobar, Francisco Javier; Fandiño-Losada, Andrés; Gutiérrez-Martinez, Maria Isabel

    2017-09-01

    Given the context and the number of armed conflict victims in the Colombian Pacific coast and their difficulties to access psycho-social care, Narrative Community-based Group Therapy appears as a viable mental health intervention. The objective of this study is to describe the process of implementation and results of the intervention in Afro-Colombian victims of violence, in the municipalities of Buenaventura and Quibdó. More specifically, we will be looking at the perspectives of workers and supervisors, through evaluative case studies and individual in-depth interviews. The therapy allows us to identify support and coping systems through coexistence, communication and interaction. It requires an adaptation process to the diversity of knowledge and expressions of victims of Colombian violence, greater empathy from care providers and rigor in their profiles selection, facilities ensuring security and confidentiality, and links with other educational, employment and recreational organizations. It is important to include these results while improving current and future intervention processes.

  1. Implementation of adaptive radiation therapy for urinary bladder carcinoma - Imaging, planning and image guidance

    Energy Technology Data Exchange (ETDEWEB)

    Tuomikoski, Laura; Collan, Juhani; Keyrilaeinen, Jani; Saarilahti, Kauko; Tenhunen, Mikko [Dept. of Oncology, Helsinki Univ. Central Hospital, Helsinki (Finland)], e-mail: laura.tuomikoski@hus.fi; Korhonen, Juha [Dept. of Oncology, Helsinki Univ. Central Hospital, Helsinki (Finland); Clinical Research Inst. Helsinki Univ. Central Hospital Ltd, Helsinki (Finland); Visapaeae, Harri [Dept. of Oncology, Helsinki Univ. Central Hospital, Helsinki (Finland); Dept. of Urology, Helsinki Univ. Central Hospital, Helsinki (Finland); Sairanen, Jukka [Dept. of Urology, Helsinki Univ. Central Hospital, Helsinki (Finland)

    2013-10-15

    Background: Adaptive radiation therapy (ART) for urinary bladder cancer has emerged as a promising alternative to conventional RT with potential to minimize radiation-induced toxicity to healthy tissues. In this work we have studied bladder volume variations and their effect on healthy bladder dose sparing and intra fractional margins, in order to refine our ART strategy. Material and methods: An online ART treatment strategy was followed for five patients with urinary bladder cancer with the tumors demarcated using Lipiodol. A library of 3-4 predefined treatment plans for each patient was created based on four successive computed tomography (CT) scans. Cone beam CT (CBCT) images were acquired before each treatment fraction and after the treatment at least weekly. In partial bladder treatment the sparing of the healthy part of the bladder was investigated. The bladder wall displacements due to bladder filling were determined in three orthogonal directions (CC, AP, DEX-SIN) using the treatment planning CT scans. An ellipsoidal model was applied in order to find the theoretical maximum values for the bladder wall displacements. Moreover, the actual bladder filling rate during treatment was evaluated using the CBCT images. Results: In partial bladder treatment the volume of the bladder receiving high absorbed doses was generally smaller with a full than empty bladder. The estimation of the bladder volume and the upper limit for the intra fractional movement of the bladder wall could be represented with an ellipsoidal model with a reasonable accuracy. Observed maximum growth of bladder dimensions was less than 10 mm in all three orthogonal directions during 15 minute interval. Conclusion: The use of Lipiodol contrast agent enables partial bladder treatment with reduced irradiation of the healthy bladder volume. The ellipsoidal bladder model can be used for the estimation of the bladder volume changes and the upper limit of the bladder wall movement during the treatment

  2. Identification of barriers that impede the implementation of nicotine replacement therapy in the acute cardiac care setting.

    Science.gov (United States)

    May, Fiona C; Stocks, Nigel; Barton, Christopher

    2008-12-01

    Nicotine replacement therapy (NRT) has been shown to increase 12-month abstinence rates by as much as 50% when compared with placebo; however, NRT seems to be underutilized in the acute cardiac setting. This study explores the attitudes and beliefs of healthcare professionals regarding the use of NRT in acute cardiac inpatients, in an effort to identify and expose barriers that may impede the use of this drug in the acute cardiac care environment. Framework analysis formed the methodological foundation of the study and provided the structure for analysis of data generated via qualitative, semistructured one-on-one interviews. A purposive sample of healthcare professionals practicing in the acute cardiac care setting informed the study. Although health care professionals expressed strong views regarding the benefits of implementing NRT as a smoking cessation intervention, barriers were identified that hinder its use. Financial implications, lack of knowledge and safety issues all contributed to the institutional justification for rejecting hospital-based NRT as a secondary prevention intervention in the acute cardiac setting. To proactively reduce the incidence of secondary cardiac events, education of healthcare professionals concerning tobacco addiction and available cessation treatments in the acute cardiac patient is paramount. Nicotine replacement products require further investigation to ascertain their safety and financial viability in the acute cardiac setting. Findings may support the implementation of NRT in the inpatient cardiac setting, and ultimately help curb the incidence of smoking-related mortality owing to secondary cardiac events.

  3. Group schema therapy for personality disorders: A pilot study for implementation in acute psychiatric in-patient settings.

    Science.gov (United States)

    Nenadić, Igor; Lamberth, Sina; Reiss, Neele

    2017-07-01

    Group schema therapy (GST) has been proposed as a novel long-term treatment programme for borderline and cluster C personality disorders. We implemented a short-term GST programme (12-15 sessions, based on the manual by Farrell and Shaw (2012), including both cognitive / behavioural and experiential interventions for in-patients (n=9) with either borderline or cluster C personality disorders (and axis I co-morbidities) treated in a (sub)acute psychiatric in-patient setting. We evaluated pre- and post-treatment self-report of maladaptive and adaptive schema modes (using the SMI) and early maladaptive schemas (YSQ-3), as well as overall symptom severity (brief symptom check list, BSCL-53-S), patient satisfaction (ZUF-8) and group climate and coherence (GCQ-S). We found significant reduction of symptoms, and trend-level improvement for schema mode activation, but not maladaptive schemas. Effect sizes of Cohen's d=0.857 for symptoms and d=0.693 for maladaptive schema mode reduction were, however, lower than previous GST trials in in-patient settings with a longer treatment phase and outpatient GST trials using the Farrell and Shaw-model, indicating importance of duration in ST treatment. Our findings in this uncontrolled study provide first evidence that GST (based on the Farrell and Shaw model) can be implemented and adapted for use in short-term in-patient (sub)acute settings. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  4. Dialectical Behavior Therapy of borderline patients with and without substance use problems. Implementation and long-term effects.

    Science.gov (United States)

    van den Bosch, Louisa M C; Verheul, Roel; Schippers, Gerard M; van den Brink, Wim

    2002-01-01

    The aim of this article is to examine whether standard Dialectical Behavior Therapy (DBT) (1) can be successfully implemented in a mixed population of borderline patients with or without comorbid substance abuse (SA), (2) is equally efficacious in reducing borderline symptomatology among those with and those without comorbid SA, and (3) is efficacious in reducing the severity of the substance use problems. The implementation of DBT is examined qualitatively. The impact of comorbid SA on its efficacy, as well as on its efficacy in terms of reducing SA, is investigated in a randomized clinical trial comparing DBT with treatment-as-usual (TAU) in 58 female borderline patients with (n = 31) and without (n = 27) SA. Standard DBT can be applied in a group of borderline patients with and without comorbid SA. Major implementation problems did not occur. DBT resulted in greater reductions of severe borderline symptoms than TAU, and this effect was not modified by the presence of comorbid SA. Standard DBT, as it was delivered in our study, however, had no effect on SA problems. Standard DBT can be effectively applied with borderline patients with comorbid SA problems, as well as those without. Standard DBT, however, is not more efficacious than TAU in reducing substance use problems. We propose that, rather than developing separate treatment programs for dual diagnosis patients, DBT should be "multitargeted." This means that therapists ought to be trained in addressing a range of severe manifestations of personality pathology in the impulse control spectrum, including suicidal and self-damaging behaviors, binge eating, and SA.

  5. Becoming Therapeutic Agents: A Grounded Theory of Mothers' Process When Implementing Cognitive Behavioural Therapy at Home with an Anxious Child.

    Science.gov (United States)

    Pishva, Rana

    2017-05-01

    The premise of parent-centred programmes for parents of anxious children is to educate and train caregivers in the sustainable implementation of cognitive behaviour therapy (CBT) in the home. The existing operationalization of parent involvement, however, does not address the systemic, parent or child factors that could influence this process. The qualitative approach of grounded theory was employed to examine patterns of action and interaction involved in the complex process of carrying out CBT with one's child in one's home. A grounded theory goes beyond the description of a process, offering an explanatory theory that brings taken-for-granted meanings and processes to the surface. The theory that emerged from the analysis suggests that CBT implementation by mothers of anxious children is characterized by the evolution of mothers' perception of their child and mothers' perception of their role as well as a shift from reacting with emotion to responding pragmatically to the child. Changes occur as mothers recognize the crisis, make links between the treatment rationale, child's symptoms and their own parenting strategies, integrate tenets of CBT for anxiety and eventually focus on sustaining therapeutic gains through natural life transitions. The theory widens our understanding of mothers' role, therapeutic engagement, process, and decision-making. The theory also generates new hypotheses regarding parent involvement in the treatment of paediatric anxiety disorders and proposes novel research avenues that aim to maximize the benefits of parental involvement in the treatment of paediatric anxiety disorders. Copyright © 2016 John Wiley & Sons, Ltd. Mothers of anxious youth who take part in parent-centred programmes experience a shift in their perception of the child and of their role. Parental strategy after CBT implementation shifts from emotional empathy to cognitive empathy. Mothers experience significant challenges and require additional support in prevention

  6. Evaluation the implementation of volumetric modulated arc therapy QA in the radiation therapy treatment according to various factors by using the portal dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Kim, So Hyeon; Bae, Sun Myung; Seo, Dong Rin; Kang, Tae Young; Baek, Geum Mun [Dept. of Radiation Oncology, ASAN Medical Center, Seoul (Korea, Republic of)

    2015-12-15

    The pre-treatment QA using Portal dosimetry for Volumetric Arc Therapy To analyze whether maintaining the reproducibility depending on various factors. Test was used for TrueBeam STx{sup TM} (Ver.1.5, Varian, USA). Varian Eclipse Treatment planning system(TPS) was used for planning with total of seven patients include head and neck cancer, lung cancer, prostate cancer, and cervical cancer was established for a Portal dosimetry QA plan. In order to measure these plans, Portal Dosimetry application (Ver.10) (Varian) and Portal Vision aS1000 Imager was used. Each Points of QA was determined by dividing, before and after morning treatment, and the after afternoon treatment ended (after 4 hours). Calibration of EPID(Dark field correction, Flood field correction, Dose normalization) was implemented before Every QA measure points. MLC initialize was implemented after each QA points and QA was retried. Also before QA measurements, Beam Ouput at the each of QA points was measured using the Water Phantom and Ionization chamber(IBA dosimetry, Germany). The mean values of the Gamma pass rate(GPR, 3%, 3mm) for every patients between morning, afternoon and evening was 97.3%, 96.1%, 95.4% and the patient's showing maximum difference was 95.7%, 94.2% 93.7%. The mean value of GPR before and after EPID calibration were 95.94%, 96.01%. The mean value of Beam Output were 100.45%, 100.46%, 100.59% at each QA points. The mean value of GPR before and after MLC initialization were 95.83%, 96.40%. Maintain the reproducibility of the Portal Dosimetry as a VMAT QA tool required management of the various factors that can affect the dosimetry.

  7. Motion-Compensated Estimation of Delivered Dose during External BeamRadiation Therapy: Implementation in Philips’ Pinnacle3 Treatment Planning System

    OpenAIRE

    Bharat, S.; Parikh, P.; Noel, C; Meltsner, M.; Bzdusek, K.; Kaus, M.

    2012-01-01

    Purpose: Recent research efforts investigating dose escalation techniques for three-dimensional conformal radiation therapy (3D CRT) andintensity modulated radiation therapy (IMRT) have demonstrated great benefit when high-dose hypofractionated treatment schemes are implemented16,21. The use of these paradigms emphasizes the importanceof smaller treatment margins to avoid high dose to surrounding normal tissue or organs at risk (OARs). However, tighter margins may leadto under-dosage of the t...

  8. The therapist?s role in the implementation of internet-based cognitive behavioural therapy for patients with depression: study protocol

    OpenAIRE

    Mol, Mayke; Dozeman, Els; van Schaik, Digna J. F.; Vis, Christiaan P. C. D.; Riper, Heleen; Smit, Jan H.

    2016-01-01

    Background Internet-based Cognitive Behavioural Therapy (iCBT) for the treatment of depressive disorders is innovative and promising. Various studies have demonstrated large effect sizes up to 2.27, but implementation in routine practice lags behind. Mental health therapists play a significant role in the uptake of internet-based interventions. Therefore, it is interesting to study factors that influence the therapists in whether they apply internet-based therapy or not. This study, as part o...

  9. Online dose reconstruction for tracked volumetric arc therapy: Real-time implementation and offline quality assurance for prostate SBRT.

    Science.gov (United States)

    Kamerling, Cornelis Ph; Fast, Martin F; Ziegenhein, Peter; Menten, Martin J; Nill, Simeon; Oelfke, Uwe

    2017-11-01

    Firstly, this study provides a real-time implementation of online dose reconstruction for tracked volumetric arc therapy (VMAT). Secondly, this study describes a novel offline quality assurance tool, based on commercial dose calculation algorithms. Online dose reconstruction for VMAT is a computationally challenging task in terms of computer memory usage and calculation speed. To potentially reduce the amount of memory used, we analyzed the impact of beam angle sampling for dose calculation on the accuracy of the dose distribution. To establish the performance of the method, we planned two single-arc VMAT prostate stereotactic body radiation therapy cases for delivery with dynamic MLC tracking. For quality assurance of our online dose reconstruction method we have also developed a stand-alone offline dose reconstruction tool, which utilizes the RayStation treatment planning system to calculate dose. For the online reconstructed dose distributions of the tracked deliveries, we could establish strong resemblance for 72 and 36 beam co-planar equidistant beam samples with less than 1.2% deviation for the assessed dose-volume indicators (clinical target volume D98 and D2, and rectum D2). We could achieve average runtimes of 28-31 ms per reported MLC aperture for both dose computation and accumulation, meeting our real-time requirement. To cross-validate the offline tool, we have compared the planned dose to the offline reconstructed dose for static deliveries and found excellent agreement (3%/3 mm global gamma passing rates of 99.8%-100%). Being able to reconstruct dose during delivery enables online quality assurance and online replanning strategies for VMAT. The offline quality assurance tool provides the means to validate novel online dose reconstruction applications using a commercial dose calculation engine. © 2017 The Authors. Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  10. Animal-assisted therapy: evaluation and implementation of a complementary therapy to improve the psychological and physiological health of critically ill patients.

    Science.gov (United States)

    DeCourcey, Mary; Russell, Anne C; Keister, Kathy J

    2010-01-01

    Animal-assisted therapy has gained widespread support in a variety of health care settings, including critical care units. This article seeks to review some of the current animal-assisted therapy, define a structured program, and evaluate the potential ability of the therapy to enhance the progress and health of our patients.

  11. Improved overall survival after implementation of targeted therapy for patients with metastatic renal cell carcinoma: Results from the Danish Renal Cancer Group (DARENCA) study-2

    DEFF Research Database (Denmark)

    Sørensen, Anne V.; Donskov, Frede; Hermann, Gregers G.

    2014-01-01

    AbstractAim To evaluate the implementation of targeted therapy on overall survival (OS) in a complete national cohort of patients with metastatic renal cell carcinoma (mRCC). Methods All Danish patients with mRCC referred for first line treatment with immunotherapy, TKIs or mTOR-inhibitors between...

  12. Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS.

    Science.gov (United States)

    Polonsky, Maxim; Azbel, Lyuba; Wickersham, Jeffrey A; Taxman, Faye S; Grishaev, Evgeny; Dvoryak, Sergey; Altice, Frederick L

    2015-03-01

    Ukraine is experiencing one of the most volatile HIV epidemics globally, fueled primarily by people who inject drugs (PWIDs), and a parallel incarceration epidemic. Opioid substitution therapy (OST) is internationally recognized as one of the most effective forms of treatment for opioid dependence and is among the most effective HIV prevention strategies available, yet efforts to adopt it in Ukraine's Criminal Justice System (CJS) have been thwarted. To understand the reluctance of the Ukrainian CJS to adopt OST despite the overwhelming evidence pointing to its health benefits and improved criminal justice outcomes, we conducted the first survey of Ukrainian prison administrative, medical and custodial staff (N=243) attitudes towards addiction in general, OST, and people living with HIV/AIDS (PLWHA) in representative regions of Ukraine. Results revealed that Ukrainian CJS workers' attitudes toward OST, PLWHA, and drug addiction were universally negative, but differed substantially along geographic and occupational lines. Whereas geographic and cultural proximity to the European Union drove positive attitudes in the west, in the southern region we observed an identifiability effect, as workers who worked directly with prisoners held the most positive attitudes. We also found that knowledge mediated the effect of drug intolerance on OST attitudes. In Ukraine, adoption of OST is more influenced by myths, biases and ideological prejudices than by existing scientific evidence. By elucidating existing attitudes among CJS personnel, this study will help to direct subsequent interventions to address the barriers to implementing evidence-based HIV prevention treatments. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Evidence-based practice implementation: case report of the evolution of a quality improvement program in a multicenter physical therapy organization.

    Science.gov (United States)

    Stevans, Joel M; Bise, Christopher G; McGee, John C; Miller, Debora L; Rockar, Paul; Delitto, Anthony

    2015-04-01

    Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians. © 2015 American Physical Therapy Association.

  14. Accessibility and implementation in UK services of an effective depression relapse prevention programme - mindfulness-based cognitive therapy (MBCT): ASPIRE study protocol.

    Science.gov (United States)

    Rycroft-Malone, Jo; Anderson, Rob; Crane, Rebecca S; Gibson, Andy; Gradinger, Felix; Owen Griffiths, Heledd; Mercer, Stewart; Kuyken, Willem

    2014-05-24

    Mindfulness-based cognitive therapy (MBCT) is a cost-effective psychosocial prevention programme that helps people with recurrent depression stay well in the long term. It was singled out in the 2009 National Institute for Health and Clinical Excellence (NICE) Depression Guideline as a key priority for implementation. Despite good evidence and guideline recommendations, its roll-out and accessibility across the UK appears to be limited and inequitably distributed. The study aims to describe the current state of MBCT accessibility and implementation across the UK, develop an explanatory framework of what is hindering and facilitating its progress in different areas, and develop an Implementation Plan and related resources to promote better and more equitable availability and use of MBCT within the UK National Health Service. This project is a two-phase qualitative, exploratory and explanatory research study, using an interview survey and in-depth case studies theoretically underpinned by the Promoting Action on Implementation in Health Services (PARIHS) framework. Interviews will be conducted with stakeholders involved in commissioning, managing and implementing MBCT services in each of the four UK countries, and will include areas where MBCT services are being implemented successfully and where implementation is not working well. In-depth case studies will be undertaken on a range of MBCT services to develop a detailed understanding of the barriers and facilitators to implementation. Guided by the study's conceptual framework, data will be synthesized across Phase 1 and Phase 2 to develop a fit for purpose implementation plan. Promoting the uptake of evidence-based treatments into routine practice and understanding what influences these processes has the potential to support the adoption and spread of nationally recommended interventions like MBCT. This study could inform a larger scale implementation trial and feed into future implementation of MBCT with other

  15. Understanding clinician attitudes towards implementation of guided self-help cognitive behaviour therapy for those who hear distressing voices: using factor analysis to test normalisation process theory.

    Science.gov (United States)

    Hazell, Cassie M; Strauss, Clara; Hayward, Mark; Cavanagh, Kate

    2017-07-24

    The Normalisation Process Theory (NPT) has been used to understand the implementation of physical health care interventions. The current study aims to apply the NPT model to a secondary mental health context, and test the model using exploratory factor analysis. This study will consider the implementation of a brief cognitive behaviour therapy for psychosis (CBTp) intervention. Mental health clinicians were asked to complete a NPT-based questionnaire on the implementation of a brief CBTp intervention. All clinicians had experience of either working with the target client group or were able to deliver psychological therapies. In total, 201 clinicians completed the questionnaire. The results of the exploratory factor analysis found partial support for the NPT model, as three of the NPT factors were extracted: (1) coherence, (2) cognitive participation, and (3) reflexive monitoring. We did not find support for the fourth NPT factor (collective action). All scales showed strong internal consistency. Secondary analysis of these factors showed clinicians to generally support the implementation of the brief CBTp intervention. This study provides strong evidence for the validity of the three NPT factors extracted. Further research is needed to determine whether participants' level of seniority moderates factor extraction, whether this factor structure can be generalised to other healthcare settings, and whether pre-implementation attitudes predict actual implementation outcomes.

  16. Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait

    Directory of Open Access Journals (Sweden)

    Katoue MG

    2016-06-01

    Full Text Available Background: Pharmacists can provide beneficial pharmaceutical care services to patients receiving Parenteral Nutrition (PN therapy by working within Nutrition Support Teams (NSTs. Objective: This study was designed to explore pharmacists’ role in PN therapy in hospitals of Kuwait, sources of PN-related information, opinions on NSTs, perceptions about the barriers to pharmaceutical care implementation and views on how to enhance their practices. Methods: Data were collected via face-to-face semi-structured interviews with the senior Total Parenteral Nutrition (TPN pharmacists at all the hospitals which provide TPN preparation services (six governmental hospitals and one private hospital in Kuwait. Descriptive statistics were used to describe pharmacists’ demographic details and practice site characteristics. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: The pharmacists mainly performed technical tasks such as TPN compounding with minimal role in providing direct patient care. They used multiple different sources of TPN-related information to guide their practice. They reported positive and negative experiences with physicians depending on their practice environment. None of the hospitals had a functional NST. However, pharmacists expressed preference to work within NSTs due to the potential benefits of enhanced communication and knowledge exchange among practitioners and to improve service. Pharmacists perceived several barriers to providing pharmaceutical care including lack of reliable sources of TPN-related information, lack of a standard operating procedure for TPN across hospitals, insufficient staff, time constraints and poor communication between TPN pharmacists. To overcome these barriers, they recommended fostering pharmacists’ education on TPN, establishing national standards for TPN practices, provision of pharmacy staff, development of NSTs, enhancing TPN pharmacists

  17. Treatment failure in cognitive-behavioural therapy: therapeutic alliance as a precondition for an adherent and competent implementation of techniques.

    Science.gov (United States)

    Weck, Florian; Grikscheit, Florian; Jakob, Marion; Höfling, Volkmar; Stangier, Ulrich

    2015-03-01

    therapeutic alliance in cognitive-behavioural treatment. Therapeutic alliance seems to be an important precondition for the adherent and competent implementation of therapeutic techniques. Therapeutic alliance should be monitored during psychotherapeutic treatment. Cautions or limitations Results are limited to cognitive-behavioural therapy and may not be representative for other treatment approaches. Process analyses are based on highly standardized randomized controlled trials and may not be generalizable to routine care. © 2014 The British Psychological Society.

  18. Intercomparison of ionization chambers in standard X-ray beams, at radiotherapy, diagnostic radiology and radioprotection levels; Intercomparacao de camaras de ionizacao em feixes padroes de raios X, niveis radioterapia, radiodiagnostico e radioprotecao

    Energy Technology Data Exchange (ETDEWEB)

    Bessa, Ana Carolina Moreira de

    2006-07-01

    Since the calibration of radiation measurement instruments and the knowledge of their major characteristics are very important subjects, several different types of ionization chambers were intercompared in terms of their calibration coefficients and their energy dependence, in radiotherapy, diagnostic radiology and radioprotection standard beams. An intercomparison of radionuclide calibrators for nuclear medicine was performed, using three radionuclides: {sup 67}Ga, {sup 201}Tl and {sup 99m}Tc; the results obtained were all within the requirements of the national standard CNEN-NE-3.05. In order to complete the range of radiation qualities of the Calibration Laboratory of IPEN, standard radiation beam qualities, radiation protection and low energy radiation therapy levels, were established, according international recommendations. Three methodologies for the calibration of unsealed ionization chambers in X-ray beams were studied and compared. A set of Victoreen ionization chambers, specially designed for use in laboratorial intercomparisons, was submitted to characterization tests. The performance of these Victoreen ionization chambers showed that they are suitable for use in radioprotection beams, because the results obtained agree with international recommendations. However, these Victoreen ionization chambers can be used in radiotherapy and diagnostic radiology beams only with some considerations, since their performance in these beams, especially in relation to the energy dependence and stabilization time tests, did not agree with the international recommendations for dosimeters used in radiotherapy and diagnostic radiology beams. This work presents data on the performance of several types of ionization chambers in different X-ray beams, that may be useful for choosing the appropriate instrument for measurements in ionizing radiation beams. (author)

  19. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay.

    Science.gov (United States)

    Souza Possa, S; Braga Amador, C; Meira Costa, A; Takahama Sakamoto, E; Seiko Kondo, C; Maida Vasconcellos, A L; Moran de Brito, C M; Pereira Yamaguti, W

    2014-01-01

    The aim of this study was to evaluate the effectiveness of implementing a physical therapy guideline for patients undergoing upper abdominal surgery (UAS) in reducing the incidence of atelectasis and length of hospital stay in the postoperative period. A "before and after" study design with historical control was used. The "before" period included consecutive patients who underwent UAS before guideline implementation (intervention). The "after" period included consecutive patients after guideline implementation. Patients in the pre-intervention period were submitted to a program of physical therapy in which the treatment planning was based on the individual experience of each professional. On the other hand, patients who were included in the post-intervention period underwent a standardized program of physical therapy with a focus on the use of additional strategies (EPAP, incentive spirometry and early mobilization). There was a significant increase in the use of incentive spirometry and positive expiratory airway pressure after guideline implementation. Moreover, it was observed that early ambulation occurred in all patients in the post-intervention period. No patient who adhered totally to the guideline in the post-intervention period developed atelectasis. Individuals in the post-intervention period presented a shorter length of hospital stay (9.2±4.1 days) compared to patients in the pre-intervention period (12.1±8.3 days) (p<0.05). The implementation of a physical therapy guideline for patients undergoing UAS resulted in reduced incidence of atelectasis and reduction in length of hospital stay in the postoperative period. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  20. Role of FDG-PET in the Implementation of Involved-Node Radiation Therapy for Hodgkin Lymphoma Patients

    Energy Technology Data Exchange (ETDEWEB)

    Girinsky, Théodore [Department of Radiotherapy, Institut Gustave Roussy, Villejuif (France); Aupérin, Anne [Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Villejuif (France); Ribrag, Vincent [Department of Medicine, Institut Gustave Roussy, Villejuif (France); Elleuch, Manel [Department of Imaging, Institut Gustave Roussy, Villejuif (France); Fermé, Christophe [Department of Medicine, Institut Gustave Roussy, Villejuif (France); Bonniaud, Guillaume [Department of Medical Physics, Institut Gustave Roussy, Villejuif (France); Ruelle, Claude [Department of Information Technology, Institut Gustave Roussy, Villejuif (France); Alberini, Jean-Louis [Department of Imaging, Institut Curie R. Huguenin Hospital, Saint-Cloud (France); Celebic, Aljosa [Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Villejuif (France); Edeline, Véronique, E-mail: veronique.edeline@curie.fr [Department of Imaging, Institut Curie R. Huguenin Hospital, Saint-Cloud (France)

    2014-08-01

    Purpose: This study examines the role of {sup 18}F-labeled fluorodeoxyglucose positron emission tomography (FDG-PET) in the implementation of involved-node radiation therapy (INRT) in patients treated for clinical stages (CS) I/II supradiaphragmatic Hodgkin lymphoma (HL). Methods and Material: Patients with untreated CS I/II HL enrolled in the randomized EORTC/LYSA/FIL Intergroup H10 trial and participating in a real-time prospective quality assurance program were prospectively included in this study. Data were electronically obtained from 18 French cancer centers. All patients underwent APET-computed tomography (PET-CT) and a post-chemotherapy planning CT scanning. The pre-chemotherapy gross tumor volume (GTV) and the postchemotherapy clinical target volume (CTV) were first delineated on CT only by the radiation oncologist. The planning PET was then co-registered, and the delineated volumes were jointly analyzed by the radiation oncologist and the nuclear medicine physician. Lymph nodes undetected on CT but FDG-avid were recorded, and the previously determined GTV and CTV were modified according to FDG-PET results. Results: From March 2007 to February 2010, 135 patients were included in the study. PET-CT identified at least 1 additional FDG-avid lymph node in 95 of 135 patients (70.4%; 95% confidence interval [CI]: 61.9%-77.9%) and 1 additional lymph node area in 55 of 135 patients (40.7%; 95% CI: 32.4%-49.5%). The mean increases in the GTV and CTV were 8.8% and 7.1%, respectively. The systematic addition of PET to CT led to a CTV increase in 60% of the patients. Conclusions: Pre-chemotherapy FDG-PET leads to significantly better INRT delineation without necessarily increasing radiation volumes.

  1. Offering Patients Therapy Options in Unplanned Start (OPTiONS): Implementation of an educational program is feasible and effective.

    Science.gov (United States)

    Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy; Koch, Michael; Aarup, Michael; Qureshi, Abdul Rashid; Lindholm, Bengt; Rutherford, Peter

    2017-01-13

    Patients with unplanned dialysis start (UPS) have worse clinical outcomes than non-UPS patients, and receive peritoneal dialysis (PD) less frequently. In the OPTiONS study of UPS patients, an educational programme (UPS-EP) aiming at improving care of UPS patients by facilitating care pathways and enabling informed choice of dialysis modality was implemented. We here report on impact of UPS-EP on modality choice and clinical outcomes in UPS patients. This non-interventional, prospective, multi-center, observational study included 270 UPS patients from 26 centers in 6 European countries (Austria, Germany, Denmark, France, United Kingdom and Sweden) who prior to inclusion presented acutely, or were being followed by nephrologists but required urgent dialysis commencement by an acutely placed CVC or PD catheter. Effects of UPS-EP on choice and final decision of dialysis therapy and outcomes within 12 months of follow up were analysed. Among 270 UPS patients who had an unplanned start to dialysis, 214 were able to receive and 203 complete UPS-EP while 56 patients - who were older (p = 0.01) and had higher Charlson comorbidity index (CCI; p UPS-EP. Among 177 patients who chose dialysis modality after UPS-EP, 103 (58%) chose PD (but only 86% of them received PD) and 74 (42%) chose HD (95% received HD). Logistic regression analysis showed that diabetes 1.88 (1.05 - 3.37) and receiving UPS-EP, OR = 4.74 (CI, 2.05 - 10.98) predicted receipt of PD. Patients choosing PD had higher CCI (p = 0.01), higher prevalence of congestive heart failure (p UPS-EP predicted patient use of PD but 14% of those choosing PD after UPS-EP still did not receive the modality they preferred. Patient survival in patients choosing and/or receiving PD was similar to HD despite age and comorbidity disadvantages of the PD groups.

  2. Implementing person-environment approaches to prevent falls: a qualitative inquiry in applying the Westmead approach to occupational therapy home visits.

    Science.gov (United States)

    Clemson, Lindy; Donaldson, Alex; Hill, Keith; Day, Lesley

    2014-10-01

    Despite evidence of the effectiveness of home safety interventions for preventing falls, there is limited uptake of such interventions within community services. Therefore, as part of a broader translational project, we explored issues underlying the implementation of an evidence-based home safety fall prevention intervention. We conducted in-depth interviews with eight occupational therapists and two programme coordinators engaged to deliver a home safety fall prevention intervention. Six community health centres within two metropolitan regions of Melbourne, Australia participated. The RE-AIM framework and Diffusion of Innovations theory underpinned the interviews which examine the enablers and barriers to implementing a home safety fall prevention intervention and integrating it into routine community preventive practice. Analysis involved thematic and content analysis. Investment in the home safety for fall prevention intervention was supported and valued by coordinators and therapists alike, and a number of themes emerged which influenced implementation of this intervention. These included issues of: compatibility with organisational processes, individual practitioner practices and skills, a prevention approach, and client expectations; relative advantage in terms of flexibility of the process, client engagement and regional capacity building; complexity of implementing the intervention; and observability related to the invisible nature of fall prevention outcomes. Implementation of this home safety fall prevention intervention was influenced by a range of interrelated organisational, practitioner and client related factors. The findings from this project provide insights into, and opportunities to increase the sustainable implementation of the home safety fall prevention intervention into practice. © 2014 Occupational Therapy Australia.

  3. Accessibility and implementation in UK services of an effective depression relapse prevention programme – mindfulness-based cognitive therapy (MBCT): ASPIRE study protocol

    Science.gov (United States)

    2014-01-01

    Background Mindfulness-based cognitive therapy (MBCT) is a cost-effective psychosocial prevention programme that helps people with recurrent depression stay well in the long term. It was singled out in the 2009 National Institute for Health and Clinical Excellence (NICE) Depression Guideline as a key priority for implementation. Despite good evidence and guideline recommendations, its roll-out and accessibility across the UK appears to be limited and inequitably distributed. The study aims to describe the current state of MBCT accessibility and implementation across the UK, develop an explanatory framework of what is hindering and facilitating its progress in different areas, and develop an Implementation Plan and related resources to promote better and more equitable availability and use of MBCT within the UK National Health Service. Methods/Design This project is a two-phase qualitative, exploratory and explanatory research study, using an interview survey and in-depth case studies theoretically underpinned by the Promoting Action on Implementation in Health Services (PARIHS) framework. Interviews will be conducted with stakeholders involved in commissioning, managing and implementing MBCT services in each of the four UK countries, and will include areas where MBCT services are being implemented successfully and where implementation is not working well. In-depth case studies will be undertaken on a range of MBCT services to develop a detailed understanding of the barriers and facilitators to implementation. Guided by the study’s conceptual framework, data will be synthesized across Phase 1 and Phase 2 to develop a fit for purpose implementation plan. Discussion Promoting the uptake of evidence-based treatments into routine practice and understanding what influences these processes has the potential to support the adoption and spread of nationally recommended interventions like MBCT. This study could inform a larger scale implementation trial and feed into

  4. Schema therapy for borderline personality disorder : A comprehensive review of its empirical foundations, effectiveness and implementation possibilities

    NARCIS (Netherlands)

    Sempertegui Vallejo, G.A.; Karreman, A.; Arntz, A.; Bekker, M.H.J.

    2013-01-01

    Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality

  5. The development and implementation of a regional network of physiotherapists for exercise therapy in patients with peripheral arterial disease, a preliminary report

    Directory of Open Access Journals (Sweden)

    Prins MH

    2005-07-01

    Full Text Available Abstract Background Exercise therapy (ET is the main conservative and proven effective treatment of patients with intermittent claudication. Currently, the most frequent exercise prescription is a single 'go home and walk' advise, without supervision or follow-up. There is no evidence to support the efficacy of this advise and compliance is known to be low. Therefore, a systematic approach was used to guarantee quality and standardisation of treatment, optimal guideline adherence and improved of inter-professional communication between vascular surgeons and physiotherapists. In this preliminary report we would like to outline the steps taken for the development and implementation of the Network Exercise Therapy Parkstad Methods In October 2003 all 59 regional physiotherapy practices were invited to attend a symposium regarding ET in a physiotherapeutic setting. Attending physiotherapists interested in providing ET and willing to follow a certified course on ET, were asked to register. Three tastkgroups were formed to accomplish the set targets: Exercise therapy education, Exercise therapy implementation and continuity, and Inter-professional communication in the Parkstad region. Results In total 27 physiotherapists, from 22 different practices followed the educational program and are now trained and accredited to provide ET according to the guideline of the Royal Dutch Society for Physiotherapy. A web-based database wasdesigned to contain information on disease specific items provided by the vascular surgery department, and aspects with respect to ET registered by the physiotherapist. The information is regularly updated and available online. Access tothe database is restricted to vascular surgeons and physiotherapists in the network. The secondary purpose of the database is to register essential benchmark data for future analysis of ET in a physiotherapeutic setting in the Netherlands and to enable physiotherapists continuous feedback on

  6. Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial.

    Science.gov (United States)

    Nadort, Marjon; Arntz, Arnoud; Smit, Johannes H; Giesen-Bloo, Josephine; Eikelenboom, Merijn; Spinhoven, Philip; van Asselt, Thea; Wensing, Michel; van Dyck, Richard

    2009-11-01

    This study aimed to evaluate the success of implementing outpatient schema focused therapy (ST) for borderline patients in regular mental healthcare and to determine the added value of therapist telephone availability outside office hours in case of crisis (TTA). To enhance the implementation, the following adaptations regarding the original ST protocol were applied: a reduction in the frequency and duration of the therapy; training therapists of eight regular healthcare centers in ST with a structured and piloted program supported by a set of films (DVDs) with examples of ST techniques; training and supervision given by Dutch experts. Telephone availability outside office hours was randomly allocated to 50% of the therapists of each treatment center. Patient's outcome measures were assessed with a semi-structured interview and self-report measures on BPD, quality of life, general psychopathology and an ST questionnaire, before, during and after treatment. Data on 62 DSM-IV defined BPD patients were available. Intention-to-treat analyses showed that after 1.5 years of ST 42% of the patients had recovered from BPD. No added value of therapist telephone availability (TTA) was found on the BPDSI score nor on any other measure after 1.5 years of ST. ST for BPD can be successfully implemented in regular mental healthcare. Treatment results and dropout were comparable to a previous clinical trail. No additional effect of extra crisis support with TTA outside office hours ST was found.

  7. Feasibility and Impact of Implementing Motivational Enhancement Therapy--Cognitive Behavioral Therapy as a Substance Use Treatment Intervention in School-Based Settings

    Science.gov (United States)

    Belur, Vinetha; Dennis, Michael L.; Ives, Melissa L.; Vincent, Robert; Muck, Randolph

    2014-01-01

    The expansion of behavioral health services to school-based health centers under the Affordable Care Act (Public Law 111-148) presents an opportunity to improve access to substance use disorders treatment for youth and reduce their substance use, and emotional, health, and school problems. We explore the feasibility of implementing five to seven…

  8. Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline

    NARCIS (Netherlands)

    Wees, P.J. van der; Zagers, C.A.; Die, S.E. de; Hendriks, E.J.; Nijhuis-Van der Sanden, M.W.G.; Bie, R.A. de

    2013-01-01

    BACKGROUND: Clinical practice guidelines have been developed to assist healthcare practitioners in clinical decision making. Publication of clinical practice guidelines does not automatically lead to their uptake and barrier identification has been recognized as an important step in implementation

  9. Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence

    National Research Council Canada - National Science Library

    Gisel Viviana Osorio-Cuellar; Sara Gabriela Pacichana-Quinayáz; Francisco Javier Bonilla-Escobar; Andrés Fandiño-Losada; Maria Isabel Gutiérrez-Martinez

    ... as a viable mental health intervention. The objective of this study is to describe the process of implementation and results of the intervention in Afro-Colombian victims of violence, in the municipalities of Buenaventura and Quibdó...

  10. Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence

    National Research Council Canada - National Science Library

    Osorio-Gisel Viviana Cuellar; Pacichana-Sara Gabriela Quinayaz; Bonilla-Francisco Javier Escobar; Fandiño-Andres Losada; Gutierrez-Maria Isabel Martinez

    2017-01-01

    ... as a viable mental health intervention. The objective of this study is to describe the process of implementation and results of the intervention in Afro-Colombian victims of violence, in the municipalities of Buenaventura and Quibdó...

  11. Design and implementation of home-based virtual reality exposure therapy system with a virtual eCoach

    NARCIS (Netherlands)

    Hartanto, D.; Brinkman, W.P.; Kampmann, I.L.; Morina, N.; Emmelkamp, P.G.; Neerincx, M.A.

    2015-01-01

    Current developments of virtual reality exposure therapy (VRET) system focus mainly on systems that can be used in health clinics under the direct supervision of a therapist. Offering patients however the possibility to do this treatment at home would make VRET more accessible. In this paper we

  12. Implementation of co-trimoxazole preventive therapy policy for malaria in HIV-infected pregnant women in the public health facilities in Tanzania

    Directory of Open Access Journals (Sweden)

    Kamuhabwa AAR

    2016-12-01

    Full Text Available Appolinary AR Kamuhabwa, Richard Gordian, Ritah F Mutagonda Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Background: In 2011, Tanzania adopted a policy for provision of daily co-trimoxazole prophylaxis to HIV-infected pregnant women for prevention of malaria and other opportunistic infections. As per the policy, HIV-infected pregnant women should not be given sulfadoxine-pyrimethamine (SP for intermittent preventive therapy. The challenges associated with this policy change and the extent to which the new policy for prevention of malaria in pregnant women coinfected with HIV was implemented need to be assessed. Aim: To assess the implementation of malaria-preventive therapy policy among HIV-infected pregnant women in the public health facilities in Dar es Salaam, Tanzania. Methodology: The study was conducted in Kinondoni Municipality, Dar es Salaam, Tanzania, from January 2015 to July 2015. Three hundred and fifty-three HIV-infected pregnant women who were attending antenatal clinics (ANCs and using co-trimoxazole for prevention of malaria were interviewed. Twenty-six health care workers working at the ANCs were also interviewed regarding provision of co-trimoxazole prophylaxis to pregnant women. A knowledge scale was used to grade the level of knowledge of health care providers. Focus group discussions were also conducted with 18 health care workers to assess the level of implementation of the policy and the challenges encountered. Results: Twenty-three (6.5% pregnant women with known HIV serostatus were using co-trimoxazole for prevention of opportunistic infections even before they became pregnant. Out of the 353 HIV-infected pregnant women, eight (2.5% were coadministered with both SP and co-trimoxazole. Sixty (16.7% pregnant women had poor adherence to co-trimoxazole prophylaxis. Out of the 26 interviewed health care providers, 20 had high

  13. A Standardized Method of Preventing and Managing Emergencies within the Context of Evidence-Based Therapy Implementation

    Science.gov (United States)

    Urgelles, Jessica; Donohue, Brad; Wilks, Chelsey; Van Hasselt, Vincent B.; Azrin, Nathan H.

    2012-01-01

    Families served within child welfare settings evidence a wide range of emergencies or unexpected crises or circumstances that may lead to danger and make it difficult for them to focus on treatment planning. Mental health treatment providers are often unprepared to effectively manage emergencies during implementation of evidence-based prescribed…

  14. Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands

    NARCIS (Netherlands)

    Harriet Wittink; Raymond Swinkels; Jan Custers; Roland van Peppen; Anna Beurskens

    2011-01-01

    In many countries, the need for physical therapists to use standardised measures has been recognised and is recommended in clinical practice guidelines. Research has shown a lack of clinimetric knowledge and clinical application of measurement instruments in daily practice may hamper implementation

  15. Universal antiretroviral therapy for HIV-infected children: a review of the benefits and risks to consider during implementation

    Directory of Open Access Journals (Sweden)

    Linda Barlow-Mosha

    2017-01-01

    Conclusion: Overall, our findings suggest that the benefits could outweigh the risks and support universal ART for all HIV-infected children, but recognize that national programmes will need to put measures in place to minimize the risks if they choose to implement the strategy.

  16. Utilizing Benchmarking to Study the Effectiveness of Parent-Child Interaction Therapy Implemented in a Community Setting

    Science.gov (United States)

    Self-Brown, Shannon; Valente, Jessica R.; Wild, Robert C.; Whitaker, Daniel J.; Galanter, Rachel; Dorsey, Shannon; Stanley, Jenelle

    2012-01-01

    Benchmarking is a program evaluation approach that can be used to study whether the outcomes of parents/children who participate in an evidence-based program in the community approximate the outcomes found in randomized trials. This paper presents a case illustration using benchmarking methodology to examine a community implementation of…

  17. Public-academic partnerships: the Beck Initiative: a partnership to implement cognitive therapy in a community behavioral health system.

    Science.gov (United States)

    Stirman, Shannon Wiltsey; Buchhofer, Regina; McLaulin, J Bryce; Evans, Arthur C; Beck, Aaron T

    2009-10-01

    The Beck Initiative is a partnership between researchers and clinicians at a large university and an urban behavioral health managed care system. Both partners share a commitment to ensuring that consumers in the community have access to competently delivered, individualized, evidence-based mental health care and that the providers who serve them have the support they need to deliver high-quality evidence-based treatments. Central features of the program are individualized training and consultation in cognitive therapy for each provider agency and policies to promote the sustainability of the initiative and its continuing evolution to meet the needs of providers and consumers.

  18. The history of antiretroviral therapy and of its implementation in resource-limited areas of the world.

    Science.gov (United States)

    Vella, Stefano; Schwartländer, Bernard; Sow, Salif Papa; Eholie, Serge Paul; Murphy, Robert L

    2012-06-19

    HIV/AIDS not only represents the most severe epidemic in modern times, but also the greatest public health challenge in history. The response of the scientific community has been impressive and in just a few years, turned an inevitably fatal disease into a chronic manageable although not yet curable condition. The development of antiretroviral therapy is not only the history of scientific advancements: it is the result of the passionate 'alliance' towards a common goal between researchers, doctors and nurses, pharmaceutical industries, regulators, public health officials and the community of HIV-infected patients, which is rather unique in the history of medicine. In addition, the rapid and progressive development of antiretroviral therapy has not only proven to be life-saving for many millions but has been instrumental in unveiling the inequities in access to health between rich and poor countries of the world. Optimal benefits indeed, are not accessible to all people living with HIV, with challenges to coverage and sustainability in low and middle income countries. This paper will review the progress made, starting from the initial despairing times, till the current battle towards universal access to treatment and care for all people living with HIV.

  19. The long winding road of opioid substitution therapy implementation in South-East Asia: challenges to scale up

    Directory of Open Access Journals (Sweden)

    Gary Reid

    2014-03-01

    Full Text Available The South-East Asia Region contains an estimated 400,000-500,000 people who inject drugs (PWID. HIV prevalence among PWID is commonly 20% or higher in Indonesia, Thailand, Myanmar and some regions of India. Opioid substitution therapy (OST is an important HIV prevention intervention in this part of the world. However, key challenges and barriers to scale up of OST exist, including: pervasive stigma and discrimination towards PWID; criminalisation of drug use overshadowing a public health response; lack of political will and national commitment; low financial investment; focus towards traditional treatment models of detoxification and rehabilitation; inadequate dosing of OST; and poor monitoring and evaluation of programmes. Our review of local evidence highlights that OST can be successful within the Asian context. Such evidence should be utilised more widely to advocate for policy change and increased political commitment to ensure OST reaches substantially more drug users.

  20. The legal landscape for advanced therapies: material and institutional implementation of European Union rules in France and the United Kingdom.

    Science.gov (United States)

    Mahalatchimy, Aurélie; Rial-Sebbag, Emmanuelle; Tournay, Virginie; Faulkner, Alex

    2012-01-01

    In 2007, the European Union adopted a lex specialis, Regulation (EC) No. 1394/2007 on advanced therapy medicinal products (ATMPs), a new legal category of medical product in regenerative medicine. The regulation applies to ATMPs prepared industrially or manufactured by a method involving an industrial process. It also provides a hospital exemption, which means that medicinal products not regulated by EU law do not benefit from a harmonized regime across the European Union but have to respect national laws. This article describes the recent EU laws, and contrasts two national regimes, asking how France and the United Kingdom regulate ATMPs which do and do not fall under the scope of Regulation (EC) No. 1394/2007. What are the different legal categories and their enforceable regimes, and how does the evolution of these highly complex regimes interact with the material world of regenerative medicine and the regulatory bodies and socioeconomic actors participating in it?

  1. Development and implementation of a non Gaussian model for the lateral dose prediction in a proton therapy treatment planning system

    Science.gov (United States)

    Bellinzona, V. E.

    2017-05-01

    Challenging issues in treatment planning system for hadrontherapy are the accurate and fast calculation of dose distribution, the reduction in memory space required to store the dose kernel of individual pencil beams and the shortening of computation time for dose optimization and calculation. In this framework, the prediction of lateral dose distributions is a topic of great interest because currently the double gaussian parametrization is typically used as approximation although other parameterizations are also available. The best accuracy for this kind of calculations can be obtained by Monte Carlo methods, at the expense of a long computing time. This work aims to present a flexible computational model for the calculation of the lateral profile of a pencil proton beam and the results of its implementation in a treatment planning system. The model calculation are compared with the currently used double gaussian approximation and the Monte Carlo calculations, and the tests are performed in water and in presence of inhomogeneities.

  2. Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for rasburicase therapy in the context of G6PD deficiency genotype.

    Science.gov (United States)

    Relling, M V; McDonagh, E M; Chang, T; Caudle, K E; McLeod, H L; Haidar, C E; Klein, T; Luzzatto, L

    2014-08-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with development of acute hemolytic anemia (AHA) induced by a number of drugs. We provide guidance as to which G6PD genotypes are associated with G6PD deficiency in males and females. Rasburicase is contraindicated in G6PD-deficient patients due to the risk of AHA and possibly methemoglobinemia. Unless preemptive genotyping has established a positive diagnosis of G6PD deficiency, quantitative enzyme assay remains the mainstay of screening prior to rasburicase use. The purpose of this article is to help interpret the results of clinical G6PD genotype tests so that they can guide the use of rasburicase. Detailed guidelines on other aspects of the use of rasburicase, including analyses of cost-effectiveness, are beyond the scope of this document. Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines are published and updated periodically on https://www.pharmgkb.org/page/cpic to reflect new developments in the field.

  3. Clinical implementation of a GPU-based simplified Monte Carlo method for a treatment planning system of proton beam therapy.

    Science.gov (United States)

    Kohno, R; Hotta, K; Nishioka, S; Matsubara, K; Tansho, R; Suzuki, T

    2011-11-21

    We implemented the simplified Monte Carlo (SMC) method on graphics processing unit (GPU) architecture under the computer-unified device architecture platform developed by NVIDIA. The GPU-based SMC was clinically applied for four patients with head and neck, lung, or prostate cancer. The results were compared to those obtained by a traditional CPU-based SMC with respect to the computation time and discrepancy. In the CPU- and GPU-based SMC calculations, the estimated mean statistical errors of the calculated doses in the planning target volume region were within 0.5% rms. The dose distributions calculated by the GPU- and CPU-based SMCs were similar, within statistical errors. The GPU-based SMC showed 12.30-16.00 times faster performance than the CPU-based SMC. The computation time per beam arrangement using the GPU-based SMC for the clinical cases ranged 9-67 s. The results demonstrate the successful application of the GPU-based SMC to a clinical proton treatment planning.

  4. Integrating community pharmacy into community based anti-retroviral therapy program: A pilot implementation in Abuja, Nigeria.

    Directory of Open Access Journals (Sweden)

    Yohanna Kambai Avong

    Full Text Available The landscape of Human Immunodeficiency Virus (HIV epidemic control is shifting with the United Nations Programme on HIV/AIDS (UNAIDS 90-90-90 benchmarks for epidemic control. Community-based Antiretroviral Therapy (CART models have improved treatment uptake and demonstrated good clinical outcomes. We assessed the feasibility of integrating community pharmacy as a task shift structure for differentiated community ART in Abuja-Nigeria.Stable patients on first line ART regimens from public health facilities were referred to community pharmacies in different locations within the Federal Capital Territory, Abuja for prescription refills and treatment maintenance. Bio-demographic and clinical data were collected from February 25, 2016 to May 31st, 2017 and descriptive statistics analysis applied. The outcomes of measure were prescription refill and patient retention in care at the community pharmacy.Almost 10% of stable patients on treatment were successfully devolved from eight health facilities to ten community pharmacies. Median age of the participants was 35 years [interquartile range (IQR; 30, 41] with married women in the majority. Prescription refill was 100% and almost all the participants (99.3% were retained in care after they were devolved to the community pharmacies. Only one participant was lost-to-follow-up as a result of death.Excellent prescription refill and high retention in care with very low loss-to-follow-up were associated with the community pharmacy model. The use of community pharmacy for community ART is feasible in Nigeria. We recommend the scale up of the model in all the 36 states of Nigeria.

  5. Genetically Guided Statin Therapy on Statin Perceptions, Adherence, and Cholesterol Lowering: A Pilot Implementation Study in Primary Care Patients

    Directory of Open Access Journals (Sweden)

    Josephine H. Li

    2014-03-01

    Full Text Available Statin adherence is often limited by side effects. The SLCO1B1*5 variant is a risk factor for statin side effects and exhibits statin-specific effects: highest with simvastatin/atorvastatin and lowest with pravastatin/rosuvastatin. The effects of SLCO1B1*5 genotype guided statin therapy (GGST are unknown. Primary care patients (n = 58 who were nonadherent to statins and their providers received SLCO1B1*5 genotyping and guided recommendations via the electronic medical record (EMR. The primary outcome was the change in Beliefs about Medications Questionnaire, which measured patients’ perceived needs for statins and concerns about adverse effects, measured before and after SLCO1B1*5 results. Concurrent controls (n = 59 were identified through the EMR to compare secondary outcomes: new statin prescriptions, statin utilization, and change in LDL-cholesterol (LDL-c. GGST patients had trends (p = 0.2 towards improved statin necessity and concerns. The largest changes were the “need for statin to prevent sickness” (p < 0.001 and “concern for statin to disrupt life” (p = 0.006. GGST patients had more statin prescriptions (p < 0.001, higher statin use (p < 0.001, and greater decrease in LDL-c (p = 0.059 during follow-up. EMR delivery of SLCO1B1*5 results and recommendations is feasible in the primary care setting. This novel intervention may improve patients’ perceptions of statins and physician behaviors that promote higher statin adherence and lower LDL-c.

  6. The haemtrack home therapy reporting system: Design, implementation, strengths and weaknesses: A report from UK Haemophilia Centre Doctors Organisation.

    Science.gov (United States)

    Hay, C R M; Xiang, H; Scott, M; Collins, P W; Liesner, R; Dolan, G; Hollingsworth, R

    2017-09-01

    Haemtrack is an electronic home treatment diary for patients with inherited bleeding disorders, introduced in 2008. It aimed to improve the timeliness and completeness of patient-reported treatment records, to facilitate analysis of treatment and outcome trends. The system is easy to use, responsive and accessible. The software uses Microsoft technologies with a SQL Server database and an ASP.net website front-end, running on personal computers, android and I-phones. Haemtrack interfaces with the UK Haemophilia Centre Information System and the National Haemophilia Database (NHD). Data are validated locally by Haemophilia Centres and centrally by NHD. Data collected include as follows: treatment brand, dose and batch number, time/date of bleed onset and drug administration, reasons for treatment (prophylaxis, bleed, follow-up), bleed site, severity, pain-score and outcome. Haemtrack was used by 90% of haemophilia treatment centres (HTCs) in 2015, registering 2683 patients using home therapy of whom 1923 used Haemtrack, entering >17 000 treatments per month. This included 68% of all UK patients with severe haemophilia A. Reporting compliance varied and 55% of patients reported ≥75% of potential usage. Centres had a median 78% compliance overall. A strategy for progressively improving compliance is in place. Age distribution and treatment intensity were similar in Haemtrack users/non-users with severe haemophilia treated prophylactically. The Haemtrack system is a valuable tool that may improve treatment compliance and optimize treatment regimen. Analysis of national treatment trends and large-scale longitudinal, within-patient analysis of changes in regimen and/or product will provide valuable insights that will guide future clinical practice. © 2017 John Wiley & Sons Ltd.

  7. Implementation of integrated therapies for comorbid post-traumatic stress disorder and substance use disorders in community substance abuse treatment programs.

    Science.gov (United States)

    Killeen, Therese K; Back, Sudie E; Brady, Kathleen T

    2015-05-01

    The high prevalence of trauma and post-traumatic stress disorder (PTSD) in individuals with substance use disorders (SUDs) presents a number of treatment challenges for community treatment providers and programs in the USA. Although several evidence-based, integrated therapies for the treatment of comorbid PTSD/SUD have been developed, rates of utilisation of such practices remain low in community treatment programs. The goal of this article was to review the extant literature on common barriers that prevent adoption and implementation of integrated treatments for PTSD/SUD among substance abuse community treatment programs. Organisational, provider-level and patient-level factors that drive practice decisions were discussed, including organisational philosophy of care policies, funding and resources, as well as provider and patient knowledge and attitudes related to implementation of new integrated treatments for comorbid PTSD and SUD. Understanding and addressing these community treatment challenges may facilitate use of evidence-based integrated treatments for comorbid PTSD and SUD. © 2015 Australasian Professional Society on Alcohol and other Drugs.

  8. Sustained Implementation of Cognitive-Behavioral Therapy for Youth Anxiety and Depression: Long-term Effects of Structured Training and Consultation on Therapist Practice in the Field.

    Science.gov (United States)

    Chu, Brian C; Crocco, Sofia Talbott; Arnold, Cassidy C; Brown, Ruth; Southam-Gerow, Michael A; Weisz, John R

    2015-02-01

    Identifying factors that promote sustained implementation of evidence-based treatments (EBTs) after therapists receive training is critical for professional psychology. To address the field's minimal knowledge in this area, we interviewed community-based therapists (N = 23) who had completed intensive training in cognitive behavioral therapy (CBT) for either anxiety or depression as part of a randomized effectiveness trial (Southam-Gerow et al., 2010; Weisz et al., 2009). Therapists were interviewed three to five years after completion of the initial trial, representing one of the longest-term follow-ups of therapist practices after training. Therapists viewed each protocol and their individual CBT strategies as effective and appropriate for the majority of their current anxiety and depression caseloads. However, therapists used parts of each protocol much more frequently than the protocol as a whole (i.e., 78.5% used parts of the Coping Cat, and 7.5% used the whole protocol; 58.6% used parts of the PASCET, and 20% used the whole protocol). Therapists reported using problem-solving the most and exposure exercises the least for current anxious cases; they used cognitive restructuring the most and homework the least for current depression cases. Interventions that were more difficult to implement in usual care settings were less likely to be sustained. Future efforts should evaluate the characteristics and structure of EBTs that are most acceptable to therapists and should investigate which kinds of ongoing learning supports will maintain therapist skills in and continued use of EBTs.

  9. Mental illness stigma and engagement in an implementation trial for Cognitive Processing Therapy at a diverse community health center: a qualitative investigation.

    Science.gov (United States)

    Valentine, Sarah E; Dixon, Louise; Borba, Christina P C; Shtasel, Derri L; Marques, Luana

    The present study aimed to describe associations between various types of mental health stigma and help-seeking behaviors among ethnically diverse clients with posttraumatic stress disorder (PTSD) served by an urban community health clinic. The present study draws qualitative data from a parent National Institute of Mental Health Study that aims to identify barriers and facilitators of implementing Cognitive Processing Therapy (CPT) for PTSD. A total of 24 participants from the initial phase of the trial were included in the present study. Mental health stigma emerged as one notable barrier to seeking mental health treatment, as participants described how experiences of environment-level stigma, internalized (self-)stigma and perceived (felt) stigma from their family, friends and previous healthcare providers influenced their decisions to seek care. Despite these barriers to help seeking, many clients also reported that positive interactions with informal and formal support systems, and encouragement from study therapists, helped to combat mental health stigma and facilitate decisions to participate in an implementation trial for CPT. Findings suggest that providers in community health settings may need to attend directly to stigma at the initiation of mental health treatment.

  10. Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands.

    Science.gov (United States)

    Swinkels, Raymond A H M; van Peppen, Roland P S; Wittink, Harriet; Custers, Jan W H; Beurskens, Anna J H M

    2011-05-22

    In many countries, the need for physical therapists to use standardised measures has been recognised and is recommended in clinical practice guidelines. Research has shown a lack of clinimetric knowledge and clinical application of measurement instruments in daily practice may hamper implementation of these guidelines. The aims of our study were a) to investigate the current use of measurement instruments by Dutch physical therapists; b) to investigate the facilitators and barriers in using measurement instruments. To get a complete and valid overview of relevant barriers and facilitators, different methods of data collection were used. We conducted a literature search, semi-structured interviews with 20 physical therapists and an online survey. Facilitators are the fact that most therapists indicated a positive attitude and were convinced of the advantages of the use of measurement instruments. The most important barriers to the use of measurement instruments included physical therapists' competence and problems in changing behaviour, practice organisation (no room; no time) and the unavailability and feasibility of measurement instruments. Furthermore, physical therapists indicated the need to have a core set of measurement instruments with a short user's instruction on application, scoring and interpretation. The main barriers are on the level of the physical therapist (lack of knowledge; not focusing on the use of outcome measures) and organisation (lack of time; availability; lack of management support).There seems to be a disparity between what physical therapists say and what they do. The majority of participating physical therapists indicated a positive attitude and were convinced of the advantages of the use of measurement instruments. However, the main problem for physical therapists is when to use which instrument for what patient (lack of knowledge). Furthermore, physical therapists indicated a need to compile a core set of measurement instruments with

  11. Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands

    Directory of Open Access Journals (Sweden)

    Wittink Harriet

    2011-05-01

    Full Text Available Abstract Background In many countries, the need for physical therapists to use standardised measures has been recognised and is recommended in clinical practice guidelines. Research has shown a lack of clinimetric knowledge and clinical application of measurement instruments in daily practice may hamper implementation of these guidelines. Objectives The aims of our study were a to investigate the current use of measurement instruments by Dutch physical therapists; b to investigate the facilitators and barriers in using measurement instruments. Methods To get a complete and valid overview of relevant barriers and facilitators, different methods of data collection were used. We conducted a literature search, semi-structured interviews with 20 physical therapists and an online survey. Results Facilitators are the fact that most therapists indicated a positive attitude and were convinced of the advantages of the use of measurement instruments. The most important barriers to the use of measurement instruments included physical therapists' competence and problems in changing behaviour, practice organisation (no room; no time and the unavailability and feasibility of measurement instruments. Furthermore, physical therapists indicated the need to have a core set of measurement instruments with a short user's instruction on application, scoring and interpretation. Conclusions The main barriers are on the level of the physical therapist (lack of knowledge; not focusing on the use of outcome measures and organisation (lack of time; availability; lack of management support. There seems to be a disparity between what physical therapists say and what they do. The majority of participating physical therapists indicated a positive attitude and were convinced of the advantages of the use of measurement instruments. However, the main problem for physical therapists is when to use which instrument for what patient (lack of knowledge. Furthermore, physical

  12. Polymorphisms in pfdhfr and pfdhps genes after five years of artemisinin combination therapy (ACT) implementation from urban Kolkata, India.

    Science.gov (United States)

    Chatterjee, Moytrey; Ganguly, Swagata; Saha, Pabitra; Guha, Subhasish K; Maji, Ardhendu Kumar

    2017-09-01

    In India, sulphadoxine-pyrimethamine (SP) is now in use as a partner drug of ACT (AS+SP) to treat uncomplicated falciparum malaria since 2010. Declined trend of AS+SP efficacy has been reported from north-eastern states of the country. It is not possible to determine the efficacy of SP alone from any study with ACT. So, this work was designed to study the pattern of polymorphisms in pfdhfr and pfdhps genes to predict the SP resistance status among parasite population of urban Kolkata after five years of ACT implementation. A total of 125 P. falciparum positive patients were enrolled in the study during December 2014 to July 2016 and treated with AS+SP. Parasitic DNA was isolated and subjected to sequencing of pfdhfr and pfdhps genes directly from purified PCR products. Genotyping of both the genes was successfully done in 113 isolates. In pfdhfr, 94.69% (107/113) isolates showed mutations at codon 59 and 108. A double mutant genotype ANRNI was mostly prevalent (107/113, 94.69%), while wild-type genotype ANCSI was found only in 5.3% (6/113) isolates. In pfdhps, mutations were recorded at codon 436 and 437 in 65.49% (74/113) and 23.01% (26/113) isolates, respectively. In combined pfdhfr-pfdhps genes, triple mutant ANRNI-FAKAA was most prevalent (45/113, 39.82%) followed by double mutant ANRNI-SAKAA (37/113, 32.74%) and quadruple mutant ANRNI-FGKAA (24/113, 21.24%). SP resistance hallmark mutations i.e., quadruple (AIRNI-SAEAA) or quintuple (AIRNI-SGEAA) genotype in pfdhfr and pfdhps was absent which indicates that SP components of used ACT is still effective in the study area. It is also evident by the clinical response of AS+SP. Monitoring the efficacy of this combination (both by therapeutic and molecular marker study) at a regular interval is highly suggested to record any development of SP resistance in near future. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay

    Directory of Open Access Journals (Sweden)

    S. Souza Possa

    2014-03-01

    Full Text Available Objective: The aim of this study was to evaluate the effectiveness of implementing a physical therapy guideline for patients undergoing upper abdominal surgery (UAS in reducing the incidence of atelectasis and length of hospital stay in the postoperative period. Materials and methods: A “before and after” study design with historical control was used. The “before” period included consecutive patients who underwent UAS before guideline implementation (intervention. The “after” period included consecutive patients after guideline implementation. Patients in the pre‐intervention period were submitted to a program of physical therapy in which the treatment planning was based on the individual experience of each professional. On the other hand, patients who were included in the post‐intervention period underwent a standardized program of physical therapy with a focus on the use of additional strategies (EPAP, incentive spirometry and early mobilization. Results: There was a significant increase in the use of incentive spirometry and positive expiratory airway pressure after guideline implementation. Moreover, it was observed that early ambulation occurred in all patients in the post‐intervention period. No patient who adhered totally to the guideline in the post‐intervention period developed atelectasis. Individuals in the post‐intervention period presented a shorter length of hospital stay (9.2 ± 4.1 days compared to patients in the pre‐intervention period (12.1 ± 8.3 days (p < 0.05. Conclusion: The implementation of a physical therapy guideline for patients undergoing UAS resulted in reduced incidence of atelectasis and reduction in length of hospital stay in the postoperative period. Resumo: Objetivo: O objetivo deste estudo foi avaliar a eficácia da implementação de uma diretriz de fisioterapia para doentes submetidos a cirurgia abdominal superior (UAS na

  14. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay

    Directory of Open Access Journals (Sweden)

    S. Souza Possa

    2014-03-01

    Full Text Available Objective: The aim of this study was to evaluate the effectiveness of implementing a physical therapy guideline for patients undergoing upper abdominal surgery (UAS in reducing the incidence of atelectasis and length of hospital stay in the postoperative period. Materials and methods: A “before and after” study design with historical control was used. The “before” period included consecutive patients who underwent UAS before guideline implementation (intervention. The “after” period included consecutive patients after guideline implementation. Patients in the pre-intervention period were submitted to a program of physical therapy in which the treatment planning was based on the individual experience of each professional. On the other hand, patients who were included in the post-intervention period underwent a standardized program of physical therapy with a focus on the use of additional strategies (EPAP, incentive spirometry and early mobilization. Results: There was a significant increase in the use of incentive spirometry and positive expiratory airway pressure after guideline implementation. Moreover, it was observed that early ambulation occurred in all patients in the post-intervention period. No patient who adhered totally to the guideline in the post-intervention period developed atelectasis. Individuals in the post-intervention period presented a shorter length of hospital stay (9.2 ± 4.1 days compared to patients in the pre-intervention period (12.1 ± 8.3 days (p < 0.05. Conclusion: The implementation of a physical therapy guideline for patients undergoing UAS resulted in reduced incidence of atelectasis and reduction in length of hospital stay in the postoperative period. Resumo: Objetivo: O objetivo deste estudo foi avaliar a eficácia da implementação de uma diretriz de fisioterapia para doentes submetidos a cirurgia abdominal superior (UAS na redução da incid

  15. Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects-an observational study.

    Science.gov (United States)

    Hafner, Sebastian; Stahl, Wolfgang; Fels, Theresa; Träger, Karl; Georgieff, Michael; Wepler, Martin

    2015-01-01

    Regional citrate anticoagulation (RCA) is being increasingly used during continuous renal replacement therapy (CRRT) in intensive care units as an alternative to systemic heparin anticoagulation. However, due to its availability in a variety of solutions and dialysis systems, RCA is still considered a complex intervention, possibly leading to confusion and pitfalls in everyday practice. We therefore tested retrospectively if the introduction of RCA as a new anticoagulation strategy for CRRT was feasible and had not negatively impacted efficacy, safety, metabolic stability, filter lifetime, and cost-effectiveness compared to well-established systemic heparin. This observational, retrospective study was performed on a non-cardiac surgical and trauma intensive care unit (ICU) in a university hospital. All charts of patients receiving one of the CRRT techniques from May 2006 to April 2010 were reviewed. The first 60 consecutive patients receiving CRRT with regional citrate anticoagulation after its implementation in February 2008 (continuous veno-venous haemodialysis, Multifiltrate® with integrated CiCa® system, AV 1000 S® filter, n = 60) were included in the study. The last 50 consecutive patients with systemic heparin anticoagulation therapy (continuous veno-venous haemodiafiltration, PRISMAFLEX®, AN69® filter, n = 50), treated immediately before the introduction of RCA, were used as a historic control group. Both treatment modalities were effective in terms of uraemia control. Patients in the citrate group presented with significantly higher pH levels, lower ionized calcium levels, and higher sodium levels compared with the heparin treated group, however, without notable adverse clinical events. Interestingly, mean circuit lifetime was significantly longer in the citrate group (48.6 ± 24.2 h vs. 18.8 ± 13.5 h; p parameters, i.e. different filters, modes of dialysis, and flow parameters not having been standardized, we were unable to draw a

  16. Effectiveness of a training package for implementing a community-based occupational therapy program in dementia: a cluster randomized controlled trial.

    Science.gov (United States)

    Döpp, Carola M E; Graff, Maud J L; Teerenstra, Steven; Olde Rikkert, Marcel G M; Nijhuis-van der Sanden, Maria W G; Vernooij-Dassen, Myrra J F J

    2015-10-01

    Evaluate the effectiveness of a training package to implement a community occupational therapy program for people with dementia and their caregiver (COTiD). Cluster randomized controlled trial. A total of 45 service units including 94 occupational therapists, 48 managers, 80 physicians, treating 71 client-caregiver couples. Control intervention: A postgraduate course for occupational therapists only. A training package including the usual postgraduate course, additional training days, outreach visits, regional meetings, and access to a reporting system for occupational therapists. Physicians and managers received newsletters, had access to a website, and were approached by telephone. The intended adherence of therapists to the COTiD program. This was assessed using vignettes. clients' daily functioning, caregivers' sense of competence, quality of life, and self-perceived performance of daily activities of both clients and caregivers. Between-group differences were assessed using multilevel analyses with therapist and intervention factors as covariates. No significant between-group differences between baseline and 12 months were found for adherence (1.58, 95% CI -0.10 to 3.25), nor for any client or caregiver outcome. A higher number of coaching sessions and higher self-perceived knowledge of dementia at baseline positively correlated with adherence scores. In contrast, experiencing more support from occupational therapy colleagues or having conducted more COTiD treatments at baseline negatively affected adherence scores. The training package was not effective in increasing therapist adherence and client-caregiver outcomes. This study suggests that coaching sessions and increasing therapist knowledge on dementia positively affect adherence. NCT01117285. © The Author(s) 2014.

  17. Implementation and Operational Research: Effect of Universal Access to Antiretroviral Therapy on HIV/AIDS Mortality in Mexico 1990-2011.

    Science.gov (United States)

    Hernández-Ávila, Juan E; Palacio-Mejía, Lina S; Hernández-Romieu, Alfonso; Bautista-Arredondo, Sergio; Sepúlveda Amor, Jaime; Hernández-Ávila, Mauricio

    2015-07-01

    Universal coverage of highly active antiretroviral therapy (HAART) for HIV/AIDS in Mexico was achieved in a staggered fashion. First, HAART was made available in 1997 for employees in the formal sector and subsequently, in 2003, for informal sector workers and the unemployed population. We evaluated the impact of this free universal HAART program on HIV/AIDS mortality in the Mexican population aged 15 years or older. Time-series cross-sectional data analysis of standardized HIV/AIDS mortality rates (1990-2011) using marginal linear models with inflection points at 1994, 1997, and 2003. Men employed in the formal sector experienced the greatest effect of access to HAART, with a 32% reduction in mortality from 1997 to 2011 (P mortality increased from 1990 to 2003, then stabilizing at 7 deaths per 100,000. For women in the informal sector, mortality increased from 1990 to 2011. We found large between-state variability: mortality decreased by 59% in Mexico City while it increased by 245% in Tabasco during the study period. Six of 32 states achieved statistically significant reductions in mortality while 5 states continued to experience increasing mortality rates despite universal HAART. Access to universal HAART has had relative success in Mexico. The heterogeneity of HIV/AIDS mortality by employment status, gender, and state of residence highlight urgent needs to improve health equity with pro-poor and gender-responsive programs and a call for country-specific operational research in HIV/AIDS prevention and treatment. Our results may apply to other countries seeking to implement universal access to antiretroviral therapy.

  18. Towards the clinical implementation of iterative low-dose cone-beam CT reconstruction in image-guided radiation therapy: Cone/ring artifact correction and multiple GPU implementation

    Energy Technology Data Exchange (ETDEWEB)

    Yan, Hao, E-mail: steve.jiang@utsouthwestern.edu, E-mail: xun.jia@utsouthwestern.edu; Shi, Feng; Jiang, Steve B.; Jia, Xun, E-mail: steve.jiang@utsouthwestern.edu, E-mail: xun.jia@utsouthwestern.edu [Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390 (United States); Wang, Xiaoyu; Cervino, Laura [Center for Advanced Radiotherapy Technologies and Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California 92037 (United States); Bai, Ti [Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390 and Institute of Image Processing and Pattern Recognition, Xi’an Jiaotong University, Xi’an, Shaanxi 710049 (China); Folkerts, Michael [Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390 and Department of Physics, University of California San Diego, La Jolla, California 92037 (United States)

    2014-11-01

    Purpose: Compressed sensing (CS)-based iterative reconstruction (IR) techniques are able to reconstruct cone-beam CT (CBCT) images from undersampled noisy data, allowing for imaging dose reduction. However, there are a few practical concerns preventing the clinical implementation of these techniques. On the image quality side, data truncation along the superior–inferior direction under the cone-beam geometry produces severe cone artifacts in the reconstructed images. Ring artifacts are also seen in the half-fan scan mode. On the reconstruction efficiency side, the long computation time hinders clinical use in image-guided radiation therapy (IGRT). Methods: Image quality improvement methods are proposed to mitigate the cone and ring image artifacts in IR. The basic idea is to use weighting factors in the IR data fidelity term to improve projection data consistency with the reconstructed volume. In order to improve the computational efficiency, a multiple graphics processing units (GPUs)-based CS-IR system was developed. The parallelization scheme, detailed analyses of computation time at each step, their relationship with image resolution, and the acceleration factors were studied. The whole system was evaluated in various phantom and patient cases. Results: Ring artifacts can be mitigated by properly designing a weighting factor as a function of the spatial location on the detector. As for the cone artifact, without applying a correction method, it contaminated 13 out of 80 slices in a head-neck case (full-fan). Contamination was even more severe in a pelvis case under half-fan mode, where 36 out of 80 slices were affected, leading to poorer soft tissue delineation and reduced superior–inferior coverage. The proposed method effectively corrects those contaminated slices with mean intensity differences compared to FDK results decreasing from ∼497 and ∼293 HU to ∼39 and ∼27 HU for the full-fan and half-fan cases, respectively. In terms of efficiency boost

  19. Research Protocol: Development, implementation and evaluation of a cognitive behavioural therapy-based intervention programme for the management of anxiety symptoms in South African children with visual impairments

    Directory of Open Access Journals (Sweden)

    Lisa Visagie

    2015-02-01

    Full Text Available Background: Childhood anxiety presents a serious mental health problem, and it is one of the most common forms of psychological distress reported by youth worldwide. The prevalence of anxiety symptoms amongst South African youth is reported to be significantly higher than in other parts of the world. These high prevalence rates become even more significant when viewed in terms of children with visual impairments, as it is suggested that children with physical disabilities may be more prone, than their non-disabled peers, for the development of psychological difficulties. Objectives: The main aim of this study is to develop, implement and evaluate a specifically tailored anxiety intervention programme for use with South African children with visual impairments. Method: A specifically tailored cognitive-behavioural therapy-based anxiety intervention, for 9–13 year old South African children with visual impairments, will be evaluated in two special schools. The study will employ a randomised wait-list control group design with pre- postand follow-up intervention measures, with two groups each receiving a 10 session anxiety intervention programme. The main outcome measure relates to the participants’ symptoms of anxiety as indicated on the Revised Child Anxiety and Depression Scale. Conclusion: If the anxiety intervention programme is found to be effective in reducing symptoms of anxiety, this universal intervention will lay down the foundation upon which future contextually sensitive (South African anxiety intervention programmes can be built.

  20. Utilization of Radiation Therapy in Norway After the Implementation of The National Cancer Plan—A National, Population-Based Study

    Energy Technology Data Exchange (ETDEWEB)

    Åsli, Linn M., E-mail: linn.merete.asli@kreftregisteret.no [Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo (Norway); Kvaløy, Stein O. [Division of Cancer, Surgery, and Transplantation, Oslo University Hospital and University of Oslo, Oslo (Norway); Jetne, Vidar [Department of Medical Physics, Oslo University Hospital, Oslo (Norway); Myklebust, Tor Å. [Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo (Norway); Levernes, Sverre G. [Department of Medical Physics, Oslo University Hospital, Oslo (Norway); The Norwegian Radiation Protection Authority, Østerås (Norway); Tveit, Kjell M. [Department of Oncology, Oslo University Hospital and University of Oslo, Oslo (Norway); Green, Tor O. [Department of Medical Physics, Oslo University Hospital, Oslo (Norway); Johannesen, Tom B. [Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo (Norway)

    2014-11-01

    Purpose: To estimate actual utilization rates of radiation therapy (RT) in Norway, describe time trends (1997-2010), and compare these estimates with corresponding optimal RT rates. Methods and Materials: Data from the population-based Cancer Registry of Norway was used to identify all patients diagnosed with cancer and/or treated by RT for cancer in 1997-2010. Radiation therapy utilization rates (RURs) were calculated as (1) the proportion of incident cancer cases who received RT at least once within 1 year of diagnosis (RUR{sub 1Y}); and (2) the proportion who received RT within 5 years of diagnosis (RUR{sub 5Y}). The number of RT treatment courses per incident cancer case (TCI) was also calculated for all cancer sites combined. The actual RURs were compared with corresponding Australian and Canadian epidemiologic- and evidence-based model estimates and criterion-based benchmark estimates of optimal RURs. The TCIs were compared with TCI estimates from the 1997 Norwegian/National Cancer Plan (NCP). Joinpoint regression was used to identify changes in trends and to estimate annual percentage change (APC) in actual RUR{sub 1Y} and actual TCI. Results: The actual RUR{sub 5Y} (all sites) increased significantly to 29% in 2005 but still differed markedly from the Australian epidemiologic- and evidence-based model estimate of 48%. With the exception of RUR{sub 5Y} for breast cancer and RUR{sub 1Y} for lung cancers, all actual RURs were markedly lower than optimal RUR estimates. The actual TCI increased significantly during the study period, reaching 42.5% in 2010, but was still lower than the 54% recommended in the NCP. The trend for RUR{sub 1Y} (all sites) and TCI changed significantly, with the annual percentage change being largest during the first part of the study period. Conclusions: Utilization rates of RT in Norway increased after the NCP was implemented and RT capacity was increased, but they still seem to be lower than optimal levels.

  1. Reducing the burden of diarrhea among children under five years old: lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria.

    Science.gov (United States)

    Charyeva, Zulfiya; Cannon, Molly; Oguntunde, Olugbenga; Garba, Aminu Magashi; Sambisa, William; Bassi, Amos Paul; Ibrahim, Mohammed Auwal; Danladi, Saba'atu Elizabeth; Lawal, Nurudeen

    2015-05-01

    In Nigeria, diarrhea remains one of the leading causes of death among children under five years old. Oral Rehydration Therapy (ORT) corners were introduced to health facilities in Bauchi and Sokoto states to serve as points of treatment for sick children and equip caregivers with necessary skills in case management of diarrhea and diarrhea prevention. The operations research study examined the effect of facility-based ORT corners on caregivers' knowledge and skills in management of simple and moderate diarrhea at home, as well as caregivers' and service providers' perceived facilitators and barriers to utilization and delivering of ORT corner services. It also examined whether ORT activities were conducted according to the established protocols. This quantitative study relied on multiple sources of information to provide a complete picture of the current status of ORT corner services, namely surveys with ORT corner providers (N = 21), health facility providers (N = 23) and caregivers (N = 229), as well as a review of service statistics and health facility observations. Frequency distribution and binary analysis were conducted. The study revealed that ORT corner users were more knowledgeable in diarrhea prevention and management and demonstrated better skills for managing diarrhea at home than ORT corner non-users. However, the percentage of knowledgeable ORT users is not optimal, and providers need to continue to work toward improving such knowledge. ORT corner providers identified a lack of supplies as the major barrier for providing services. Furthermore, the study revealed a lack of information, education and communication materials, supportive supervision, and protocols and guidelines for delivering ORT corner services, as well as inadequate documentation of services provided at ORT corners. Recommendations for ORT corners program planners and implementers include ensuring all ORT corners have oral rehydration salt (ORS) packages and salt, sugar

  2. Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia.

    Science.gov (United States)

    Bazazi, Alexander R; Wickersham, Jeffrey A; Wegman, Martin P; Culbert, Gabriel J; Pillai, Veena; Shrestha, Roman; Al-Darraji, Haider; Copenhaver, Michael M; Kamarulzaman, Adeeba; Altice, Frederick L

    2017-08-01

    Incarcerated people living with HIV and opioid dependence face enormous challenges to accessing evidence-based treatment during incarceration and after release into the community, placing them at risk of poor HIV treatment outcomes, relapse to opioid use and accompanying HIV transmission risk behaviors. Here we describe in detail the design and implementation of Project Harapan, a prospective clinical trial conducted among people living with HIV and opioid dependence who transitioned from prison to the community in Malaysia from 2010 to 2014. This trial involved 2 interventions: within-prison initiation of methadone maintenance therapy and an evidence-based behavioral intervention adapted to the Malaysian context (the Holistic Health Recovery Program for Malaysia, HHRP-M). Individuals were recruited and received the interventions while incarcerated and were followed for 12months after release to assess post-release HIV transmission risk behaviors and a range of other health-related outcomes. Project Harapan was designed as a fully randomized 2×2 factorial trial where individuals would be allocated in equal proportions to methadone maintenance therapy and HHRP-M, methadone maintenance therapy alone, HHRP-M alone, or control. Partway through study implementation, allocation to methadone maintenance therapy was changed from randomization to participant choice; randomization to HHRP-M continued throughout. We describe the justification for this study; the development and implementation of these interventions; changes to the protocol; and screening, enrollment, treatment receipt, and retention of study participants. Logistical, ethical, and analytic issues associated with the implementation of this study are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. HIV-1 Drug-Resistance Surveillance among Treatment-Experienced and -Naïve Patients after the Implementation of Antiretroviral Therapy in Ghana

    Science.gov (United States)

    Ishikawa, Koichi; Brandful, James A. M.; Ofori, Sampson B.; Yamaoka, Shoji; Ampofo, William K.; Sugiura, Wataru

    2013-01-01

    Background Limited HIV-1 drug-resistance surveillance has been carried out in Ghana since the implementation of antiretroviral therapy (ART). This study sought to provide data on the profile of HIV-1 drug resistance in ART-experienced and newly diagnosed individuals in Ghana. Methods Samples were collected from 101 HIV-1-infected patients (32 ART-experienced cases with virological failure and 69 newly diagnosed ART-naïve cases, including 11 children), in Koforidua, Eastern region of Ghana, from February 2009 to January 2010. The pol gene sequences were analyzed by in-house HIV-1 drug-resistance testing. Results The most prevalent HIV-1 subtype was CRF02_AG (66.3%, 67/101) followed by unique recombinant forms (25.7%, 26/101). Among 31 ART-experienced adults, 22 (71.0%) possessed at least one drug-resistance mutation, and 14 (45.2%) had two-class-resistance to nucleoside and non-nucleoside reverse-transcriptase inhibitors used in their first ART regimen. Importantly, the number of accumulated mutations clearly correlated with the duration of ART. The most prevalent mutation was lamivudine-resistance M184V (n = 12, 38.7%) followed by efavirenz/nevirapine-resistance K103N (n = 9, 29.0%), and zidovudine/stavudine-resistance T215Y/F (n = 6, 19.4%). Within the viral protease, the major nelfinavir-resistance mutation L90M was found in one case. No transmitted HIV-1 drug-resistance mutation was found in 59 ART-naïve adults, but K103N and G190S mutations were observed in one ART-naïve child. Conclusions Despite expanding accessibility to ART in Eastern Ghana, the prevalence of transmitted HIV-1 drug resistance presently appears to be low. As ART provision with limited options is scaled up nationwide in Ghana, careful monitoring of transmitted HIV-1 drug resistance is necessary. PMID:23977189

  4. Priority setting for the implementation of artemisinin-based combination therapy policy in Tanzania: evaluation against the accountability for reasonableness framework

    Directory of Open Access Journals (Sweden)

    Mori Amani

    2012-03-01

    Full Text Available Abstract Background Priority setting for artemisinin-based antimalarial drugs has become an integral part of malaria treatment policy change in malaria-endemic countries. Although these drugs are more efficacious, they are also more costly than the failing drugs. When Tanzania changed its National Malaria Treatment Policy in 2006, priority setting was an inevitable challenge. Artemether-lumefantrine was prioritised as the first-line drug for the management of uncomplicated malaria to be available at a subsidized price at public and faith-based healthcare facilities. Methods This paper describes the priority-setting process, which involved the selection of a new first-line antimalarial drug in the implementation of artemisinin-based combination therapy policy. These descriptions were further evaluated against the four conditions of the accountability for reasonableness framework. According to this framework, fair decisions must satisfy a set of publicity, relevance, appeals, and revision and enforcement conditions. In-depth interviews were held with key informants using pretested interview guides, supplemented with a review of the treatment guideline. Purposeful sampling was used in order to explore the perceptions of people with different backgrounds and perspectives. The analysis followed an editing organising style. Results Publicity: The selection decision of artemether-lumefantrine but not the rationale behind it was publicised through radio, television, and newspaper channels in the national language, Swahili. Relevance: The decision was grounded on evidences of clinical efficacy, safety, affordability, and formulation profile. Stakeholders were not adequately involved. There was neither an appeals mechanism to challenge the decision nor enforcement mechanisms to guarantee fairness of the decision outcomes. Conclusions The priority-setting decision to use artemether-lumefantrine as the first-line antimalarial drug failed to satisfy the four

  5. Barreiras à implementação da Terapia Compressiva Barreras a la implementación de la Terapia Compresiva Barriers to implementation of Compression Therapy

    Directory of Open Access Journals (Sweden)

    Alda Pereira

    2012-03-01

    Panel de Delphi online. Después se desarrolló un estudio transversal descriptivo analítico, mediante la aplicación de cuestionarios construidos con ese fin en una muestra accidental de 241 profesionales de la salud (enfermeros y médicos que trabajan en los Cuidados de Salud Primarios. Con los datos construimos y validamos la escala de Evaluación de Barreras a la Implementación de la Terapia Compresiva en la Úlcera Venosa (ABITCUV. En los resultados destacamos que, en lo que concierne las barreras que constituyen la escala, los profesionales de salud consideraron ser, por orden decreciente de peso/importancia: el déficit de formación, el déficit de recursos materiales y financieros y la ausencia de normas y protocolo de prácticas. Después surgieron el rechazo del cliente, la falta de motivación y el reconocimiento institucional del profesional y la resistencia del profesional al cambio/nuevas prácticas. Esta jerarquización de las barreras hecha por los profesionales reveló ser similar a aquella sugerida por los expertos del Panel de Delphi.Despite the effectiveness of compression therapy in the treatment of venous ulcers being scientifically demonstrated, it is not widely used. The aim of this study was to determine the barriers/ obstacles to its implementation and extensive use. A literature review allowed identification of a set of potential barriers, which were then validated and ranked for burden/importance by experts in leg ulcers via an online Delphi Panel. After this, we developed a cross-sectional descriptive and analytical study, with a convenience sample of 241 healthcare professionals (nurses and doctors in primary health care, using questionnaires constructed for this purpose. Based on the data, we constructed and validated the Assessment of Barriers to Implementation of Compression Therapy in Venous Ulcer scale (ABITCUV. The results indicated that healthcare professionals considered the barriers in following descending order of burden

  6. Implementing music therapy on an adolescent inpatient unit: a mixed-methods evaluation of acceptability, experience of participation and perceived impact.

    Science.gov (United States)

    Patterson, Sue; Duhig, Michael; Darbyshire, Chris; Counsel, Robin; Higgins, Niall; Williams, Ian

    2015-10-01

    We aimed to assess the feasibility of delivering a music therapy program on adolescent psychiatric wards. We undertook a mixed-methods evaluation of a pilot program. Various active and receptive techniques were employed in group music therapy sessions delivered as part of a structured clinical program. Data collected in interviews with participants and staff and feedback questionnaires were thematically and descriptively analysed and triangulated. Data from 62 questionnaires returned by 43 patients who took part in 16 music therapy sessions, and seven staff, evidenced strong support for music therapy. Patients typically reported experiencing sessions as relaxing, comforting, uplifting, and empowering; >90% would participate by choice and use music therapeutically in the future. Staff endorsed music therapy as valuable therapeutically, reporting that patients engaged enthusiastically and identified sessions as improving their own moods and ward milieu. Integration of music therapy in inpatient treatment of adolescents is feasible and acceptable, and is valued by staff and patients as a complement to 'talking therapies'. Participation is enjoyed and associated with outcomes including improvement in mood, expression of feelings and social engagement consistent with recovery. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  7. Cognitive Processing Therapy for Spanish-speaking Latinos: A Formative Study of a Model-Driven Cultural Adaptation of the Manual to Enhance Implementation in a Usual Care Setting.

    Science.gov (United States)

    Valentine, Sarah E; Borba, Christina P C; Dixon, Louise; Vaewsorn, Adin S; Guajardo, Julia Gallegos; Resick, Patricia A; Wiltsey Stirman, Shannon; Marques, Luana

    2017-03-01

    As part of a larger implementation trial for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) in a community health center, we used formative evaluation to assess relations between iterative cultural adaption (for Spanish-speaking clients) and implementation outcomes (appropriateness and acceptability) for CPT. Qualitative data for the current study were gathered through multiple sources (providers: N = 6; clients: N = 22), including CPT therapy sessions, provider fieldnotes, weekly consultation team meetings, and researcher fieldnotes. Findings from conventional and directed content analysis of the data informed refinements to the CPT manual. Data-driven refinements included adaptations related to cultural context (i.e., language, regional variation in wording), urban context (e.g., crime/violence), and literacy level. Qualitative findings suggest improved appropriateness and acceptability of CPT for Spanish-speaking clients. Our study reinforces the need for dual application of cultural adaptation and implementation science to address the PTSD treatment needs of Spanish-speaking clients. © 2016 Wiley Periodicals, Inc.

  8. Better adherence to pre-antiretroviral therapy guidelines after implementing an electronic medical record system in rural Kenyan HIV clinics: a multicenter pre-post study

    NARCIS (Netherlands)

    Oluoch, Tom; Kwaro, Daniel; Ssempijja, Victor; Katana, Abraham; Langat, Patrick; Okeyo, Nicky; Abu-Hanna, Ameen; de Keizer, Nicolette

    2015-01-01

    The monitoring of pre-antiretroviral therapy (pre-ART) is a key indicator of HIV quality of care. This study investigated the association of an electronic medical record system (EMR) with adherence to pre-ART guidelines in rural HIV clinics in Kenya. A retrospective study was carried out to assess

  9. Research Protocol: Development, implementation and evaluation of a cognitive behavioural therapy-based intervention programme for the management of anxiety symptoms in South African children with visual impairments

    National Research Council Canada - National Science Library

    Visagie, Lisa; Loxton, Helene; Silverman, Wendy K

    2015-01-01

    ... and evaluate a specifically tailored anxiety intervention programme for use with South African children with visual impairments. Method: A specifically tailored cognitive-behavioural therapy-based anxiety intervention, for 9-13 year old South African children with visual impairments, will be evaluated in two special schools. The study will employ a rando...

  10. Consensus Guidelines for Implementing Pencil-Beam Scanning Proton Therapy for Thoracic Malignancies on Behalf of the PTCOG Thoracic and Lymphoma Subcommittee

    NARCIS (Netherlands)

    Chang, Joe Y.; Zhang, Xiaodong; Knopf, Antje; Li, Heng; Mori, Shinichiro; Dong, Lei; Lu, Hsiao-Ming; Liu, Wei; Badiyan, Shahed N.; Both, Stephen; Meijers, Arturs; Lin, Liyong; Flampouri, Stella; Li, Zuofeng; Umegaki, Kikuo; Simone, Charles B.; Zhu, Xiaorong R.

    2017-01-01

    Pencil-beam scanning (PBS) proton therapy (PT), particularly intensity modulated PT, represents the latest advanced PT technology for treating cancers, including thoracic malignancies. On the basis of virtual clinical studies, PBS-PT appears to have great potential in its ability to tightly tailor

  11. Mid-term effects of serial sleep deprivation therapy implemented in cognitive-behavioral treatment on the neuroendocrine response to clomipramine in patients with major depression.

    Science.gov (United States)

    Kundermann, Bernd; Strate, Peter; Hemmeter-Spernal, Julia; Huber, Martin Tobias; Krieg, Jürgen-Christian; Lautenbacher, Stefan

    2009-04-01

    While data dealing with neurobiological effects of sleep deprivation (SD) are mainly restricted to the acute effects of a single night, only few studies have investigated mid-term effects after repeated SD. We therefore examined the clinical and hormonal characteristics of depressive patients before and after serial SD to determine potential sustained effects, focusing especially on serotoninergic functions. One tool to investigate serotoninergic dysfunction in depression is the use of serotoninergic agents to stimulate hormonal secretion, which is assumed to normalize during a clinically effective therapy. Eighteen drug-free inpatients with unipolar major depression received cognitive-behavioral treatment for three weeks and - according to a randomized control design - additional SD therapy (six nights of total SD within three weeks, separated by nights of recovery sleep) or no SD therapy (control group). Serotoninergic function was assessed by measuring cortisol and prolactin in response to intravenously administered clomipramine (12.5mg) before and after the treatment period. The post-treatment challenge test was performed three days after the last SD night. Apart from of a transient overnight improvement of mood induced by SD, both groups showed a comparable clinical course during the three-week treatment period. Compared to the control group, the SD-treated patients exhibited significantly decreased pre-stimulation cortisol levels and significantly increased cortisol responses to clomipramine, whereas no treatment effects were observed for prolactin. In conclusion, our findings suggest that the mid-term effects of serial SD therapy lead to a normalization of serotoninergic dysfunction, although an obvious impact on clinical symptoms was not detected.

  12. Implementation of tomo-therapy in France: clinic results over two years; Mise en oeuvre de la tomotherapie en France: resultats cliniques a deux ans

    Energy Technology Data Exchange (ETDEWEB)

    Giraud, P.; Yassa, M. [Hopital europeen Georges-Pompidou, 75 - Paris (France); Giraud, P.; Zefkili, S.; Campana, F. [Institut Curie, 75 - Paris (France); Kantor, G.; Dejean, C. [Institut Bergonie, 33 - Bordeaux (France); Lisbona, A.; Mahe, M.A. [Centre Rene-Gauducheau, 44 - Nantes (France)

    2010-10-15

    As three French centres (Curie Institute in Paris, Bergonie Institute in Bordeaux, and Rene-Gauducheau centre in Nantes) have been equipped with helical tomo-therapy in 2007, the authors discuss the results obtained after two years of operation. More than six hundred patients have been treated, mainly for head or neck, central nervous system, thorax, pelvic and abdominal cavity, and bone tumours. Session durations, acute toxicity rates, and toxicity effects are discussed. Short communication

  13. The effect of low level laser therapy in different wavelengths in the treatment of oral mucositis—proposal for extra-oral implementation

    Science.gov (United States)

    Moraes, J. J. C.; Queiroga, A. S.; de Biase, R. C. C. G.; Leite, E. P.; Cabral Júnior, C. R.; Limeira Júnior, F. A.

    2009-09-01

    The oral mucositis is the most frequent acute oral complication resulting from antineoplastic treatment and may worsen the clinical condition of the patient and interfere with his/her quality of life. This study aimed to comparatively evaluate, from a clinical point of view, the effect of Laser Therapy λ660 nm (wavelength of the red Laser) and λ830 nm (wavelength of the infrared Laser), at extra-oral points, in remission of severity of oral mucositis and pain associated with it in pediatric oncological patients undergoing chemotherapy with the anticancer drug methotrexate, noting which of the two wavelength is the most appropriate to this new technique. The sample consisted of 13 patients placed at random in each group and subjected to sessions of Low Level Laser Therapy, at pre-determined extra-oral points for five consecutive days, starting at the beginning of the observation of mucositis injuries. It became possible to note that from the group of patients in the group of Laser λ830 nm ( n = 6; 46.15%), four ( n = 4; 66.67%) of these patients had remission of injuries to grade 0 (WHO), and as for pain, five patients ( n = 5; 83.33%) showed no painful symptoms for mucositis injuries. In the Laser λ660 nm group ( n = 7; 53.85%), only two patients ( n = 2; 28.57%) achieved a regression of lesions to grade 0 (WHO), while four patients ( n = 4; 57.14%) had no pain. So, the extra-oral application of Laser Therapy was effective in treating injuries of oral mucositis in the patients treated; and Laser Therapy in the infrared spectrum (λ830 nm) was more effective in the treatment of oral mucositis injuries compared to the red spectrum (λ660 nm), which can be explained by the greater power of penetration of infrared rays, acting in a more expressive way in deeper places.

  14. Prevention of cardiovascular disease guided by total risk estimations - challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy.

    LENUS (Irish Health Repository)

    Zannad, Faiez

    2011-11-03

    This paper presents a summary of the potential practical and economic barriers to implementation of primary prevention of cardiovascular disease guided by total cardiovascular risk estimations in the general population. It also reviews various possible solutions to overcome these barriers. The report is based on discussion among experts in the area at a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy that took place in September 2009. It includes a review of the evidence in favour of the \\'treat-to-target\\' paradigm, as well as potential difficulties with this approach, including the multiple pathological processes present in high-risk patients that may not be adequately addressed by this strategy. The risk-guided therapy approach requires careful definitions of cardiovascular risk and consideration of clinical endpoints as well as the differences between trial and \\'real-world\\' populations. Cost-effectiveness presents another issue in scenarios of finite healthcare resources, as does the difficulty of documenting guideline uptake and effectiveness in the primary care setting, where early modification of risk factors may be more beneficial than later attempts to manage established disease. The key to guideline implementation is to improve the quality of risk assessment and demonstrate the association between risk factors, intervention, and reduced event rates. In the future, this may be made possible by means of automated data entry and various other measures. In conclusion, opportunities exist to increase guideline implementation in the primary care setting, with potential benefits for both the general population and healthcare resources.

  15. Implementation of Cell Samples as Controls in National Proficiency Testing for Clopidogrel Therapy-Related CYP2C19 Genotyping in China: A Novel Approach.

    Directory of Open Access Journals (Sweden)

    Guigao Lin

    Full Text Available Laboratories are increasingly requested to perform CYP2C19 genetic testing when managing clopidogrel therapy, especially in patients with acute coronary syndrome undergoing percutaneous coronary intervention. To ensure high quality molecular testing and ascertain that the referring clinician has the correct information for CYP2C19 genotype-directed antiplatelet therapy, a proficiency testing scheme was set up to evaluate the laboratory performance for the entire testing process. Proficiency panels of 10 cell samples encompassing the common CYP2C19 genetic polymorphisms were distributed to 62 participating laboratories for routine molecular testing and the responses were analyzed for accuracy of genotyping and the reporting of results. Data including the number of samples tested, the accreditation/certification status, and test methodology of each individual laboratory were also reviewed. Fifty-seven of the 62 participants correctly identified the CYP2C19 variants in all samples. There were six genotyping errors, with a corresponding analytical sensitivity of 98.5% (333/338 challenges; 95% confidence interval: 96.5-99.5% and an analytic specificity of 99.6% (281/282; 95% confidence interval: 98.0-99.9%. Reports of the CYP2C19 genotyping results often lacked essential information. In conclusion, clinical laboratories demonstrated good analytical sensitivity and specificity; however, the pharmacogenetic testing community requires additional education regarding the correct reporting of CYP2C19 genetic test results.

  16. TH-C-17A-06: A Hardware Implementation and Evaluation of Robotic SPECT: Toward Molecular Imaging Onboard Radiation Therapy Machines

    Energy Technology Data Exchange (ETDEWEB)

    Yan, S; Touch, M [Duke University Medical Physics Graduate Program, Durham, NC (United States); Bowsher, J; Yin, F [Duke University Medical Physics Graduate Program, Durham, NC (United States); Duke University Medical Center, Durham, NC (United States); Cheng, L [Duke University Medical Center, Durham, NC (United States)

    2014-06-15

    Purpose: To construct a robotic SPECT system and demonstrate its capability to image a thorax phantom on a radiation therapy flat-top couch. The system has potential for on-board functional and molecular imaging in radiation therapy. Methods: A robotic SPECT imaging system was developed utilizing a Digirad 2020tc detector and a KUKA KR150-L110 robot. An imaging study was performed with the PET CT Phantom, which includes 5 spheres: 10, 13, 17, 22 and 28 mm in diameter. Sphere-tobackground concentration ratio was 6:1 of Tc99m. The phantom was placed on a flat-top couch. SPECT projections were acquired with a parallel-hole collimator and a single pinhole collimator. The robotic system navigated the detector tracing the flat-top table to maintain the closest possible proximity to the phantom. For image reconstruction, detector trajectories were described by six parameters: radius-of-rotation, x and z detector shifts, and detector rotation θ, tilt ϕ and twist γ. These six parameters were obtained from the robotic system by calibrating the robot base and tool coordinates. Results: The robotic SPECT system was able to maneuver parallel-hole and pinhole collimated SPECT detectors in close proximity to the phantom, minimizing impact of the flat-top couch on detector-to-COR (center-ofrotation) distance. In acquisitions with background at 1/6th sphere activity concentration, photopeak contamination was heavy, yet the 17, 22, and 28 mm diameter spheres were readily observed with the parallel hole imaging, and the single, targeted sphere (28 mm diameter) was readily observed in the pinhole region-of-interest (ROI) imaging. Conclusion: Onboard SPECT could be achieved by a robot maneuvering a SPECT detector about patients in position for radiation therapy on a flat-top couch. The robot inherent coordinate frame could be an effective means to estimate detector pose for use in SPECT image reconstruction. PHS/NIH/NCI grant R21-CA156390-01A1.

  17. "I should have discharged him but I felt guilty": a qualitative investigation of clinicians' emotions in the context of implementing occupational therapy.

    Science.gov (United States)

    Kolehmainen, Niina; McAnuff, Jennifer

    2014-10-02

    Clinicians' emotions about practice are a potentially powerful yet largely overlooked factor in implementation of good-quality care. The present paper expands the current, limited evidence about clinicians' emotions by (i) describing clinician-reported examples of emotions about practice and (ii) identifying the clinical situations in which, according to clinicians, emotions emerge and influence practice. Semi-structured, face-to-face interviews with 25 clinicians (children's occupational therapists) were conducted across six health care organisations. Participants were asked to reflect on their practice in two recent patient cases, one that they perceived 'successful' and another 'unsuccessful'. Interviews were transcribed verbatim, and the transcripts were analysed for emerging themes. A proportion of transcripts were independently read and coded, and the themes were validated through critical discussion. A key theme was clinicians' emotions, especially negative emotions including guilt, anger, worry, frustration and inadequacy. These were described in connection with situations where the clinicians perceived that (i) they failed to provide good quality care, (ii) they were unable to achieve positive health outcomes or engage the patient or (iii) there was conflict between what they were asked to do and the norms they held important. Clinicians experience a range of negative emotions about practice. These are particularly likely to emerge in situations where clinicians perceive that their actions and practice fall short of the standards, norms or outcomes that they hold as important. The results inform the specification of emotions and emotion-triggering situations for future investigations of health care implementation.

  18. Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection.

    Science.gov (United States)

    Caudle, Abigail S; Yang, Wei T; Krishnamurthy, Savitri; Mittendorf, Elizabeth A; Black, Dalliah M; Gilcrease, Michael Z; Bedrosian, Isabelle; Hobbs, Brian P; DeSnyder, Sarah M; Hwang, Rosa F; Adrada, Beatriz E; Shaitelman, Simona F; Chavez-MacGregor, Mariana; Smith, Benjamin D; Candelaria, Rosalind P; Babiera, Gildy V; Dogan, Basak E; Santiago, Lumarie; Hunt, Kelly K; Kuerer, Henry M

    2016-04-01

    Placing clips in nodes with biopsy-confirmed metastasis before initiating neoadjuvant therapy allows for evaluation of response in breast cancer. Our goal was to determine if pathologic changes in clipped nodes reflect the status of the nodal basin and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of clipped nodes, improves the false-negative rate (FNR) compared with SLND alone. A prospective study of patients with biopsy-confirmed nodal metastases with a clip placed in the sampled node was performed. After neoadjuvant therapy, patients underwent axillary surgery and the pathology of the clipped node was compared with other nodes. Patients undergoing TAD had SLND and selective removal of the clipped node using iodine-125 seed localization. The FNR was determined in patients undergoing complete axillary lymphadenectomy (ALND). Of 208 patients enrolled in this study, 191 underwent ALND, with residual disease identified in 120 (63%). The clipped node revealed metastases in 115 patients, resulting in an FNR of 4.2% (95% CI, 1.4 to 9.5) for the clipped node. In patients undergoing SLND and ALND (n = 118), the FNR was 10.1% (95% CI, 4.2 to 19.8), which included seven false-negative events in 69 patients with residual disease. Adding evaluation of the clipped node reduced the FNR to 1.4% (95% CI, 0.03 to 7.3; P = .03). The clipped node was not retrieved as an SLN in 23% (31 of 134) of patients, including six with negative SLNs but metastasis in the clipped node. TAD followed by ALND was performed in 85 patients, with an FNR of 2.0% (1 of 50; 95% CI, 0.05 to 10.7). Marking nodes with biopsy-confirmed metastatic disease allows for selective removal and improves pathologic evaluation for residual nodal disease after chemotherapy. © 2016 by American Society of Clinical Oncology.

  19. SU-E-CAMPUS-T-03: Development and Implementation of An Anthropomorphic Pediatric Spine Phantom for the Assessment of Craniospinal Irradiation Procedures in Proton Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, D; Summers, P; Followill, D; Sahoo, N; Mahajan, A; Stingo, F; Kry, S [UT MD Anderson Cancer Center, Houston, TX (United States)

    2014-06-15

    Purpose: To design an anthropomorphic pediatric spine phantom for use in the evaluation of proton therapy facilities for clinical trial participation by the Imaging and Radiation Oncology Core (IROC) Houston QA Center (formerly RPC). Methods: This phantom was designed to perform an end-to-end audit of the proton spine treatment process, including simulation, dose calculation by the treatment planning system (TPS), and proton treatment delivery. The design incorporated materials simulating the thoracic spinal column of a pediatric patient, along with two thermoluminescent dosimeter (TLD)-100 capsules and radiochromic film embedded in the phantom for dose evaluation. Fourteen potential materials were tested to determine relative proton stopping power (RSP) and Hounsfield unit (HU) values. Each material was CT scanned at 120kVp, and the RSP was obtained from depth ionization scans using the Zebra multilayer ion chamber (MLIC) at two energies: 160 MeV and 250 MeV. To determine tissue equivalency, the measured RSP for each material was compared to the RSP calculated by the Eclipse TPS for a given HU. Results: The materials selected as bone, tissue, and cartilage substitutes were Techron HPV Bearing Grade (Boedeker Plastics, Inc.), solid water, and blue water, respectively. The RSP values did not differ by more than 1.8% between the two energies. The measured RSP for each selected material agreed with the RSP calculated by the Eclipse TPS within 1.2%. Conclusion: An anthropomorphic pediatric proton spine phantom was designed to evaluate proton therapy delivery. The inclusion of multiple tissue substitutes increases heterogeneity and the level of difficulty for institutions to successfully treat the phantom. The following attributes will be evaluated: absolute dose agreement, distal range, field width, junction match and right/left dose profile alignment. The phantom will be tested at several institutions using a 5% dose agreement criterion, and a 5%/3mm gamma analysis

  20. From policy to practice: exploring the implementation of antiretroviral therapy access and retention policies between 2013 and 2016 in six sub-Saharan African countries

    Directory of Open Access Journals (Sweden)

    Julie Ambia

    2017-11-01

    Full Text Available Abstract Background Understanding the implementation of 2013 World Health Organization (WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection at the facility level provides important lessons for the roll-out of future HIV policies. Methods A national policy review was conducted in six sub-Saharan African countries to map the inclusion of the 2013 WHO HIV treatment recommendations. Twenty indicators of policy adoption were selected to measure ART access (n = 12 and retention (n = 8. Two sequential cross-sectional surveys were conducted in facilities between 2013/2015 (round 1 and 2015/2016 (round 2 from ten health and demographic surveillance sites in Kenya, Malawi, South Africa, Tanzania, Uganda and Zimbabwe. Using standardised questionnaires, facility managers were interviewed. Descriptive analyses were used to assess the change in the proportion of facilities that implemented these policy indicators between rounds. Results Although, expansion of ART access was explicitly stated in all countries’ policies, most lacked policies that enhanced retention. Overall, 145 facilities were included in both rounds. The proportion of facilities that initiated ART at CD4 counts of 500 or less cells/μL increased between round 1 and 2 from 12 to 68%, and facilities initiating patients on 2013 WHO recommended ART regimen increased from 42 to 87%. There were no changes in the proportion of facilities reporting stock-outs of first-line ART in the past year (18 to 11% nor in the provision of three-month supply of ART (43 to 38%. None of the facilities provided community-based ART delivery. Conclusion The increase in ART initiation CD4 threshold in most countries, and substantial improvements made in the provision of WHO recommended first-line ART regimens demonstrates that rapid adoption of WHO recommendations is possible. However, improved logistics and resources and/or changes in policy are required

  1. Pilot implementation

    DEFF Research Database (Denmark)

    Hertzum, Morten; Bansler, Jørgen P.; Havn, Erling C.

    2012-01-01

    implementation, and provide three empirical illustrations of our model. We conclude that pilot implementation has much merit as an ISD technique when system performance is contingent on context. But we also warn developers that, despite their seductive conceptual simplicity, pilot implementations can...

  2. Pilot implementation

    DEFF Research Database (Denmark)

    Hertzum, Morten; Bansler, Jørgen P.; Havn, Erling C.

    2012-01-01

    implementation and provide three empirical illustrations of our model. We conclude that pilot implementation has much merit as an ISD technique when system performance is contingent on context. But we also warn developers that, despite their seductive conceptual simplicity, pilot implementations can be difficult...

  3. Pilot Implementations

    DEFF Research Database (Denmark)

    Manikas, Maria Ie

    This PhD dissertation engages in the study of pilot (system) implementation. In the field of information systems, pilot implementations are commissioned as a way to learn from real use of a pilot system with real data, by real users during an information systems development (ISD) project and before...... objective. The prevalent understanding is that pilot implementations are an ISD technique that extends prototyping from the lab and into test during real use. Another perception is that pilot implementations are a project multiple of co-existing enactments of the pilot implementation. From this perspective...

  4. Implementing a practice change: early initiation of continuous renal replacement therapy during neonatal extracorporeal life support standardizes care and improves short-term outcomes.

    Science.gov (United States)

    Murphy, Heidi J; Cahill, John B; Twombley, Katherine E; Annibale, David J; Kiger, James R

    2017-10-30

    We hypothesized that a standardized approach to early continuous renal replacement therapy (CRRT) during neonatal extracorporeal life support (ECLS) results in greater homogeneity of CRRT initiation times with improvements in fluid balance and outcomes. Retrospective analysis of data (2007-2015) obtained from neonates treated prior to (E1; n = 32) and after (E2; n = 31) a 2011 practice change: CRRT initiation within 48 h of ECLS. Birthweight, gestational age, ECLS mode, and age at ECLS initiation were similar to each epoch. Survival [E1: median 75%, E2: 71%] and length of ECLS [E1: median 221 h, E2: 180 h] were comparable. During E2, 100% of infants received CRRT (vs. E1: 37%; p CRRT within 48 h of ECLS (vs. E1: 13%; p CRRT differed between Epochs [E1: median 105 h, E2: 9 h; p CRRT initiation [E1: 4.13 kg (29% above baseline), E2: 3.19 kg (0%); p CRRT within 48 h of ECLS cannulation, leading to decreased practice variation and improved short-term outcomes including decreased weight gain at CRRT initiation and faster return to baseline weight during the first 7 days of ECLS. We did not demonstrate changes in duration of ECLS, invasive ventilation, or survival.

  5. One-year outcomes of women started on antiretroviral therapy during pregnancy before and after the implementation of Option B+ in Malawi: A retrospective chart review.

    Science.gov (United States)

    Kamuyango, Alfred A; Hirschhorn, Lisa R; Wang, Wenjia; Jansen, Perry; Hoffman, Risa M

    2014-09-01

    To compare one-year outcomes of women started on antiretroviral therapy (ART) during pregnancy in the pre-Option B+ era to those in the Option B+ era. A retrospective chart review was performed at three sites in Malawi. Women were included in the 'pre-Option B+' cohort if they started ART during pregnancy for a CD4 count Option B+' cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher's exact and ANOVA F-tests. A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%, P Option B+ cohort had poor adherence or defaulted, these differences were not significant. At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.

  6. The Implementation of an Integrative Model of Adventure-Based Counseling and Adlerian Play Therapy Value-Based Taught by Parents to Children to Increase Adjustment Ability of Preschool Children

    Directory of Open Access Journals (Sweden)

    Rita Eka Izzaty

    2016-11-01

    Full Text Available This study was conducted for two reasons. First, pre-school age is the foundation for the subsequent development. Second, the previous research findings show that there are behavioral problems which affect the development of subsequent development. This study aims to increase children’s social ability by employing An Integrative Model of Adventure-Based Counseling and Adlerian Play Therapy, a counseling model emphasizing the importance of play providing opportunity for children to express their feelings in natural situation and insight toward personality and environment by modifying teaching cultural values by parents to children. This study employed an action study. The prior data collection techniques were conducting literary study, surveying on cultural values taught, and selecting a counseling model. The subjects were four preschool children (4-6 years old with behavioral problems. The study was conducted in 2 cycles with several steps: planning, action, evaluation, and reflection. The finding of this research shows that an Integrative Model of Adventure-Based Counseling and Adlerian Play Therapy can increase children social ability and decrease non adaptive behavior. The reflection of employing counseling model modified with cultural values taught by parents to children is when using this model, counselors truly examine the duration of the implementation, the children’s condition, the counselors’ condition, the type of play, and the purpose of each steps which must be detailed.

  7. Implementation and Operational Research: Community-Based Adherence Clubs for the Management of Stable Antiretroviral Therapy Patients in Cape Town, South Africa: A Cohort Study.

    Science.gov (United States)

    Grimsrud, Anna; Lesosky, Maia; Kalombo, Cathy; Bekker, Linda-Gail; Myer, Landon

    2016-01-01

    Community-based models of antiretroviral therapy (ART) delivery are widely discussed as a priority in the expansion of HIV treatment services, but data on their effectiveness are limited. We examined outcomes of ART patients decentralized to community-based adherence clubs (CACs) in Cape Town, South Africa and compared these to patients managed in the community health center. The analysis included 8150 adults initiating ART from 2002 to 2012 in a public sector service followed until the end of 2013. From June 2012, stable patients (on ART >12 months, suppressed viral load) were referred to CACs. Loss to follow-up (LTFU) was compared between services using proportional hazards models with time-varying covariates and inverse probability weights of CAC participation. Of the 2113 CAC patients (71% female, 7% youth ages ≤ 24 years), 94% were retained on ART after 12 months. Among CAC patients, LTFU [adjusted hazard ratio (aHR): 2.17, 95% confidence interval (CI): 1.26 to 3.73 ] and viral rebound (aHR 2.24, 95% CI: 1.00 to 5.04) were twice as likely in youth (16-24 years old) compared with older patients, but no difference in the risk of LTFU or viral rebound was observed by sex (P-values 0.613 and 0.278, respectively). CAC participation was associated with a 67% reduction in the risk of LTFU (aHR: 0.33, 95% CI: 0.27 to 0.40) compared with community health centre, and this association persisted when stratified by patient demographic and clinic characteristics. CACs are associated with reduced risk of LTFU compared with facility-based care. Community-based models represent an important development to facilitate ART delivery and possibly improve patient outcomes.

  8. SU-F-T-168: Development and Implementation of An Anthropomorphic Head & Neck Phantom for the Assessment of Proton Therapy Treatment Procedures

    Energy Technology Data Exchange (ETDEWEB)

    Branco, D; Taylor, P; Frank, S; Li, H; Zhang, X; Mehrens, H; Guindani, M; Followill, D [UT MD Anderson Cancer Center, Houston, TX (United States)

    2016-06-15

    Purpose: To design a Head and Neck (H&N) anthropomorphic QA phantom that the Imaging and Radiation Oncology Core Houston (IROC-H) can use to verify the quality of intensity modulated proton therapy (IMPT) H&N treatments for institutions participating in NCI clinical trials. Methods: The phantom was created to serve as a remote auditing tool for IROC-H to evaluate an institution’s IMPT planning and delivery abilities. The design was based on the composition, size, and geometry of a generalized oropharyngeal tumor and contains critical structures (parotids and spinal cord). Radiochromic film in the axial and sagittal planes and thermoluminescent dosimeters (TLD)-100 capsules were embedded in the phantom and used to perform the dose delivery evaluation. A CT simulation was used to create a passive scatter and a spot scanning treatment plan with typical clinical constraints for H&N cancer. The IMPT plan was approved by a radiation oncologist and the phantom was irradiated multiple times. The measured dose distribution using a 7%/4mm gamma analysis (85% of pixels passing) and point doses were compared with the treatment planning system calculations. Results: The designed phantom could not achieve the target dose prescription and organ at risk dose constraints with the passive scatter treatment plan. The target prescription dose could be met but not the parotid dose constraint. The average TLD point dose ratio in the target was 0.975, well within the 5% acceptance criterion. The dose distribution analysis using various acceptance criteria, 5%/4mm, 5%/3mm, 7%/4mm and 7%/5mm, had average pixel passing rates of 85.9%, 81.8%, 89.6% and 91.6%, and respectively. Conclusion: An anthropomorphic IMPT H&N phantom was designed that can assess the dose delivery of proton sites wishing to participate in clinical trials using a 5% TLD dose and 7%/4mm gamma analysis acceptance criteria.

  9. Successful Implementation of Image-Guided Radiation Therapy Quality Assurance in the Trans Tasman Radiation Oncology Group 08.01 PROFIT Study

    Energy Technology Data Exchange (ETDEWEB)

    Middleton, Mark, E-mail: mark.middleton@roq.net.au [Radiation Oncology Queensland, St. Andrews Hospital, Toowoomba, Queensland (Australia); Frantzis, Jim; Healy, Brendan; Jones, Mark; Murry, Rebecca [Radiation Oncology Queensland, St. Andrews Hospital, Toowoomba, Queensland (Australia); Kron, Tomas [Peter MacCallum Cancer Centre, Melbourne (Australia); Plank, Ashley [Toowoomba Cancer Research Centre, St. Andrews Hospital, Toowoomba, Queensland (Australia); Catton, Charles [Department of Radiation Oncology, Princess Margaret Hospital, Toronto (Canada); Martin, Jarad [Radiation Oncology Queensland, St. Andrews Hospital, Toowoomba, Queensland (Australia)

    2011-12-01

    Purpose: The quality assurance (QA) of image-guided radiation therapy (IGRT) within clinical trials is in its infancy, but its importance will continue to grow as IGRT becomes the standard of care. The purpose of this study was to demonstrate the feasibility of IGRT QA as part of the credentialing process for a clinical trial. Methods and Materials: As part of the accreditation process for a randomized trial in prostate cancer hypofraction, IGRT benchmarking across multiple sites was incorporated. Each participating site underwent IGRT credentialing via a site visit. In all centers, intraprostatic fiducials were used. A real-time assessment of analysis of IGRT was performed using Varian's Offline Review image analysis package. Two-dimensional (2D) kV and MV electronic portal imaging prostate patient datasets were used, consisting of 39 treatment verification images for 2D/2D comparison with the digitally reconstructed radiograph derived from the planning scan. The influence of differing sites, image modality, and observer experience on IGRT was then assessed. Results: Statistical analysis of the mean mismatch errors showed that IGRT analysis was performed uniformly regardless of institution, therapist seniority, or imaging modality across the three orthogonal planes. Conclusions: The IGRT component of clinical trials that include sophisticated planning and treatment protocols must undergo stringent QA. The IGRT technique of intraprostatic fiducials has been shown in the context of this trial to be undertaken in a uniform manner across Australia. Extending this concept to many sites with different equipment and IGRT experience will require a robust remote credentialing process.

  10. Image guided adaptive external beam radiation therapy for cervix cancer: Evaluation of a clinically implemented plan-of-the-day technique.

    Science.gov (United States)

    Buschmann, Martin; Majercakova, Katarina; Sturdza, Alina; Smet, Stephanie; Najjari, Dina; Daniel, Michaela; Pötter, Richard; Georg, Dietmar; Seppenwoolde, Yvette

    2017-10-11

    Radiotherapy for cervix cancer is challenging in patients exhibiting large daily changes in the pelvic anatomy, therefore adaptive treatments (ART) have been proposed. The aim of this study was the clinical implementation and subsequent evaluation of plan-of-the-day (POTD)-ART for cervix cancer in supine positioning. The described workflow was based on standard commercial equipment and current quality assurance (QA) methods. A POTD strategy, which employs a VMAT plan library consisting of an empty bladder plan, a full bladder plan and a motion robust backup plan, was developed. Daily adaption was guided by cone beam computed tomography (CBCT) imaging after which the best plan from the library was selected. Sixteen patients were recruited in a clinical study on ART, for nine POTD was applied due to their large organ motion derived from two computed tomography (CT) scans with variable bladder filling. All patients were treated to 45Gy in 25 fractions. Plan selection frequencies over the treatment course were analyzed. Daily doses in the rectum, bladder and cervix-uterus target (CTV-T) were derived and compared to a simulated non-adapted treatment (non-ART), which employed the robust plan for each fraction. Additionally, the adaption consistency was determined by repeating the plan selection procedure one month after treatment by a group of experts. ART-specific QA methods are presented. 225 ART fractions with CBCTs were analyzed. The empty bladder plan was delivered in 49% of the fractions in the first treatment week and this number increased to 78% in the fifth week. The daily coverage of the CTV-T was equivalent between ART and the non-ART simulation, while the daily total irradiated volume V42.75Gy (95% of prescription dose) was reduced by a median of 87cm3. The median delivered V42.75Gy was 1782cm3. Daily delivered doses (V42.75Gy, V40Gy, V30G) to the organs at risk were statistically significantly reduced by ART, with a median difference in daily V42.75Gy in

  11. Neutron-photon mixed field dosimetry by TLD-700 glow curve analysis and its implementation in dose monitoring for Boron Neutron Capture Therapy (BNCT) treatments

    Energy Technology Data Exchange (ETDEWEB)

    Boggio, E. F.; Longhino, J. M. [Centro Atomico Bariloche, Departamento de Fisica de Reactores y Radiaciones / CNEA, Av. E. Bustillo Km 9.5, R8402AGP San Carlos de Bariloche (Argentina); Andres, P. A., E-mail: efboggio@cab.cnea.gov.ar [Centro Atomico Bariloche, Division Proteccion Radiologica / CNEA, Av. E. Bustillo Km 9.5, R8402AGP San Carlos de Bariloche (Argentina)

    2015-10-15

    BNCT is a cancerous cells selective, non-conventional radiotherapy modality to treat malignant tumors such as glioblastoma, melanoma and recurrent head and neck cancer. It consists of a two-step procedure: first, the patient is injected with a tumor localizing drug containing a non-radioactive isotope (Boron-10) with high slow neutron capture cross-section. In a second step, the patient is irradiated with neutrons, which are absorbed by the Boron-10 agent with the subsequently nuclear reaction B- 10(n,a)Li-7, thereby resulting in dose at cellular level due to the high-Let particles. The neutron fields suitable for BNCT are characterized by high neutron fluxes and low gamma dose. Determination of each component is not an easy task, especially when the volume of measurement is quite small or inaccessible for a miniature ionization chamber, for example. A method of measuring the photon and slow neutron dose(mainly by N-14 and B-10) from the glow curve (GC) analysis of a single {sup 7}LiF thermoluminescence detector is evaluated. This method was suggested by the group headed by Dr. Grazia Gambarini. The dosemeters used were TLD-600 ({sup 6}LiF:Mg,Ti with 95.6% {sup 6}Li) and TLD-700 ({sup 7}LiF:Mg,Ti with 99.9% {sup 7}LiF) from Harshaw. Photon dose measurement using the GC analysis method with TLD-700 in mixed fields requires the relation of the two main peaks of a TLD-600 GC shape obtained from an exposition to the same neutron field, and a photon calibrated GC with TLD-700. The requirements for slow neutron dose measurements are similar. In order to properly apply the GC analysis method at the Ra-6 Research Reactor BNCT facility, measurements were carried out in a standard water phantom, fully characterized on the BNCT beam by conventional techniques (activation detectors and paired ionization chambers technique). Next, the method was implemented in whole body dose monitoring of a patient undergoing a BNCT treatment, using a Bo MAb (Bottle Manikin Absorption) phantom

  12. Towards a first implementation of the WLIMES approach in living system studies advancing the diagnostics and therapy in augmented personalized medicine.

    Science.gov (United States)

    Simeonov, Plamen L

    2017-12-01

    The goal of this paper is to advance an extensible theory of living systems using an approach to biomathematics and biocomputation that suitably addresses self-organized, self-referential and anticipatory systems with multi-temporal multi-agents. Our first step is to provide foundations for modelling of emergent and evolving dynamic multi-level organic complexes and their sustentative processes in artificial and natural life systems. Main applications are in life sciences, medicine, ecology and astrobiology, as well as robotics, industrial automation, man-machine interface and creative design. Since 2011 over 100 scientists from a number of disciplines have been exploring a substantial set of theoretical frameworks for a comprehensive theory of life known as Integral Biomathics. That effort identified the need for a robust core model of organisms as dynamic wholes, using advanced and adequately computable mathematics. The work described here for that core combines the advantages of a situation and context aware multivalent computational logic for active self-organizing networks, Wandering Logic Intelligence (WLI), and a multi-scale dynamic category theory, Memory Evolutive Systems (MES), hence WLIMES. This is presented to the modeller via a formal augmented reality language as a first step towards practical modelling and simulation of multi-level living systems. Initial work focuses on the design and implementation of this visual language and calculus (VLC) and its graphical user interface. The results will be integrated within the current methodology and practices of theoretical biology and (personalized) medicine to deepen and to enhance the holistic understanding of life. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Technical Note: Implementation of biological washout processes within GATE/GEANT4—A Monte Carlo study in the case of carbon therapy treatments

    Energy Technology Data Exchange (ETDEWEB)

    Martínez-Rovira, I., E-mail: immamartinez@gmail.com; Jouvie, C.; Jan, S. [Service Hospitalier Frédéric Joliot, Commissariat à l’énergie atomique et aux énergies alternatives (CEA/DSV/I2BM/SHFJ), 4 place du général Leclerc, 91401 Orsay Cedex (France)

    2015-04-15

    Purpose: The imaging of positron emitting isotopes produced during patient irradiation is the only in vivo method used for hadrontherapy dose monitoring in clinics nowadays. However, the accuracy of this method is limited by the loss of signal due to the metabolic decay processes (biological washout). In this work, a generic modeling of washout was incorporated into the GATE simulation platform. Additionally, the influence of the washout on the β{sup +} activity distributions in terms of absolute quantification and spatial distribution was studied. Methods: First, the irradiation of a human head phantom with a {sup 12}C beam, so that a homogeneous dose distribution was achieved in the tumor, was simulated. The generated {sup 11}C and {sup 15}O distribution maps were used as β{sup +} sources in a second simulation, where the PET scanner was modeled following a detailed Monte Carlo approach. The activity distributions obtained in the presence and absence of washout processes for several clinical situations were compared. Results: Results show that activity values are highly reduced (by a factor of 2) in the presence of washout. These processes have a significant influence on the shape of the PET distributions. Differences in the distal activity falloff position of 4 mm are observed for a tumor dose deposition of 1 Gy (T{sub ini} = 0 min). However, in the case of high doses (3 Gy), the washout processes do not have a large effect on the position of the distal activity falloff (differences lower than 1 mm). The important role of the tumor washout parameters on the activity quantification was also evaluated. Conclusions: With this implementation, GATE/GEANT 4 is the only open-source code able to simulate the full chain from the hadrontherapy irradiation to the PET dose monitoring including biological effects. Results show the strong impact of the washout processes, indicating that the development of better models and measurement of biological washout data are

  14. Anticoagulation therapy in elderly patients with atrial fibrillation: results from the Registry of Atrial Fibrillation To Investigate the Implementation of New Guidelines (RAFTING).

    Science.gov (United States)

    Pipilis, Athanasios; Farmakis, Dimitrios; Kaliambakos, Sotirios; Goudevenos, John; Lekakis, John

    2017-07-01

    Patients with atrial fibrillation aged 75 years or older have a CHA2DS2VASc score that dictates oral anticoagulants. We recorded physicians' anticoagulation attitudes in elderly patients with atrial fibrillation and assessed the impact of stroke and bleeding risk. Atrial Fibrillation To Investigate the Implementation of New Guidelines , a countrywide prospective registry performed in Greece during 2010, a period when only vitamin-K antagonists (VKA) were available, enrolled 1127 patients with atrial fibrillation diagnosis during Emergency Departments visit in 31 representative hospitals; 807 patients had known atrial fibrillation and of those, 342 aged 75 years or older. We recorded preadmission anticoagulation treatment and associated it with clinical characteristics and stroke/bleeding risk. Patients on VKA (n = 207; 61%) were younger (81 ± 4 vs. 83 ± 5; P 4) or modified HASBLED (low: 0-2, high: >2) scores. VKA were prescribed in 65% of patients with very high CHA2DS2VASc score as compared with 55% of those with high score (P = 0.065). VKA were used equally in low or high-modified HASBLED score (61% vs. 59%; P = 0.78). The interaction between CHA2DS2VASc and HASBLED was significant (P < 0.001) in patients on VKA; in patients with low HASBLED, VKA use was similar in high versus very high CHA2DS2VASc score (58 vs. 64%), whereas in patients with high HASBLED, VKA use tended to be higher in very high versus high CHA2DS2VASc score (66 vs. 43%). In this countrywide atrial fibrillation registry, 61% of elderly patients received VKA, a decision driven mainly by stroke risk. VKA use was not higher in patients with low bleeding risk.

  15. Proton therapy

    Science.gov (United States)

    Proton beam therapy; Cancer - proton therapy; Radiation therapy - proton therapy; Prostate cancer - proton therapy ... that use x-rays to destroy cancer cells, proton therapy uses a beam of special particles called ...

  16. School-based diagnosis and treatment of malaria by teachers using rapid diagnostic tests and artemisinin-based combination therapy: experiences and perceptions of users and implementers of the Learner Treatment Kit, southern Malawi.

    Science.gov (United States)

    Mphwatiwa, Treza; Witek-McManus, Stefan; Mtali, Austin; Okello, George; Nguluwe, Paul; Chatsika, Hard; Roschnik, Natalie; Halliday, Katherine E; Brooker, Simon J; Mathanga, Don P

    2017-08-07

    Training teachers to diagnose uncomplicated malaria using malaria rapid diagnostic tests and treat with artemisinin-based combination therapy has the potential to improve the access of primary school children (6-14 years) to prompt and efficient treatment for malaria, but little is known about the acceptability of such an intervention. This qualitative study explored experiences and perceptions of users and implementers of a programme of school-based malaria case management via a first-aid kit-the Learner Treatment Kit (LTK)-implemented as part of a cluster-randomized controlled trial in Zomba district, Malawi. From 29 primary schools where teachers were trained to test and treat school children for malaria using the LTK, six schools were purposively selected on the basis of relative intervention usage (low, medium or high); school size and geographical location. In total eight focus group discussions were held with school children, parents and guardians, and teachers; and 20 in-depth interviews were conducted with key stakeholders at the school, district and national levels. Interviews were recorded, transcribed, and analysed using a thematic analysis approach. The LTK was widely perceived by respondents to be a worthwhile intervention, with the opinion that trained teachers were trusted providers of malaria testing and treatment to school children. Benefits of the programme included a perception of improved access to malaria treatment for school children; decreased school absenteeism; and that the programme supported broader national health and education policies. Potential barriers to successful implementation expressed included increased teacher workloads, a feeling of inadequate supervision from health workers, lack of incentives and concerns for the sustainability of the programme regarding the supply of drugs and commodities. Training teachers to test for and treat uncomplicated malaria in schools was well received by both users and implementers alike, and

  17. SU-F-P-37: Implementation of An End-To-End QA Test of the Radiation Therapy Imaging, Planning and Delivery Process to Identify and Correct Possible Sources of Deviation

    Energy Technology Data Exchange (ETDEWEB)

    Salinas Aranda, F; Suarez, V; Arbiser, S; Sansogne, R [Vidt Centro Medico, Ciudad Autonoma De Buenos Aires, Ciudad Autonoma de Buenos Aire (Argentina)

    2016-06-15

    Purpose: To implement an end-to-end QA test of the radiation therapy imaging, planning and delivery process, aimed to assess the dosimetric agreement accuracy between planned and delivered treatment, in order to identify and correct possible sources of deviation. To establish an internal standard for machine commissioning acceptance. Methods: A test involving all steps of the radiation therapy: imaging, planning and delivery process was designed. The test includes analysis of point dose and planar dose distributions agreement between TPS calculated and measured dose. An ad hoc 16 cm diameter PMMA phantom was constructed with one central and four peripheral bores that can accommodate calibrated electron density inserts. Using Varian Eclipse 10.0 and Elekta XiO 4.50 planning systems, IMRT, RapidArc and 3DCRT with hard and dynamic wedges plans were planned on the phantom and tested. An Exradin A1SL chamber is used with a Keithley 35617EBS electrometer for point dose measurements in the phantom. 2D dose distributions were acquired using MapCheck and Varian aS1000 EPID.Gamma analysis was performed for evaluation of 2D dose distribution agreement using MapCheck software and Varian Portal Dosimetry Application.Varian high energy Clinacs Trilogy, 2100C/CD, 2000CR and low energy 6X/EX where tested.TPS-CT# vs. electron density table were checked for CT-scanners used. Results: Calculated point doses were accurate to 0.127% SD: 0.93%, 0.507% SD: 0.82%, 0.246% SD: 1.39% and 0.012% SD: 0.01% for LoX-3DCRT, HiX-3DCRT, IMRT and RapidArc plans respectively. Planar doses pass gamma 3% 3mm in all cases and 2% 2mm for VMAT plans. Conclusion: Implementation of a simple and reliable quality assurance tool was accomplished. The end-to-end proved efficient, showing excellent agreement between planned and delivered dose evidencing strong consistency of the whole process from imaging through planning to delivery. This test can be used as a first step in beam model acceptance for clinical

  18. Clinical Implementation of a Model-Based In Vivo Dose Verification System for Stereotactic Body Radiation Therapy–Volumetric Modulated Arc Therapy Treatments Using the Electronic Portal Imaging Device

    Energy Technology Data Exchange (ETDEWEB)

    McCowan, Peter M., E-mail: pmccowan@cancercare.mb.ca [Medical Physics Department, CancerCare Manitoba, Winnipeg, Manitoba (Canada); Asuni, Ganiyu [Medical Physics Department, CancerCare Manitoba, Winnipeg, Manitoba (Canada); Van Uytven, Eric [Medical Physics Department, CancerCare Manitoba, Winnipeg, Manitoba (Canada); Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba (Canada); VanBeek, Timothy [Medical Physics Department, CancerCare Manitoba, Winnipeg, Manitoba (Canada); McCurdy, Boyd M.C. [Medical Physics Department, CancerCare Manitoba, Winnipeg, Manitoba (Canada); Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba (Canada); Department of Radiology, University of Manitoba, Winnipeg, Manitoba (Canada); Loewen, Shaun K. [Department of Oncology, University of Calgary, Calgary, Alberta (Canada); Ahmed, Naseer; Bashir, Bashir; Butler, James B.; Chowdhury, Amitava; Dubey, Arbind; Leylek, Ahmet; Nashed, Maged [CancerCare Manitoba, Winnipeg, Manitoba (Canada)

    2017-04-01

    Purpose: To report findings from an in vivo dosimetry program implemented for all stereotactic body radiation therapy patients over a 31-month period and discuss the value and challenges of utilizing in vivo electronic portal imaging device (EPID) dosimetry clinically. Methods and Materials: From December 2013 to July 2016, 117 stereotactic body radiation therapy–volumetric modulated arc therapy patients (100 lung, 15 spine, and 2 liver) underwent 602 EPID-based in vivo dose verification events. A developed model-based dose reconstruction algorithm calculates the 3-dimensional dose distribution to the patient by back-projecting the primary fluence measured by the EPID during treatment. The EPID frame-averaging was optimized in June 2015. For each treatment, a 3%/3-mm γ comparison between our EPID-derived dose and the Eclipse AcurosXB–predicted dose to the planning target volume (PTV) and the ≥20% isodose volume were performed. Alert levels were defined as γ pass rates <85% (lung and liver) and <80% (spine). Investigations were carried out for all fractions exceeding the alert level and were classified as follows: EPID-related, algorithmic, patient setup, anatomic change, or unknown/unidentified errors. Results: The percentages of fractions exceeding the alert levels were 22.6% for lung before frame-average optimization and 8.0% for lung, 20.0% for spine, and 10.0% for liver after frame-average optimization. Overall, mean (± standard deviation) planning target volume γ pass rates were 90.7% ± 9.2%, 87.0% ± 9.3%, and 91.2% ± 3.4% for the lung, spine, and liver patients, respectively. Conclusions: Results from the clinical implementation of our model-based in vivo dose verification method using on-treatment EPID images is reported. The method is demonstrated to be valuable for routine clinical use for verifying delivered dose as well as for detecting errors.

  19. Implementation of Antiretroviral Therapy for Life in Pregnant/Breastfeeding HIV+ Women (Option B+) Alongside Rollout and Changing Guidelines for ART Initiation in Rural Zimbabwe: The Lablite Project Experience.

    Science.gov (United States)

    Ford, Deborah; Muzambi, Margaret; Nkhata, Misheck J; Abongomera, George; Joseph, Sarah; Ndlovu, Makosonke; Mabugu, Travor; Grundy, Caroline; Chan, Adrienne K; Cataldo, Fabian; Kityo, Cissy; Seeley, Janet; Katabira, Elly; Gilks, Charles F; Reid, Andrew; Hakim, James; Gibb, Diana M

    2017-04-15

    Lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (Option B+) was rolled out in Zimbabwe from 2014, with simultaneous raising of the CD4 treatment threshold to 500 cells per cubic millimeter in nonpregnant/breastfeeding adults and children 5 years and over. Lablite is an implementation project in Zimbabwe, Malawi, and Uganda evaluating ART rollout. Routine patient-level data were collected for 6 months before and 12 months after Option B+ rollout at a district hospital and 3 primary care facilities in Zimbabwe (2 with outreach ART and 1 with no ART provision before Option B+). Between September 2013 and February 2015, there were 1686 ART initiations in the 4 facilities: 91% adults and 9% children younger than 15 years. In the 3 facilities with established ART, initiations rose from 300 during 6 months before Option B+ to 869 (2.9-fold) and 463 (1.5-fold), respectively, 0-6 months and 6-12 months after Option B+. Post-Option B+, an estimated 43% of pregnant/breastfeeding women needed ART for their own health, based on World Health Organization stage 3/4 or CD4 ≤350 per cubic millimeter (64% for CD4 ≤500). Seventy-four men (22%) and 123 nonpregnant/breastfeeding women (34%) initiated ART with CD4 >350 after the CD4 threshold increase. Estimated 12-month retention on ART was 79% (69%-87%) in Option B+ women (significantly lower in younger women, P = 0.01) versus 93% (91%-95%) in other adults (difference P ART initiations in all patient groups after implementation of World Health Organization 2013 guidelines. Retention of Option B+ women was poorer than retention of other adults; younger women require attention because they are more likely to disengage from care.

  20. The relative influence of team climate, team norms and social network norms on health professionals' implementation of a national recommendation to offer service-users diagnosed with schizophrenia family intervention therapy.

    Science.gov (United States)

    Hanbury, A

    2013-01-01

    Social influence is an important variable influencing health professionals' adoption of clinical recommendations. Different theories conceptualise social influence in different ways. This study operationalised three different forms of social influence--team climate, team norms (descriptive and injunctive) and social network norms (descriptive and injunctive), and compared their ability to predict mental health professionals' self-reported intention to adopt a national, clinical recommendation. A cross-sectional survey was developed, measuring the constructs in relation to intention to offer service-users family an intervention therapy, as part of a larger, theory-based implementation study. The survey was administered to all mental health professionals in one mental health trust. Using multiple regression, descriptive network norms were found to be the only significant predictor of intention. This suggests that behaviour change interventions in this context may benefit from promoting descriptive network norms, for example, emphasising the adoption behaviour of influential peers. Given the high degree of overlap found between network and team members in this study, and the potential challenges of targeting behaviour-change interventions at informal, more difficult to identify networks, future research is needed to evaluate the feasibility of targeting behaviour-change interventions at social networks compared with formal teams.

  1. Clinical Pharmacogenetics Implementation

    Science.gov (United States)

    WEITZEL, KRISTIN W.; ELSEY, AMANDA R.; LANGAEE, TAIMOUR Y.; BURKLEY, BENJAMIN; NESSL, DAVID R.; OBENG, ANIWAA OWUSU; STALEY, BENJAMIN J.; DONG, HUI-JIA; ALLAN, ROBERT W.; LIU, J. FELIX; COOPER-DEHOFF, RHONDA M.; ANDERSON, R. DAVID; CONLON, MICHAEL; CLARE-SALZLER, MICHAEL J.; NELSON, DAVID R.; JOHNSON, JULIE A.

    2014-01-01

    Current challenges exist to widespread clinical implementation of genomic medicine and pharmacogenetics. The University of Florida (UF) Health Personalized Medicine Program (PMP) is a pharmacist-led, multidisciplinary initiative created in 2011 within the UF Clinical Translational Science Institute. Initial efforts focused on pharmacogenetics, with long-term goals to include expansion to disease-risk prediction and disease stratification. Herein we describe the processes for development of the program, the challenges that were encountered and the clinical acceptance by clinicians of the genomic medicine implementation. The initial clinical implementation of the UF PMP began in June 2012 and targeted clopidogrel use and the CYP2C19 genotype in patients undergoing left heart catheterization and percutaneous-coronary intervention (PCI). After 1 year, 1,097 patients undergoing left heart catheterization were genotyped preemptively, and 291 of those underwent subsequent PCI. Genotype results were reported to the medical record for 100% of genotyped patients. Eighty patients who underwent PCI had an actionable genotype, with drug therapy changes implemented in 56 individuals. Average turnaround time from blood draw to genotype result entry in the medical record was 3.5 business days. Seven different third party payors, including Medicare, reimbursed for the test during the first month of billing, with an 85% reimbursement rate for outpatient claims that were submitted in the first month. These data highlight multiple levels of success in clinical implementation of genomic medicine. PMID:24616371

  2. Implementing TQM.

    Science.gov (United States)

    Bull, G; Maffetone, M A; Miller, S K

    1992-01-01

    Total quality management (TQM) is an organized, systematic approach to problem solving and continuous improvement. American corporations have found that TQM is an excellent way to improve competitiveness, lower operating costs, and improve productivity. Increasing numbers of laboratories are investigating the benefits of TQM. For this month's column, we asked our respondents: What steps has your laboratory taken to implement TQM?

  3. Implementation Politics

    DEFF Research Database (Denmark)

    Hegland, Troels Jacob; Raakjær, Jesper

    2008-01-01

    level are supplemented or even replaced by national priorities. The chapter concludes that in order to capture the domestic politics associated with CFP implementation in Denmark, it is important to understand the policy process as a synergistic interaction between dominant interests, policy alliances...

  4. Initial findings from a mixed-methods evaluation of computer-assisted therapy for substance misuse in prisoners: Development, implementation and clinical outcomes from the ‘Breaking Free Health & Justice’ treatment and recovery programme

    Directory of Open Access Journals (Sweden)

    Sarah Elison

    2015-08-01

    Full Text Available Background: Within the United Kingdom’s ‘Transforming Rehabilitation’ agenda, reshaping drug and alcohol interventions in prisons is central to the Government’s approach to addressing substance dependence in the prison population and reduce reoffending. To achieve this, a through-care project to support offenders following release, ‘Gateways’, is taking place providing ‘through the gate’ support to released offenders, including help with organising accommodation, education and employment, and access to a peer supporter. In addition, Gateways is providing access to an evidence-based computer-assisted therapy (CAT programme for substance misuse, Breaking Free Health & Justice (BFHJ. Developed in partnership with the Ministry of Justice (MoJ National Offender Management Services (NOMS, and based on a community version of the programme, Breaking Free Online (BFO, BFHJ provides access to clinically-robust techniques based on cognitive behavioural therapy (CBT and promotes the role of technology-enhanced approaches in recovery from substance misuse. The BFHJ programme is provided via ‘Virtual Campus’ (VC, a secure, web-based learning environment delivered by NOMS and the Department for Business, Innovation and Skills, which has no links to websites not approved by MoJ, and provides prisoners with access to online training courses around work and skills. Providing BFHJ on VC makes the programme the world’s first online healthcare programme to be provided in prisons. Aims: Although here is an emerging evidence-base for the effectiveness of the community version of the BFO programme and its implementation within community treatment settings (Davies, Elison, Ward, & Laudet, 2015; Elison, Davies, & Ward, 2015a, 2015b; Elison, Humphreys, Ward, & Davies, 2013; Elison, Ward, Davies, Lidbetter, et al., 2014; Elison, Ward, Davies, & Moody, 2014, its potential within prison settings requires exploration. This study therefore sought to

  5. Therapy: a new nonsurgical therapy option for benign thyroid nodules?

    DEFF Research Database (Denmark)

    Hegedüs, Laszlo

    2009-01-01

    Despite the increasing implementation of iodization programs, benign nodular thyroid disease will remain a prevalent therapeutic concern for decades. recent research suggests that nonsurgical therapy, including radioactive iodine, radiofrequency thermal ablation and percutaneous laser ablation...

  6. Family Therapy

    Science.gov (United States)

    Family therapy Overview By Mayo Clinic Staff Family therapy is a type of psychological counseling (psychotherapy) that can help family members improve communication and resolve conflicts. Family therapy is usually provided ...

  7. Modeling Internal Radiation Therapy

    NARCIS (Netherlands)

    van den Broek, Egon; Schouten, Theo E.; Pellegrini, M.; Fred, A.; Filipe, J.; Gamboa, H.

    2011-01-01

    A new technique is described to model (internal) radiation therapy. It is founded on morphological processing, in particular distance transforms. Its formal basis is presented as well as its implementation via the Fast Exact Euclidean Distance (FEED) transform. Its use for all variations of internal

  8. Hormone Therapy

    Science.gov (United States)

    ... vaginal lining gets thinner, dryer, and less elas- tic. Vaginal dryness may cause pain during sexual intercourse . ... when a woman starts taking hormone therapy. Some research suggests that for women who start combined therapy ...

  9. Insulin Therapy

    Science.gov (United States)

    ... Your Health Resources Drugs, Procedures & Devices Prescription Medicines Insulin Therapy Insulin Therapy Share Print When you digest food, your ... you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells ...

  10. Gene Therapy

    Science.gov (United States)

    Gene therapy Overview Gene therapy involves altering the genes inside your body's cells in an effort to treat or stop disease. Genes contain your ... that don't work properly can cause disease. Gene therapy replaces a faulty gene or adds a new ...

  11. Role of music therapy in integrative oncology.

    Science.gov (United States)

    Magill, Lucanne

    2006-01-01

    Music therapy is an evidence-based complementary therapy that enhances quality of life in cancer patients and their caregivers. The role of music therapy in integrative oncology encompassed care and treatment of patients and family members , ongoing collaboration with the health care team, and the provision of music therapy services that may benefit the cancer center community. Clinical work includes ongoing assessment and the implementation of specific music therapy techniques aimed at reducing challenging symptoms and enhancing overall well-being and quality of life. This article outlines music therapy methods and the role that the music therapist has in integrative oncology programs.

  12. Implementing multifactorial psychotherapy research in online virtual environments (IMPROVE-2: study protocol for a phase III trial of the MOST randomized component selection method for internet cognitive-behavioural therapy for depression

    Directory of Open Access Journals (Sweden)

    Edward Watkins

    2016-10-01

    Full Text Available Abstract Background Depression is a global health challenge. Although there are effective psychological and pharmaceutical interventions, our best treatments achieve remission rates less than 1/3 and limited sustained recovery. Underpinning this efficacy gap is limited understanding of how complex psychological interventions for depression work. Recent reviews have argued that the active ingredients of therapy need to be identified so that therapy can be made briefer, more potent, and to improve scalability. This in turn requires the use of rigorous study designs that test the presence or absence of individual therapeutic elements, rather than standard comparative randomised controlled trials. One such approach is the Multiphase Optimization Strategy, which uses efficient experimentation such as factorial designs to identify active factors in complex interventions. This approach has been successfully applied to behavioural health but not yet to mental health interventions. Methods/Design A Phase III randomised, single-blind balanced fractional factorial trial, based in England and conducted on the internet, randomized at the level of the patient, will investigate the active ingredients of internet cognitive-behavioural therapy (CBT for depression. Adults with depression (operationalized as PHQ-9 score ≥ 10, recruited directly from the internet and from an UK National Health Service Improving Access to Psychological Therapies service, will be randomized across seven experimental factors, each reflecting the presence versus absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, self-compassion training using a 32-condition balanced fractional factorial design (2IV 7-2. The primary outcome is symptoms of depression (PHQ-9 at 12 weeks. Secondary outcomes include symptoms of anxiety and process measures related to hypothesized mechanisms

  13. What Is Music Therapy?

    Science.gov (United States)

    American Music Therapy Association Home Contact News Help/FAQ Members Only Login About Music Therapy & AMTA What is Music Therapy? Definition and ... is Music Therapy? Print Email Share What is Music Therapy What is Music Therapy? Music Therapy is ...

  14. Music Therapy in Europe

    DEFF Research Database (Denmark)

    2015-01-01

    Professional development and recognition is an 'old' issue in music therapy but still a relevant, complex and crucial one. Burning questions regarding professionalisation are at the forefront of most music therapy associations’ agendas across Europe and beyond, and feed back directly to the work...... of the EMTC. Considering the wider political, socio-economic, cultural and disciplinary aspects of professionalisation, different development pathways impact directly on music therapy practice, training, ethics, professional collaboration and employment conditions. Although a number of endeavours have been...... implemented regarding music therapy’s professional development and recognition in different countries, documentation and sharing of such endeavours on international level has been limited and scattered. Drawing from the EMTC’s work since the early ‘90s, as well as from colleagues’ experiences (and struggles...

  15. Gamification in physical therapy: More than using games

    NARCIS (Netherlands)

    Janssen, J; Verschuren, O.; Renger, W.J.; Ermers, J.; Ketelaar, M.; Ee, R. van

    2017-01-01

    The implementation of computer games in physical therapy is motivated by characteristics such as attractiveness, motivation, and engagement, but these do not guarantee the intended therapeutic effect of the interventions. Yet, these characteristics are important variables in physical therapy

  16. Gamification in Physical Therapy : More Than Using Games

    NARCIS (Netherlands)

    Janssen, Joep; Verschuren, Olaf; Renger, Willem Jan; Ermers, Jose; Ketelaar, Marjolijn; van Ee, Raymond

    The implementation of computer games in physical therapy is motivated by characteristics such as attractiveness, motivation, and engagement, but these do not guarantee the intended therapeutic effect of the interventions. Yet, these characteristics are important variables in physical therapy

  17. Some recommendations and examples in the activation therapy practical implementation (according to L.K. Garkavi, E.B. Kvakina and M.A. Ukolova’s research studies

    Directory of Open Access Journals (Sweden)

    Alla I. Shikhlyarova

    2015-11-01

    Full Text Available Knowledge of laws of the different organism reactions to external and internal influences in case both of general unspecific adaptational reactions of different types and the periodic system of the repetitive pattern reactions offers us a possibility to target and control the organism resistance level using the activation therapy methods. Given are some examples of using the available biologically active means and the programmed modes of their dosing which demonstrate simplicity and efficacy of the stable health state restoration and maintenance.

  18. Implementing change in respiratory care.

    Science.gov (United States)

    Stoller, James K

    2010-06-01

    Though people are generally averse to change, change and innovation are critically important in respiratory care to maintain scientific and clinical progress. This paper reviews the issue of change in respiratory care. I summarize several available models of organizational and personal change (ie, those of Kotter and of Silversin and Kornacki, and the Intentional Change Theory of Boyatzis), review the characteristics of change-avid respiratory therapy departments, offer an example of a change effort in respiratory care (implementation of respiratory care protocols) and then analyze this change effort as it took place at one institution, the Cleveland Clinic, using these models. Finally, I present the results of an analysis of change-avid respiratory therapy departments and offer some suggestions regarding change management for the profession and for individual respiratory care clinicians. Common features of theories of organizational change include developing a sense of urgency, overcoming resistance, developing a guiding coalition, and involving key stakeholders early. With the understanding that change efforts may seem unduly "clean" and orderly in retrospect, the models help explain the sustainable success of efforts to implement the Respiratory Therapy Consult Service at the Cleveland Clinic. By implication, these models offer value in planning change efforts prospectively. Further analysis of features of change-avid respiratory therapy departments indicates 11 highly desired features, of which four that especially characterize change-avid departments include: having an up-to-date leadership team; employee involvement in change; celebrating wins; and an overall sense of progressiveness in the department. This analysis suggests that understanding and embracing change is important. To anchor change in our profession, greater attention should be given to developing a pipeline of respiratory care clinicians who, by virtue of their advanced training, have the skills

  19. Implementation of three-dimensional planning in brachytherapy of high dose rate for gynecology therapies; Implementacao de planejamento tridimensional em braquiterapia de alta taxa de dose para tratamentos ginecologicos

    Energy Technology Data Exchange (ETDEWEB)

    Sales, Camila Pessoa de

    2015-09-01

    This work aims to implement the three-dimensional (3D) planning for gynecological brachytherapy treatments. For this purpose, tests of acceptance and commissioning of brachytherapy equipment were performed to establish a quality and periodic assurance program. For this purpose, an important step was searching for a material to be used as a dummy source, since the applicators do not have any specific dummy. In addition, the validation of the use of applicators library was made for reconstruction in computed tomography (CT) and magnetic resonance imaging (MRI). In order to validate 3D planning, comparison of doses in dose assessment points used in bidimensional (2D) plans have been performed with volumetric doses to adjacent organs to the tumor. Finally, a protocol was established for 3D brachytherapy planning alternately using magnetic resonance image (MRI) and CT images, making evaluation of the dose in the tumor through the recording of MR and CT images. It was not possible to find a suitable material that could be used as dummy in MRI. However, the acquisition of the license's library for the applicators made possible the 3D planning based on MRI. No correlation was found between volumetric and specific doses analyzed, showing the importance of the implementation of 3D planning. The average ratio between D{sub 2cc} and ICRU{sub Bladder} dose was 1,74, 22% higher than the ratio found by others authors. For the rectum, D{sub 2cc} was less than dose point for 60% of fractions; the average difference was 12,5%. The average ratio between D{sub 2cc} and point dose rectum, 0,85, is equivalent to the value showed by Kim et al, 0,91. The D{sub 2cc} for sigmoid was 69% higher than point dose used, unless it was not possible compare this value, since the sigmoid point used in the 2D procedures is not used in others institutes. Relative dose in 2 cc of sigmoid was 57% of the prescription dose, the same value was found by in literature. This work enabled the

  20. Implementing an Assessment Clinic in a Residential PTSD Program

    Directory of Open Access Journals (Sweden)

    Joan McDowell

    2014-08-01

    Full Text Available Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans’ reactions to the feedback provided to them are included.

  1. Sweat Therapy.

    Science.gov (United States)

    Colmant, Stephen A.; Merta, Rod J.

    2000-01-01

    A study combined group sweating and group counseling. Four adolescent boys with disruptive behavior disorders participated in 12 sweat therapy sessions. They reported the sessions useful for sharing personal concerns and receiving assistance with problem solving. Three boys showed improvement in self-esteem. Advantages of sweat therapy over other…

  2. Intravenous Therapy.

    Science.gov (United States)

    Galliart, Barbara

    Intended for teaching licensed practical nurses, this curriculum guide provides information related to the equipment and skills required for nursing care of patients needing intravenous (IV) therapy. It also explains the roles and responsibilities of the licensed practical nurse with regard to intravenous therapy. Each of the 15 instructional…

  3. Poetry Therapy.

    Science.gov (United States)

    Evans, Ronald V.

    Poetry therapy is the method of therapy based on the principle that a poem is a special medium for expressing emotions and that this expression can have psychotherapeutic value. A survey taken in 1973 showed there were over 400 therapists treating 3,500 drug addicts, alcoholics, and mental retardates around the country. Poetry therapists…

  4. Proton Therapy

    Science.gov (United States)

    ... therapy is one of the most precise and advanced forms of radiation treatment available. How Proton Therapy is Delivered The patient is positioned on a table with a head frame or face mask covering the head. As the cyclotron smashes atoms, the protons released are directed toward ...

  5. Childhood adversity, mental ill-health and aggressive behavior in an African orphanage: Changes in response to trauma-focused therapy and the implementation of a new instructional system

    Directory of Open Access Journals (Sweden)

    Schauer Elisabeth

    2011-09-01

    Full Text Available Abstract Background The number of orphans in Sub-Saharan Africa is constantly rising. While it is known that family or community care is preferable over institutional care of African orphans, little is known about the quality of care in orphanages and possibilities of improvement. Study 1 Methods Exposure to traumatic stress, experiences of violence in the home, school and orphanage, as well as mental ill-health and aggression of 38 children (mean age of M = 8.64 years living in an orphanage in rural Tanzania were assessed at two time points. The severity of post-traumatic stress disorder symptoms (PTSD, depressive symptoms, and internalizing and externalizing problems were used as indicators of mental ill-health. Results Violence experienced in the orphanage correlated more strongly with all indicators of mental ill-health than violence in the former home, school or neighborhood at time point 1. Additionally, violence experienced in the orphanage had a positive relationship with the aggressive behavior of the children at time point 2. Study 2 Methods With the help of the pre-post assessment of Study 1, the implementation of a new instructional system and psychotherapeutic treatment (KIDNET for trauma-related illness were evaluated. Results In response to both, a change in the instructional system and psychotherapeutic treatment of PTSD, a massive decline in experienced violence and in the severity of PTSD-symptoms was found, whereas depressive symptoms and internalizing and externalizing problems exhibited little change. Conclusions These studies show that violence, especially in the orphanage, can severely contribute to mental ill-health in orphans and that mental health can be improved by implementing a new instructional system and psychotherapeutic treatment in an orphanage. Moreover, the results indicate that the experience of violence in an orphanage also plays a crucial role in aggressive behavior of the orphans.

  6. The Use of Dialectical Behavior Therapy (DBT) in Music Therapy: A Sequential Explanatory Study.

    Science.gov (United States)

    Chwalek, Carolyn M; McKinney, Cathy H

    2015-01-01

    There are published examples of how dialectical behavior therapy (DBT) and music therapy are effectively being used as separate therapies in the treatment of individuals with a variety of mental health disorders. However, research examining DBT-informed music therapy is limited. The purpose of this study was to determine whether music therapists working in mental health settings are implementing components of DBT in their work, and if so, how and why; and if not, why not and what is their level of interest in such work. We used a sequential explanatory mixed-methods research design implemented in two phases. Phase 1 was a quantitative survey of board-certified music therapists (n=260). Due to a low survey response rate (18%), and to enhance the validity of the findings, Phase 2, an embedded qualitative procedure in the form of interviews with clinicians experienced in the DBT approach, was added to the study. Both survey and interviews inquired about DBT training, use of DBT-informed music therapy, music therapy experiences used to address DBT skills, and experiences of implementing DBT-informed music therapy. Respondents indicating they implement DBT-informed music therapy (38.3%) are using components and adaptations of the standard DBT protocol. Advantages of implementing DBT-informed music therapy were identified, and more than half of the respondents who do not implement DBT in their music therapy practice also perceived this work as at least somewhat important. Disadvantages were also identified and support the need for further research. Components of DBT are used in music therapy and are valued, but there is a lack of empirical evidence to inform, refine, and guide practice. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. The clinical case for proton beam therapy

    Directory of Open Access Journals (Sweden)

    Foote Robert L

    2012-10-01

    Full Text Available Abstract Over the past 20 years, several proton beam treatment programs have been implemented throughout the United States. Increasingly, the number of new programs under development is growing. Proton beam therapy has the potential for improving tumor control and survival through dose escalation. It also has potential for reducing harm to normal organs through dose reduction. However, proton beam therapy is more costly than conventional x-ray therapy. This increased cost may be offset by improved function, improved quality of life, and reduced costs related to treating the late effects of therapy. Clinical research opportunities are abundant to determine which patients will gain the most benefit from proton beam therapy. We review the clinical case for proton beam therapy. Summary sentence Proton beam therapy is a technically advanced and promising form of radiation therapy.

  8. Music Therapy in Pediatric Healthcare

    Science.gov (United States)

    Robb, Sheri, Ed.

    2003-01-01

    Music therapy is an established health care and human services profession that is dedicated to the implementation of controlled research studies to determine the underlying mechanisms in music that are responsible for therapeutic change, as well as clinical research to direct and guide the work of the music therapist. This growing body of research…

  9. Proton radiation therapy in Canada

    Energy Technology Data Exchange (ETDEWEB)

    Grein, E.; Duzenli, C.; Pickles, T.; Ma, R.; Paton, K.; Kwa, W.; Harrison, R.; Blackmore, E. [BC Cancer Agency, Vancouver, British Columbia (Canada); TRIUMF, Vancouver, British Columbia (Canada)

    2002-04-01

    The development, commissioning, and implementation of the first Canadian Proton Radiation Therapy facility at TRIUMF in British Columbia is described. This was a collaborative project by the cyclotron physicists and staff at TRIUMF, the medical physicists and radiation oncologists of the Cancer Agency and the ocular oncology physicians of the Eye Care Center at Vancouver Hospital. (author)

  10. Psychomotoric therapy in patients with dementia

    OpenAIRE

    Jitka Suchá; Iva Holmerová

    2016-01-01

    Background: Dementia syndrome is a significant psychosocial and public health problem with important societal impact. It is important for us to learn more about methods of dementia management. Objective: To discuss principles and basic measures of psychomotor therapy in patients with dementia as well as the implementation of movement therapy and the lifestyle of patients with dementia. Methods: This research presents experience with psychomotor therapy of patients with dementia ...

  11. Technology Implementation Plan

    DEFF Research Database (Denmark)

    Jensen, Karsten Ingerslev; Schultz, Jørgen Munthe

    The Technology Implementation Plan (TIP) describes the main project results and the intended future use. The TIP is confidential.......The Technology Implementation Plan (TIP) describes the main project results and the intended future use. The TIP is confidential....

  12. Implementing Student Information Systems

    Science.gov (United States)

    Sullivan, Laurie; Porter, Rebecca

    2006-01-01

    Implementing an enterprise resource planning system is a complex undertaking. Careful planning, management, communication, and staffing can make the difference between a successful and unsuccessful implementation. (Contains 3 tables.)

  13. Hand Therapy

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Home Anatomy Hand Therapy Email to a friend * required fields From * ... ensure a healthy style of work. Find a Hand Therapist Search for a hand therapist in your ...

  14. Radiation Therapy

    Science.gov (United States)

    ... therapy, including: Fatigue Hair loss Skin changes Swelling/edema Nausea Sexual effects (reduced desire) Blood clots Your ... American Brain Tumor Association 8550 W. Bryn Mawr Ave. Ste 550 Chicago, IL 60631 © 2014 American Brain ...

  15. Sex Therapy

    Science.gov (United States)

    ... therapists have graduate degrees and can demonstrate their competence in sex therapy by becoming credentialed by the ... ways to resolve your concerns and improve your communication and intimacy. Talking about sex and intimacy may ...

  16. Proton Therapy

    Science.gov (United States)

    ... changes colon and rectal changes infertility joint changes lymphedema mouth changes secondary cancer There is a slight risk of developing cancer from radiation therapy. Following radiation treatment for cancer, you should be ...

  17. Gene Therapy

    Science.gov (United States)

    ... or improve your body's ability to fight disease. Gene therapy holds promise for treating a wide range of diseases, such as cancer, cystic fibrosis, heart disease, diabetes, hemophilia and AIDS. Researchers are still studying how and ...

  18. Alternative Therapies

    Science.gov (United States)

    ... biofeedback for learning to promote relaxation and increase oxygen flow to muscles (Schwartz & Schwartz, 1993) ; hypnotherapy for relaxation and pain relief (Hammond, 1991); magnet therapy for pain relief (Vallbona et al., 1997) ; and ...

  19. Radiation Therapy

    Science.gov (United States)

    ... Be extra careful not to spend time with children or pregnant women. Internal Radiation Therapy Makes You Give Off Radiation With systemic radiation, your body fluids ( urine , sweat, and saliva ) will give off radiation for a while. With ...

  20. Radiation Therapy

    Science.gov (United States)

    Radiation therapy is a cancer treatment. It uses high doses of radiation to kill cancer cells and stop them from ... half of all cancer patients receive it. The radiation may be external, from special machines, or internal, ...

  1. Ecodesign Implementation and LCA

    DEFF Research Database (Denmark)

    McAloone, Tim C.; Pigosso, Daniela Cristina Antelmi

    2018-01-01

    implementation into manufacturing companies. Existing methods and tools for ecodesign implementation will be described, focusing on a multifaceted approach to environmental improvement through product development. Additionally, the use of LCA in an ecodesign implementation context will be further described...... in terms of the challenges and opportunities, together with the discussion of a selection of simplified LCA tools. Finally, a seven-step approach for ecodesign implementation which has been applied by several companies will be described....

  2. Physical Therapy and Occupational Therapy in Progeria

    Science.gov (United States)

    Physical Therapy and Occupational Therapy in Progeria Information for Families and Caretakers from The Progeria Research Foundation Written ... accelerated aging in children. Children with Progeria need Physical Therapy (PT) and Occupational Therapy (OT) as often as ...

  3. Implementation of Axiomatic Language

    OpenAIRE

    Wilson, Walter W.

    2011-01-01

    This report summarizes a PhD research effort to implement a type of logic programming language called "axiomatic language". Axiomatic language is intended as a specification language, so its implementation involves the transformation of specifications to efficient algorithms. The language is described and the implementation task is discussed.

  4. Environmental Protection Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    Brekke, D.D.

    1994-01-01

    This Environmental Protection Implementation Plan is intended to ensure that the environmental program objectives of Department of Energy Order 5400.1 are achieved at SNL/California. The Environmental Protection Implementation Plan serves as an aid to management and staff to implement new environmental programs in a timely manner.

  5. [Domiciliary oxygen therapy].

    Science.gov (United States)

    Abdel Kafi, S

    2010-09-01

    In Belgium, oxygen therapy is becoming more and more accessible. When oxygen is needed for short periods or for special indications as palliative care, an agreement between mutual insurance companies and pharmacists allows the practitioner the home installation of gazeous oxygen cylinder or of oxygen concentrator. When long term oxygen therapy (LTOT) is indicated for patients with respiratory insufficiency, the pneumologist must first ask the INAMI the authorization to install one of the following modalities: oxygen concentrator with or without demand oxygen delivery cylinder and liquid oxygen. The goal of LTOT is to increase survival and quality of life. The principal and well accepted indication for LTOT is severe hypoxemia. The beneficial effects of oxygen therapy limited at night or on exertion are controversial. In order to increase patient's autonomy, oxygen can be prescribed for ambulation, respecting prescription's rules. At each step of oxygen therapy implementing (indication, choice of the device and follow-up) the patient under oxygen may benefit from a joint approach between the general practitioner and the chest specialist.

  6. [Why proton therapy? And how?

    Science.gov (United States)

    Thariat, Juliette; Habrand, Jean Louis; Lesueur, Paul; Chaikh, Abdulhamid; Kammerer, Emmanuel; Lecomte, Delphine; Batalla, Alain; Balosso, Jacques; Tessonnier, Thomas

    2018-02-05

    Proton therapy is a radiotherapy, based on the use of protons, charged subatomic particles that stop at a given depth depending on their initial energy (pristine Bragg peak), avoiding any output beam, unlike the photons used in most of the other modalities of radiotherapy. Proton therapy has been used for 60 years, but has only become ubiquitous in the last decade because of recent major advances in particle accelerator technology. This article reviews the history of clinical implementation of protons, the nature of the technological advances that now allows its expansion at a lower cost. It also addresses the technical and physical specificities of proton therapy and the clinical situations for which proton therapy may be relevant but requires evidence. Different proton therapy techniques are possible. These are explained in terms of their clinical potential by explaining the current terminology (such as cyclotrons, synchrotrons or synchrocyclotrons, using superconducting magnets, fixed line or arm rotary with passive diffusion delivery or active by scanning) in basic words. The requirements associated with proton therapy are increased due to the precision of the depth dose deposit. The learning curve of proton therapy requires that clinical indications be prioritized according to their associated uncertainties (such as range uncertainties and movement in lung tumors). Many clinical indications potentially fall under proton therapy ultimately. Clinical strategies are explained in a paralleled manuscript. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  7. Pain and Complementary Therapies.

    Science.gov (United States)

    Hamlin, Amy S; Robertson, T Michelle

    2017-12-01

    Treatment of both acute and chronic pain typically involves a combination of pharmacologic and provider-based interventions, which is effective for some patients but not for others. Use of pain medications, especially repeated and frequent usage, involves the risk of adverse reactions, overuse, and dependency. Complementary and alternative therapies (CAT) offer an alternative or adjunctive method to decrease the pain experience and enhance function and quality of life. Various evidence-based CAT methods have been proved to be effective in the management of both acute and chronic pain. Nurses are well placed to implement various CAT modalities. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Maintenance Therapy in IBD

    Science.gov (United States)

    ... Help Center Home > Resources > Maintenance Therapy Go Back Maintenance Therapy Email Print + Share The term "maintenance therapy" ... are referred to as "maintenance therapies." Why is Maintenance Therapy Needed in IBD? Both Crohn's disease and ...

  9. Family therapy

    Directory of Open Access Journals (Sweden)

    Shaikh Altamash

    2013-01-01

    Full Text Available Another major force not letting us succeed in the treatment of diabetes remains right inside the patients home, their family members. Hence, it is important to know the perception of the close family members about this simple and strong tool in diabetes, ′insulin′. The drug is nearing its century, it has not fully being accepted gracefully even in todays electronic savvy society. So, we need to strongly discover the reason for its non-acceptance, while trials are out inventing new drugs. One vital thing that can change this attitude is increasing the understanding of this drug, insulin in depth to close people around the patient, the ′family′. Underestimating family′s perception about disease and treatment for diabetes is detrimental to both diseased and the doctor. This consists of a biopsychosocial model; biological, psychological and social factors. Family forms the most important part of it. The strategies in family therapy include psychodynamic, structural, strategic, and cognitive-behavioral component. Diabetes has and will continue to rise, so will be the treatment options. From the clinicians side its to fix fasting first but from patients its fix family first. Family therapy demonstrates the importance of insulin initiation and maintenance in insulin naive patients, and continuation for others. The specific needs of such patients and their impact on family life are met with family therapy. Who needs family therapy? Benefits of family therapy and a case based approach is covered.

  10. Art Therapy

    DEFF Research Database (Denmark)

    Skov, Vibeke; Pedersen, Inge Nygaard

    2014-01-01

    Abstract Based on a Jungian approach, this article will introduce an integrative model to therapeutic change using art therapy methods as practical tools, with the aim of improving quality of life and in the prevention of depression. In a research study involving six participants, painting, clay...... work and drumming were used together with imagination and personal dialogues linked to the artwork. These art therapy processes attempted to combine the participant’s experience of inner and outer reality. The effect of gaining more knowledge about their inner reality using dreams and symbols......, was that participants gained a new understanding about their personal life. In addition, some participants were able to continue to use art therapy experiences as selfdevelopmental tools after the research study terminated. Jung’s description of the interactive relationship between the two living parts of the psyche...

  11. Music therapy

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    alternate with clear and lucid mental states. These states are important as it is here that it is possible to meet the person’s psychosocial needs. Ketil Normann’s conceps of periods of lucidity are presented and connected to clinical music therapy practice and how it is possible to use music in order...... as a consequence of person-centred care. Umeå University Medical Dissertations. New Series. Ridder, H.M. (2005). Music therapy as a way to enhance lucidity in persons with dementia in advanced stages. In: Esch, A.; Frohne-Hagemann, I.; Laqua, M.; Schirmer, H.; Seitz, E. (Eds.) Jahrbuch Musicktherapie. Forschung...... und Entwicklung Music Therapy Annual. Research and Development. 2005 (1), pp. 25-40. Reichert Verlag Wiesbaden....

  12. Implementering av kliniske retningslinjer

    OpenAIRE

    Kristensen, Atle; Wikstrøm, Dina

    2008-01-01

    ABSTRACT Background: As medical students in a psychiatric department, we experienced a lack of using medical guidelines. Our understanding is that clinical guidelines may be helpful in some clinical settings, and wanted to investigate how to implement clinical guidelines. Aims: This paper investigates the reasons as to why there is a lack of focus on medical guidelines, why it is hard to implement medical guidelines, which implementing strategies are most efficient, who should be resp...

  13. [Side Effects of Occupational Group Therapy].

    Science.gov (United States)

    Flöge, B; Fay, D; Jöbges, M; Linden, M; Muschalla, B

    2016-12-01

    Background: Occupational therapy is an important co-therapy in psychiatric therapy. It is a common belief that no risks are associated with occupational therapy. Negative effects caused by group therapy, especially occupational therapy, have not been in the focus of research yet. In this study we want to illustrate possible types and intensities of group side effects through occupational therapy. Patients and Methods: Patients of an inpatient rehabilitation facility filled out the Adverse Treatment Reaction Group Checklist. The checklist contains 47 items divided in six dimensions: group size, content, group participants, group outcome and global. The self-rating used a 5-point likert scale (0 = not at all; 4 = very much, extremely stressful) and gives information about types and intensities of the side effects. Results: 88.9 % of 45 patients reported negative effects of occupational group therapy. 28.9 % of the patients rated the side effect as at least severe. Discussion: Occupational therapy is associated with side effects as every other group therapy. Possible side effects caused by group therapy should be considered while planning and implementing occupational therapy. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Precision Medicine and PET/Computed Tomography: Challenges and Implementation.

    Science.gov (United States)

    Subramaniam, Rathan M

    2017-01-01

    Precision Medicine is about selecting the right therapy for the right patient, at the right time, specific to the molecular targets expressed by disease or tumors, in the context of patient's environment and lifestyle. Some of the challenges for delivery of precision medicine in oncology include biomarkers for patient selection for enrichment-precision diagnostics, mapping out tumor heterogeneity that contributes to therapy failures, and early therapy assessment to identify resistance to therapies. PET/computed tomography offers solutions in these important areas of challenges and facilitates implementation of precision medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Gene therapy and its implications in Periodontics

    Science.gov (United States)

    Mahale, Swapna; Dani, Nitin; Ansari, Shumaila S.; Kale, Triveni

    2009-01-01

    Gene therapy is a field of Biomedicine. With the advent of gene therapy in dentistry, significant progress has been made in the control of periodontal diseases and reconstruction of dento-alveolar apparatus. Implementation in periodontics include: -As a mode of tissue engineering with three approaches: cell, protein-based and gene delivery approach. -Genetic approach to Biofilm Antibiotic Resistance. Future strategies of gene therapy in preventing periodontal diseases: -Enhances host defense mechanism against infection by transfecting host cells with an antimicrobial peptide protein-encoding gene. -Periodontal vaccination. Gene therapy is one of the recent entrants and its applications in the field of periodontics are reviewed in general here. PMID:20376232

  16. Dance Therapy.

    Science.gov (United States)

    Leventhal, Marcia B.

    1980-01-01

    Dance therapy deals with personal growth via body-mind interaction. A change in movement expression is believed to result in a personality or behavior change. The therapist is trained to become sensitive to movement expression as it relates to the psychological, motor, and cognitive development of the child. (JN)

  17. [Corporal therapy in sexual therapy].

    Science.gov (United States)

    Bonierbale, M

    1977-12-01

    The use of corporal therapy in treating sexual problems is discussed. The erotic zones of the body are established very early in infancy. The central nervous system continues to develop 6 months after birth in human beings. Experiments done with rats show that rats that are stimulated by noise, handling, etc., develop denser and more numerous nerve cells. Touch, rhythm, and facial expression are established as the interface with the self's erotic image (established in infancy) and the world. Corporal therapy can modify the physiological functioning of the libido. It is also necessary that one accept one's sociocultural identity. Relational massage, bioenergy, and relaxation are 3 types of corporal therapy used to ameliorate sexual problems.

  18. A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy.

    Science.gov (United States)

    Gallagher, Hugh; Methven, Shona; Casula, Anna; Thomas, Nicola; Tomson, Charles R V; Caskey, Fergus J; Rose, Tracey; Walters, Stephen J; Kennedy, David; Dawnay, Anne; Cassidy, Martin; Fluck, Richard; Rayner, Hugh C; Nation, Michael

    2017-04-11

    Patients who start renal replacement therapy (RRT) for End-Stage Kidney Disease (ESKD) without having had timely access to specialist renal services have poor outcomes. At one NHS Trust in England, a community-wide CKD management system has led to a decline in the incident rate of RRT and the lowest percentage of patients presenting within 90 days of starting RRT in the UK. We describe the protocol for a quality improvement project to scale up and evaluate this innovation. The intervention is based upon an off-line database that integrates laboratory results from blood samples taken in all settings stored under different identifying labels relating to the same patient. Graphs of estimated glomerular filtration rate (eGFR) over time are generated for patients 65 years with an incoming eGFR renal centres using a mixed methods approach. We are following a stepped-wedge design. The order of implementation among participating centres will be randomly allocated. Implementation will proceed with unidirectional steps from control group to intervention group until all centres are generating graphs of eGFR over time. The primary outcome for the quantitative evaluation is the proportion of patients referred to specialist renal services within 90 days of commencing RRT, using data collected routinely by the UK Renal Registry. The qualitative evaluation will investigate facilitators and barriers to adoption and spread of the intervention. It will include: semi-structured interviews with laboratory staff, renal centre staff and service commissioners; an online survey of GPs receiving the intervention; and focus groups of primary care staff. Late presentation to nephrology for patients with ESKD is a source of potentially avoidable harm. This protocol describes a robust quantitative and qualitative evaluation of a quality improvement intervention to reduce late presentation and improve the outcomes for patients with ESKD.

  19. Implementation between Tradition and Management: Structuration and Styles of Implementation

    NARCIS (Netherlands)

    Terpstra, Jan; Havinga, Tetty

    2001-01-01

    This article presents a diachronic perspective for implementation research. It analyzes implementation practices in relation to their changing institutional context. Therefore, a comparison is made between different styles of implementation. The relationship between implementation practices and

  20. The perfect marriage: Solution-focused therapy and motivational interviewing in medical family therapy

    Directory of Open Access Journals (Sweden)

    Gage Stermensky

    2014-01-01

    Full Text Available Medical family therapy has many potential uses in behavioral medicine and primary care. Current research was reviewed to determine the most advantageous way to apply solution-focused therapy and motivational interviewing as a perfect marriage in medical family therapy. An extensive literature review was done in the following databases for medical family therapy: Proquest, EBSCO, Medline, and PsychInfo. The search resulted in 86 relevant articles, of which 46 of the most recent were selected for review. Medical family therapy lacks current research that supports solution-focused therapy or motivational interviewing. However, evidence supports the use of solution-focused therapy as a brief format, as well as the closely related intervention, motivational interviewing. While medical family therapy presents many hopeful possibilities in the fields of behavioral medicine, psychology, and marriage and family therapy, little evidence currently exists for the most effective implementation. This review found evidence supporting solution-focused therapy and motivational interviewing as the perfect marriage of the collaborative team approaches for the future implementation and use of specific interventions in medical family therapy.

  1. Frameworks for Protocol Implementation

    NARCIS (Netherlands)

    de Barros Barbosa, Ciro; de barros Barbosa, C.; Ferreira Pires, Luis; Pires, L.F.; van Sinderen, Marten J.

    1998-01-01

    This paper reports on the development of a catalogue of frameworks for protocol implementation. Frameworks are software structures developed for a specific application domain, which can be re-used in the implementation of various different concrete systems in this domain. By using frameworks we aim

  2. Implementering & Performative Potentialer

    DEFF Research Database (Denmark)

    Damkjer, Annemarie

    This thesis investigates how technology is constituted as an object of implementation. Using the theoretical lens of actor-network theory the thesis investigates how the technology of performance management becomes a matter of implementation in the Danish Defence and how the technology of perform......This thesis investigates how technology is constituted as an object of implementation. Using the theoretical lens of actor-network theory the thesis investigates how the technology of performance management becomes a matter of implementation in the Danish Defence and how the technology...... of implementation through different forms of practice that perform the technology as a project. Practices that arrange ideas on performance management in stories of change. This marks the contents of the technology, forms its vocabulary and makes possible the technology’s allocation of resources and movement across...... challenge the traditional models of implementation. It is suggested, that we view implementation practices as performative in relation to the co-configuration of technology and organizational practices and that both the co-configurative perspective and the materiality of implementation practices is included...

  3. Collaborative enterprise system implementation

    NARCIS (Netherlands)

    Wognum, P.M.; Mensink, G.J.; Bühl, H.; Ma, X.; Sedmak-Wells, M.; Fan, I.S.; Sobolewski, M.; Cha, J.

    2004-01-01

    Implementation of enterprise systems in companies is a complex and dynamic process, requiring collaboration between many different roles within and across organisational borders. Current research on implementation of enterprise systems consists of the major part of large-scale studies aimed at

  4. User participation in implementation

    DEFF Research Database (Denmark)

    Fleron, Benedicte; Rasmussen, Rasmus; Simonsen, Jesper

    2012-01-01

    Systems development has been claimed to benefit from user participation, yet user participation in implementation activities may be more common and is a growing focus of participatory-design work. We investigate the effect of the extensive user participation in the implementation of a clinical...... system by empirically analyzing how management, participating staff, and non-participating staff view the implementation process with respect to areas that have previously been linked to user participation such as system quality, emergent interactions, and psychological buy-in. The participating staff...... experienced more uncertainty and frustration than management and non-participating staff, especially concerning how to run an implementation process and how to understand and utilize the configuration possibilities of the system. This suggests that user participation in implementation introduces a need...

  5. Food Therapy in Sinosphere Asia.

    Science.gov (United States)

    Chu, Natural Hoi Sing; Yao, Chu Kion; Tan, Victoria Ping Yi

    2017-09-28

    Traditional Chinese Food Therapy has long been an integral part of dietary practices in Sinosphere Asia. This therapy is defined by the classification of foods into cooling (Yin) and heaty (Yang) and the manipulation of dietary intake of these foods as a therapeutic strategy for chronic diseases. Both functional dyspepsia (FD) and irritable bowel syndrome (IBS) are chronic, functional gut disorders widely prevalent in Sinosphere Asia. Diet is increasingly recognized as a symptom trigger in FD and IBS, and the evidence suggesting the utility of diet therapies as front-line management is growing, particularly in the West. Specifically, a diet low in Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols is an efficacious therapy for patients with IBS. In contrast, a proportion of patients with IBS in Sinosphere Asia utilize Chinese Food Therapy for symptom management. Chinese Food Therapy provides an attractive target for integration with evidence-based Western dietary therapies as a management strategy in FD and IBS. However, significant gaps in research exist with the utility of Chinese Food Therapy that first need to be addressed. This includes a lack of standardization for heaty and cooling classification, limited mechanistic rationale or clinical studies supporting its efficacy in FD and IBS, and the lack of an ideal practitioner for implementation of Chinese Food Therapy. Hence, the review provides a summary of the role of diet and nutrition in Sinosphere Asia with an emphasis on FD and IBS, and an examination of how modern dietary practices may be able to be integrated into practices in this region.

  6. Music Therapy: A Career in Music Therapy

    Science.gov (United States)

    About Music Therapy & Music Therapy Training M usic therapy is a healthcare profession that uses music to help individuals of all ages improve physical, cognitive, emotional, and social functioning. Music therapists work with children and adults with developmental ...

  7. Narrative therapy, family therapy and history

    OpenAIRE

    Harper, David J.

    2009-01-01

    This article was inspired by listening to the interesting plenary on the influence of narrative therapy on family therapy at the AFT annual conference in Manchester in September 2008. One of the issues raised concerned the historical connections between narrative therapy and the broader family therapy field. The contributors seemed keen to avoid a split between narrative therapy and the broader family therapy field and, instead, to find connections but this issue seemed difficult to negotiate...

  8. Antiproton therapy

    CERN Document Server

    Knudsen, Helge V; Bassler, Niels; Alsner, Jan; Beyer, Gerd-Jürgen; DeMarco, John J; Doser, Michael; Hajdukovic, Dragan; Hartley, Oliver; Iwamoto, Keisuke S; Jäkel, Oliver; Kovacevic, Sandra; Møller, Søren Pape; Overgaard, Jens; Petersen, Jørgen B; Ratib, Osman; Solberg, Timothy D; Vranjes, Sanja; Wouters, Bradly G

    2008-01-01

    Radiotherapy is one of the most important means we have for the treatment of localised tumours. It is therefore essential to optimize the technique, and a lot of effort goes into this endeavour. Since the proposal by Wilson in 1946 [R.R. Wilson, Radiology use of fast protons, Radiology 47 (1946) 487.] that proton beams might be better than photon beams at inactivating cancer cells, hadron therapy has been developed in parallel with photon therapy and a substantial knowledge has been gained on the effects of pions, protons and heavy ions (mostly carbon ions). Here we discuss the recent measurements by the CERN ACE collaboration of the biological effects of antiprotons, and argue that these particles very likely are the optimal agents for radiotherapy.

  9. [Functional therapy].

    Science.gov (United States)

    De Lima, G R

    1977-03-01

    This article attempts to present and explain the therapy for the most common gynecological and nongynecological problems caused by oral contraception (OC). Carcinogenic side effects include vulvar and cervical cancer, which can be treated with cryosurgery, breast cancer, usually treated either by termination of OC, or by additional hormonal therapy, endometritis, and endometrial hyperplasia and adenocarcinoma, a result of the action of progesterone on tissues continuously stimulated by estrogen. Endocrinal aspects of OC include all menopausal syndromes, most dermatological side effects, such as acne and hirsutism, nonpuerperal galactorrhea, usually due to hyperprolactinemia, and which responds very well to treatment with bromocriptine, and infections such as herpes genitalis, candida albicans, and others. OC can also cause vulvar distrophy, to be treated with testosterone propionate, and anovulation, which responds very well to treatment with clomiphene.

  10. Music Therapy

    DEFF Research Database (Denmark)

    Sanfi, Ilan

    2012-01-01

    may cause detrimental long-term effects. Three studies have examined the effect of music therapy procedural support (MTPS) under needle procedures. Consequently, this study aims at examining the effects of MTPS in an RCT. Moreover, the study addresses clinical aspects of the applied MT intervention...... and provides research-based clinical tools. Methods 41 children (1 to 10 years) were enrolled and underwent a single PIVA procedure. The children were randomly assigned to either an MT or a comparable control group receiving PIVA. In addition, the music therapy (MT) group received individualised MTPS (i.......e. music alternate engagement) before, during, and after PIVA. The intervention was performed by a trained music therapist and comprised preferred songs, improvised songs/music, and instrument playing. The study was carried out in accordance with the rules in force regarding research ethics and clinical MT...

  11. Music Therapy

    DEFF Research Database (Denmark)

    Trondalen, Gro; Bonde, Lars Ole

    2012-01-01

    Music therapy (MT) is most commonly defined as an intervention where “the therapist helps the client to promote health, using music experiences and the relationships developing through them” (Bruscia 1998). Also other definitions of MT agree that a therapeutic relationship is important for a music...... intervention to be considered MT. Other interventions that “use music for health-related goals, but in ways that do not qualify as music therapy” (Gold 2009), may be described as music medicine, or simply as music listening. In this text we elaborate on an overview chapter covering some of the different major...... music therapy orientations/models (Guided Imagery and Music, Nordoff-Robbins, Psychoanalytic, Cognitive-behavioral etc), their theoretical foundations and their practical approaches to health and wellbeing or ‘health musicking’. The relational context – the interplay of (expressive as well as receptive...

  12. MUSIC THERAPY

    OpenAIRE

    Dr. Archana Sharma

    2017-01-01

    Music Therapy is an established health profession in which music is used within a therapeutic relationship to address to physical, emotional, cognitive and social needs of individuals. After assessing the strength and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to and/or listening to music. Through musical involvement in therapeutic context, clients, abilities are strengthened and transfer to other areas of their liv...

  13. Neutron Therapy in the 21st Century

    CERN Document Server

    Kroc, Thomas K

    2014-01-01

    The question of whether or not neutron therapy works has been answered. It is a qualified yes, as is the case with all of radiation therapy. But, neutron therapy has not kept pace with the rest of radiation therapy in terms of beam delivery techniques. Modern photon and proton based external beam radiotherapy routinely implements image-guidance, beam intensity-modulation and 3-dimensional treatment planning. The current iteration of fast neutron radiotherapy does not. Addressing these deficiencies, however, is not a matter of technology or understanding, but resources. The future of neutron therapy lies in better understanding the interaction processes of radiation with living tissue. A combination of radiobiology and computer simulations is required in order to optimize the use of neutron therapy. The questions that need to be answered are: Can we connect the macroscopic with the microscopic? What is the optimum energy? What is the optimum energy spectrum? Can we map the sensitivity of the various tissues of...

  14. Types of hormone therapy

    Science.gov (United States)

    ... your doctor for regular checkups when taking HT. Alternative Names HRT- types; Estrogen replacement therapy - types; ERT- types of hormone therapy; Hormone replacement therapy - types; Menopause - types of hormone therapy; HT - types; Menopausal hormone ...

  15. About Occupational Therapy

    Science.gov (United States)

    ... if}} {{{tweet}}} About Occupational Therapy What Is Occupational Therapy? Occupational therapy practitioners ask, "What matters to you?" not, " ... about our science-driven and evidence-based profession. Occupational Therapy: Improving Function While Controlling Costs 4 4 The ...

  16. Radiation Therapy (For Parents)

    Science.gov (United States)

    ... Giving Teens a Voice in Health Care Decisions Radiation Therapy KidsHealth > For Parents > Radiation Therapy Print A ... have many questions and concerns about it. About Radiation Therapy In radiation therapy, high-energy radiation from ...

  17. Welcome to Implementation Science

    Directory of Open Access Journals (Sweden)

    Mittman Brian S

    2006-02-01

    Full Text Available Abstract Implementation research is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care. This relatively new field includes the study of influences on healthcare professional and organisational behaviour. Implementation Science will encompass all aspects of research in this field, in clinical, community and policy contexts. This online journal will provide a unique platform for this type of research and will publish a broad range of articles – study protocols, debate, theoretical and conceptual articles, rigorous evaluations of the process of change, and articles on methodology and rigorously developed tools – that will enhance the development and refinement of implementation research. No one discipline, research design, or paradigm will be favoured. Implementation Science looks forward to receiving manuscripts that facilitate the continued development of the field, and contribute to healthcare policy and practice.

  18. Data governance implementation concept

    OpenAIRE

    Ullrichová, Jana

    2016-01-01

    This master´s thesis discusses concept of implementation for data governance. The theoretical part of this thesis is about data governance. It explains why data are important for company, describes definitoons of data governance, its history, its components, its principles and processes and fitting in company. Theoretical part is amended with examples of data governance failures and banking specifics. The main goal of this thesis is to create a concept for implementing data governance and its...

  19. Environmental protection Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    R. C. Holland

    1999-12-01

    This ``Environmental Protection Implementation Plan'' is intended to ensure that the environmental program objectives of Department of Energy Order 5400.1 are achieved at SNL/California. This document states SNL/California's commitment to conduct its operations in an environmentally safe and responsible manner. The ``Environmental Protection Implementation Plan'' helps management and staff comply with applicable environmental responsibilities.

  20. Benchmarking Software Assurance Implementation

    Science.gov (United States)

    2011-05-18

    product The chicken#. (a.k.a. Process Focused Assessment ) – Management Systems ( ISO 9001, ISO 27001 , ISO 2000) – Capability Maturity Models (CMMI...Benchmarking Software Assurance Implementation Michele Moss SSTC Conference May 18, 2011 Report Documentation Page Form ApprovedOMB No. 0704-0188...00-00-2011 4. TITLE AND SUBTITLE Benchmarking Software Assurance Implementation 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER

  1. EDMS implementation challenge.

    Science.gov (United States)

    De La Torre, Marta

    2002-08-01

    The challenges faced by facilities wishing to implement an electronic medical record system are complex and overwhelming. Issues such as customer acceptance, basic computer skills, and a thorough understanding of how the new system will impact work processes must be considered and acted upon. Acceptance and active support are necessary from Senior Administration and key departments to enable this project to achieve measurable success. This article details one hospital's "journey" through design and successful implementation of an electronic medical record system.

  2. Occupational therapy, culture and diversity

    Directory of Open Access Journals (Sweden)

    Salvador Simó Algado

    2016-01-01

    Full Text Available Occupational behaviour is always an environmental behaviour because the occupation is the dialogue between human beings and their environment. Culture is key dimension in our profession. This article is based on previous research and a new review of the scientific literature on the various meanings associated with culture. In the contemporary context the globalization involves the imposition of the American way of life on a planetary scale. In front of ethnocentrism and racism a diatopical hermeneutics is proposed. A cosmopolitan citizenship can be constructed supporting diversity. The article concludes by reflecting on strategies that can be implemented from occupational therapy to develop a culturally safe occupational therapy. An archaeology of meaning must be developed in front of the Americanization. Occupational therapy needs to develop a powerful political activism in order to build an inclusive society based on human rights and sustainability. Culture and diversity are key elements in this process.

  3. [Gestalt therapy.].

    Science.gov (United States)

    Corbeil, J; Poupard, D

    1978-01-01

    The authors describe Gestalt Therapy. They retrace its fundamental theoretical axes. These are psychoanalysis, character analysis, the german Gestalt theory of perception, existentialism, and the Orient. Some principal concepts are then elaborated more fully such as the cycle of awareness, desensitization, excitation anxiety and the five defense mechanisms: retroflection, introjection, projection, deflection, and confluence. The nature and goals of the therapeutic process are also described before the presentation of some techniques specific to this approach such as enactment and role playing. Finally, certain basic Gestalt rules, which aim at facilitating and intensifying the communication process among group members, are enunciated.

  4. Nutritional Therapy.

    Science.gov (United States)

    Schwartz, Julie

    2016-03-01

    This article provides the reader with steps needed to accurately assess patient nutrition behaviors that contribute to weight gain, inability to lose weight, or inability to sustain weight loss. Evidence-based approaches in nutrition therapy that can create the daily energy deficit needed to produce 1/2 to 2 pounds of weight loss per week, and the strategies to create the energy deficit, are presented. To optimize health, long-term weight loss maintenance is needed. The benefits of using a multidisciplinary team approach in treating obesity are highlighted. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Clinical pharmacogenetics implementation: approaches, successes, and challenges.

    Science.gov (United States)

    Weitzel, Kristin W; Elsey, Amanda R; Langaee, Taimour Y; Burkley, Benjamin; Nessl, David R; Obeng, Aniwaa Owusu; Staley, Benjamin J; Dong, Hui-Jia; Allan, Robert W; Liu, J Felix; Cooper-Dehoff, Rhonda M; Anderson, R David; Conlon, Michael; Clare-Salzler, Michael J; Nelson, David R; Johnson, Julie A

    2014-03-01

    Current challenges exist to widespread clinical implementation of genomic medicine and pharmacogenetics. The University of Florida (UF) Health Personalized Medicine Program (PMP) is a pharmacist-led, multidisciplinary initiative created in 2011 within the UF Clinical Translational Science Institute. Initial efforts focused on pharmacogenetics, with long-term goals to include expansion to disease-risk prediction and disease stratification. Herein we describe the processes for development of the program, the challenges that were encountered and the clinical acceptance by clinicians of the genomic medicine implementation. The initial clinical implementation of the UF PMP began in June 2012 and targeted clopidogrel use and the CYP2C19 genotype in patients undergoing left heart catheterization and percutaneous-coronary intervention (PCI). After 1 year, 1,097 patients undergoing left heart catheterization were genotyped preemptively, and 291 of those underwent subsequent PCI. Genotype results were reported to the medical record for 100% of genotyped patients. Eighty patients who underwent PCI had an actionable genotype, with drug therapy changes implemented in 56 individuals. Average turnaround time from blood draw to genotype result entry in the medical record was 3.5 business days. Seven different third party payors, including Medicare, reimbursed for the test during the first month of billing, with an 85% reimbursement rate for outpatient claims that were submitted in the first month. These data highlight multiple levels of success in clinical implementation of genomic medicine. © 2014 Wiley Periodicals, Inc.

  6. Laser therapy in cardiovascular disease

    Science.gov (United States)

    Rindge, David

    2009-02-01

    Cardiovascular disease is the number one cause of death worldwide. It is broadly defined to include anything which adversely affects the heart or blood vessels. One-third of Americans have one or more forms of it. By one estimate, average human life expectancy would increase by seven years if it were eliminated. The mainstream medical model seeks mostly to "manage" cardiovascular disease with pharmaceuticals or to surgically bypass or reopen blocked vessels via angioplasty. These methods have proven highly useful and saved countless lives. Yet drug therapy may be costly and ongoing, and it carries the risk of side effects while often doing little or nothing to improve underlying health concerns. Similarly, angioplasty or surgery are invasive methods which entail risk. Laser therapy1 regenerates tissue, stimulates biological function, reduces inflammation and alleviates pain. Its efficacy and safety have been increasingly well documented in cardiovascular disease of many kinds. In this article we will explore the effects of laser therapy in angina, atherosclerosis, coronary artery disease, hypertension, hyperlipidemia, myocardial infarction, stroke and other conditions. The clinical application of various methods of laser therapy, including laserpuncture and transcutaneous, supravascular and intravenous irradiation of blood will be discussed. Implementing laser therapy in the treatment of cardiovascular disease offers the possibility of increasing the health and wellbeing of patients while reducing the costs and enhancing safety of medical care.

  7. Advances in radiation therapy dosimetry

    Directory of Open Access Journals (Sweden)

    Paliwal Bhudatt

    2009-01-01

    Full Text Available During the last decade, there has been an explosion of new radiation therapy planning and delivery tools. We went through a rapid transition from conventional three-dimensional (3D conformal radiation therapy to intensity-modulated radiation therapy (IMRT treatments, and additional new techniques for motion-adaptive radiation therapy are being introduced. These advances push the frontiers in our effort to provide better patient care; and with the addition of IMRT, temporal dimensions are major challenges for the radiotherapy patient dosimetry and delivery verification. Advanced techniques are less tolerant to poor implementation than are standard techniques. Mis-administrations are more difficult to detect and can possibly lead to poor outcomes for some patients. Instead of presenting a manual on quality assurance for radiation therapy, this manuscript provides an overview of dosimetry verification tools and a focused discussion on breath holding, respiratory gating and the applications of four-dimensional computed tomography in motion management. Some of the major challenges in the above areas are discussed.

  8. MONA Implementation Secrets

    DEFF Research Database (Denmark)

    Klarlund, Nils; Møller, Anders; Schwartzbach, Michael Ignatieff

    2002-01-01

    been discovered and tested over the years, including formula reductions, DAGification, guided tree automata, three-valued logic, eager minimization, BDD-based automata representations, and cache-conscious data structures. We describe these techniques and quantify their respective effects......The MONA tool provides an implementation of the decision procedures for the logics WS1S and WS2S. It has been used for numerous applications, and it is remarkably efficient in practice, even though it faces a theoretically non-elementary worst-case complexity. The implementation has matured over...

  9. MONA Implementation Secrets

    DEFF Research Database (Denmark)

    Klarlund, Nils; Møller, Anders; Schwartzbach, Michael Ignatieff

    2001-01-01

    been discovered and tested over the years, including formula reductions, DAGification, guided tree automata, three-valued logic, eager minimization, BDD-based automata representations, and cache-conscious data structures. We describe these techniques and quantify their respective effects......The Mona tool provides an implementation of the decision procedures for the logics WS1S and WS2S. It has been used for numerous applications, and it is remarkably efficient in practice, even though it faces a theoretically non-elementary worst-case complexity. The implementation has matured over...

  10. The challenge of implementation

    DEFF Research Database (Denmark)

    Andersen, Karen Heide Hauge

    2015-01-01

    of the BATCoM education at VIA University College, Denmark, the paper shows that the knowledge, use and implementation of the concepts is far from anchored in the lecturers’ daily practices. Through qualitative interviews the paper highlights different aspects considered, to determine the research question......Reaching the students in innovation and entrepreneurship courses is hard, when the courses are a requirement but not included in the main project of the curriculum. It is a major paradox for lecturers, who have never participated in and cannot see the relevance of such course, to implement...

  11. Implementing Samba 4

    CERN Document Server

    Leal, Marcelo

    2014-01-01

    This book is an implementation tutorial covering step-by-step procedures, examples, and sample code, and has a practical approach to set up a Samba 4 Server as an Active Directory Domain Controller and also set up different Samba 4 server roles.This book is ideal for system administrators who are new to the Samba 4 software, and who are looking to get a good grounding in how to use Samba 4 to implement Active Directory Services. It's assumed that you will have some experience with general system administration, Active Directory, and GNU/Linux systems. Readers are expected to have some test mac

  12. Environmental protection implementation plan

    Energy Technology Data Exchange (ETDEWEB)

    Holland, R.C.

    1998-03-01

    This Environmental Protection Implementation Plan is intended to ensure that the environmental program objectives of Department of Energy Order 5400.1 are achieved at SNL/California. This document states SNL/California`s commitment to conduct its operations in an environmentally safe and responsible manner. The Environmental Protection Implementation Plan helps management and staff comply with applicable environmental responsibilities. SNL is committed to operating in full compliance with the letter and spirit of applicable environmental laws, regulations, and standards. Furthermore, SNL/California strives to go beyond compliance with legal requirements by making every effort practical to reduce impacts to the environment to levels as low as reasonably achievable.

  13. Implementation of Emerging Technologies

    DEFF Research Database (Denmark)

    Barba, F. J.; Orlien, Vibeke; Mota, Maria J.

    2016-01-01

    Novel processing technologies have been gaining interest among food researchers due to their lower impact on nutritional and sensory properties of the products compared to the conventional thermal techniques. In this chapter some of the most well-studied (eg, high-pressure processing, pulsed...... resources. Lastly, studies with specific examples of the implementation of these novel processing technologies in food industry are described, focusing on the application of high-pressure processing and pulsed electric fields to orange juice, milk, and oysters. Higher implementation costs were observed...

  14. The Motivational Enhancement Therapy and Cognitive Behavioral Therapy Supplement: 7 Sessions of Cognitive Behavioral Therapy for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT) Series, Volume 2.

    Science.gov (United States)

    Webb, Charles; Scudder, Meleney; Kaminer, Yifrah; Kaden, Ron

    This manual, a supplement to "Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users: 5 Sessions, Cannabis Youth Treatment (CYT) Series, Volume 1", presents a seven-session cognitive behavioral treatment (CBT7) approach designed especially for adolescent cannabis users. It addresses the implementation and…

  15. Student impressions of an art therapy class.

    Science.gov (United States)

    Hensel, Desiree; Bradburn, Taylor Caitlin; Kelly, Amy; Manahan, Isabel; Merriman, Hannah; Metzinger, Faith; Moore, Heather

    2012-12-01

    Art therapy facilitates the expression of thoughts and feelings and thus may serve as a self-care strategy. This paper describes the implementation of an expressive art therapy class to teach self-care during a required sophomore level nursing wellness course and the outcomes of the class through the eyes of six students. While students were initially reluctant to engage in the activity, the shared stories revealed feelings of relaxation, empowerment, value clarification, and increased self-awareness. The implication for nursing education is that the integration of art therapy into curricula may serve as an effective strategy to teaching self-care and core professional values.

  16. Modern Radiation Therapy for Hodgkin Lymphoma

    DEFF Research Database (Denmark)

    Specht, Lena; Yahalom, Joachim; Illidge, Tim

    2014-01-01

    Radiation therapy (RT) is the most effective single modality for local control of Hodgkin lymphoma (HL) and an important component of therapy for many patients. These guidelines have been developed to address the use of RT in HL in the modern era of combined modality treatment. The role of reduced...... on Radiation Units and Measurements concepts of gross tumor volume, clinical target volume, internal target volume, and planning target volume are used for defining the targeted volumes. Newer treatment techniques, including intensity modulated radiation therapy, breath-hold, image guided radiation therapy......, and 4-dimensional imaging, should be implemented when their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control. The highly conformal involved node radiation therapy (INRT), recently introduced for patients for whom...

  17. Study on external beam radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Sook; Yoo, Seoung Yul; Yoo, Hyung Jun; Ji, Young Hoon; Lee, Dong Han; Lee, Dong Hoon; Choi, Mun Sik; Yoo, Dae Heon; Lee, Hyo Nam; Kim, Kyeoung Jung

    1999-04-01

    To develop the therapy technique which promote accuracy and convenience in external radiation therapy, to obtain the development of clinical treatment methods for the global competition. The contents of the R and D were 1. structure, process and outcome analysis in radiation therapy department. 2. Development of multimodality treatment in radiation therapy 3. Development of computation using networking techniques 4. Development of quality assurance (QA) system in radiation therapy 5. Development of radiotherapy tools 6. Development of intraoperative radiation therapy (IORT) tools. The results of the R and D were 1. completion of survey and analysis about Korea radiation therapy status 2. Performing QA analysis about ICR on cervix cancer 3. Trial of multicenter randomized study on lung cancers 4. Setting up inter-departmental LAN using MS NT server and Notes program 5. Development of ionization chamber and dose-rate meter for QA in linear accelerator 6. Development on optimized radiation distribution algorithm for multiple slice 7. Implementation on 3 dimensional volume surface algorithm and 8. Implementation on adaptor and cone for IORT.

  18. Implementing Specification Freedoms.

    Science.gov (United States)

    1983-04-01

    Sheila Coyazo for editing the final draft. Portions of this report appeared in a paper of the same name published in Science of Computer Programming [21...University of Edinburgh, Technical Report DAI 54, 1978. 21. Feather, M. S., and P. E. London, "Implementing specification freedoms," Science of Computer Programming 2

  19. Implementing function spreadsheets

    DEFF Research Database (Denmark)

    Sestoft, Peter

    2008-01-01

    : that of turning an expression into a named function. Hence they proposed a way to define a function in terms of a worksheet with designated input and output cells; we shall call it a function sheet. The goal of our work is to develop implementations of function sheets and study their application to realistic...

  20. Implementing Sustainable Institutional Practices

    Science.gov (United States)

    Shepard, Joseph; Johnson, Lewis

    2009-01-01

    Recent research has found that few institutions of higher education implemented the necessary strategies to make their campuses sustainable (Thompson and Green 2005). Ironically, universities are the segment of society with the most access to the intellectual capital needed to provide sound sustainable practices and measurements. Having top…

  1. Implementering af evidensbaseret praksis

    DEFF Research Database (Denmark)

    Scheel, Linda Schumann; Tewes, Marianne; Petersen, Preben Ulrich

    2015-01-01

    Projektet omhandler implementering af den kliniske retningslinje om identifikation, forebyggelse og behandling af delirium – i denne sammenhæng relateret til hjertepatienter. Projektet foregår på to hospitaler i Hjertecentret på Rigshospitalet, et intensivt afsnit og et sengeafsnit, i tæt...

  2. Distributed Energy Implementation Options

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chandralata N [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-13

    This presentation covers the options for implementing distributed energy projects. It distinguishes between options available for distributed energy that is government owned versus privately owned, with a focus on the privately owned options including Energy Savings Performance Contract Energy Sales Agreements (ESPC ESAs). The presentation covers the new ESPC ESA Toolkit and other Federal Energy Management Program resources.

  3. Implementation of Aerobic Programs.

    Science.gov (United States)

    American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD).

    This information is intended for health professionals interested in implementing aerobic exercise programs in public schools, institutions of higher learning, and business and industry workplaces. The papers are divided into three general sections. The introductory section presents a basis for adhering to a health fitness lifestyle, using…

  4. Implementation of lean leadership

    Directory of Open Access Journals (Sweden)

    Trenkner Małgorzata

    2016-12-01

    Full Text Available The Toyota case proves that lean leadership is of critical importance for the successful implementation and permanent functioning of Lean Production System. There is no ready formula for developing Toyota style lean leadership. However, one may gain inspiration from its experience.

  5. Implications for Curriculum Implementation

    African Journals Online (AJOL)

    Nekky Umera

    the limits to effective learning of biology may have been minimally set. ... was to create and maintain more effective learning environments through the ..... Teachers' attitudinal variables in the implementation of the further-mathematics curriculum as correlates of students' learning outcomes. Zimbabwe Journal of Educational ...

  6. DATA WAREHOUSES SECURITY IMPLEMENTATION

    Directory of Open Access Journals (Sweden)

    Burtescu Emil

    2009-05-01

    Full Text Available Data warehouses were initially implemented and developed by the big firms and they were used for working out the managerial problems and for making decisions. Later on, because of the economic tendencies and of the technological progress, the data warehou

  7. [Riding therapy in the rehabilitation of mobility-impaired children].

    Science.gov (United States)

    Mäenpää, Helena; Kela, Katri; Sätilä, Heli

    2016-01-01

    Riding therapy is a comprehensive and functional form of rehabilitation, in which the rehabilitee, the horse and the riding therapist collaborate in order to achieve individually assigned goals that support rehabilitation. In Finland, riding therapy is therapeutic rehabilitation carried out by riding therapists who have undergone approved training. The therapy is mainly implemented in an individual form, but small group working is also applied, e.g. in the form of pair therapy and therapeutic vaulting. In Europe, this form of rehabilitation has been divided into hippotherapy supporting motor functions and heilpedagogical riding therapy functioning in support of upbringing.

  8. Deciding about hormone therapy

    Science.gov (United States)

    ... to continue seeing your doctor for regular checkups. Alternative Names HRT - deciding; Estrogen replacement therapy - deciding; ERT- deciding; Hormone replacement therapy - deciding; Menopause - deciding; HT - deciding; Menopausal hormone therapy - deciding; MHT - ...

  9. Brain Stimulation Therapies

    Science.gov (United States)

    ... Magnetic Seizure Therapy Deep Brain Stimulation Additional Resources Brain Stimulation Therapies Overview Brain stimulation therapies can play ... for a shorter recovery time than ECT Deep Brain Stimulation Deep brain stimulation (DBS) was first developed ...

  10. Dystonia: Physical Therapy

    Science.gov (United States)

    ... Online Support Frequently Asked Questions Faces of Dystonia Physical Therapy Physical therapy may be an important component of treating dystonia ... everyday tasks, Since dystonia is a neurological disorder, physical therapy does not treat the dystonia directly but rather ...

  11. Laser therapy for cancer

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000905.htm Laser therapy for cancer To use the sharing features on ... Lasers are also used on the skin. How Laser Therapy is Used Laser therapy can be used to: ...

  12. Occupational Therapy (For Parents)

    Science.gov (United States)

    ... Late for the Flu Vaccine? Eating Disorders Arrhythmias Occupational Therapy KidsHealth > For Parents > Occupational Therapy Print A A ... for some kids. continue Kids Who Might Need Occupational Therapy According to the AOTA, kids with these medical ...

  13. Music therapy and depression

    National Research Council Canada - National Science Library

    Van Assche, E; De Backer, J; Vermote, R

    2015-01-01

    .... This is the reason why music therapy is also used to treat depression. To examine the efficacy of music therapy and to report on the results of recent research into the value of music therapy as a treatment for depression...

  14. American Music Therapy Association

    Science.gov (United States)

    American Music Therapy Association Home Contact News Help/FAQ Members Only Login Quick Links Facts About Music Therapy Qualifications ... with AMTA Sponsor AMTA Events Social Networking Support Music Therapy When you shop at AmazonSmile, Amazon will ...

  15. Algorithms for optimizing drug therapy

    Directory of Open Access Journals (Sweden)

    Martin Lene

    2004-07-01

    Full Text Available Abstract Background Drug therapy has become increasingly efficient, with more drugs available for treatment of an ever-growing number of conditions. Yet, drug use is reported to be sub optimal in several aspects, such as dosage, patient's adherence and outcome of therapy. The aim of the current study was to investigate the possibility to optimize drug therapy using computer programs, available on the Internet. Methods One hundred and ten officially endorsed text documents, published between 1996 and 2004, containing guidelines for drug therapy in 246 disorders, were analyzed with regard to information about patient-, disease- and drug-related factors and relationships between these factors. This information was used to construct algorithms for identifying optimum treatment in each of the studied disorders. These algorithms were categorized in order to define as few models as possible that still could accommodate the identified factors and the relationships between them. The resulting program prototypes were implemented in HTML (user interface and JavaScript (program logic. Results Three types of algorithms were sufficient for the intended purpose. The simplest type is a list of factors, each of which implies that the particular patient should or should not receive treatment. This is adequate in situations where only one treatment exists. The second type, a more elaborate model, is required when treatment can by provided using drugs from different pharmacological classes and the selection of drug class is dependent on patient characteristics. An easily implemented set of if-then statements was able to manage the identified information in such instances. The third type was needed in the few situations where the selection and dosage of drugs were depending on the degree to which one or more patient-specific factors were present. In these cases the implementation of an established decision model based on fuzzy sets was required. Computer programs

  16. Evidence Considerations for Mobile Devices in the Occupational Therapy Process

    Directory of Open Access Journals (Sweden)

    Kelly Erickson

    2015-04-01

    Full Text Available Mobile app-based device utilization, including smartphones and handheld tablets, suggests a need to evaluate evidence to guide selection and implementation of these devices in the occupational therapy process. The purpose of the research was to explore the current body of evidence in relation to mobile app-based devices and to identify factors in the use of these devices throughout the occupational therapy process. Following review of available occupational therapy profession guidelines, assistive technology literature, and available mobile device research, practitioners using mobile app-based devices in occupational therapy should consider three areas: client needs, practitioner competence, and device factors. The purpose of this guideline is to identify factors in the selection and use of mobile app-based devices throughout the occupational therapy process based on available evidence. Considerations for mobile device implementation during the occupational therapy process is addressed, including evaluating outcomes needs, matching device with the client, and identifying support needs of the client.

  17. Orchestrating Lean Implementation

    DEFF Research Database (Denmark)

    Riis, Jens Ove; Mikkelsen, Hans; Andersen, Jesper Rank

    2008-01-01

    The notion of Lean Manufacturing is not merely confined to a set of well defined techniques, but represents a broad approach to managing a company. Working with lean entails many aspects, such as production planning and control, production engineering, product development, supply chain......, and organizational issues. To become effective, many functional areas and departments must be involved. At the same time companies are embedded in a dynamic environment. The aim of the paper is to propose a comprehensive approach to better implementation of lean initiatives, based on two empirical studies. The paper...... will discuss how a concerted effort can be staged taking into account the interdependencies among individual improvement initiatives. The notion of orchestration will be introduced, and several means for orchestration will be presented. Critical behavioral issues for lean implementation will be discussed....

  18. Implementation of measurement instruments in physical therapist practice

    NARCIS (Netherlands)

    Anita Stevens

    2010-01-01

    The use of measurement instruments has become a major issue in physical therapy, but their use in daily practice is infrequent. The aims of this case report were to develop and evaluate a plan for the systematic implementation of two measurement instruments frequently recommended in Dutch physical

  19. Perceived barriers to the implementation of Isoniazid preventive ...

    African Journals Online (AJOL)

    Introduction: Isoniazid preventive therapy (IPT) reduces the risk of active TB. IPT is a key public health intervention for the prevention of TB among people living with HIV and has been recommended as part of a comprehensive HIV and AIDS care strategy. However, its implementation has been very slow and has been ...

  20. "Implementation and Social Influence"

    OpenAIRE

    2008-01-01

    This paper incorporates social psychology into implementation theory. Real individuals care not only about their material benefits but also about their social influence in terms of obedience and conformity. Using a continuous time horizon, we demonstrate a method of manipulating the decision-making process, according to which, an uninformed principal utilizes her/his power of social influence to incentivize multiple informed agents to make honest announcements. Following this method, we show ...

  1. Joint Mission Command Implementation

    Science.gov (United States)

    2016-01-22

    1 AIR WAR COLLEGE AIR UNIVERSITY JOINT MISSION COMMAND IMPLEMENTATION by Michael Dane Acord, COL, US Army A Research Report Submitted to...assigned to the Air War College, Air University, Maxwell Air Force Base (AFB), AL. Following the Army Command and General Staff College and School...holds a Bachelor’s Degree in Biology and two Masters Degrees, a Masters in Management from Troy University and a Master of Military Arts and Sciences

  2. Endobronchial ablative therapies.

    Science.gov (United States)

    Seaman, Joseph C; Musani, Ali I

    2013-09-01

    Endobronchial ablative therapies are used to address a variety of malignant and benign airway lesions. By utilizing endobronchial ablative techniques patients with symptomatic airway lesions may receive significant symptom improvement, improved quality of life, and improved life expectancy. Endobronchial ablative therapies include laser, electrocautery, argon plasma coagulation, cryotherapy, brachytherapy, and photodynamic therapy. The choice to use one therapy versus another depends on technical and patient specific factors. This article reviews indications and contraindications for each therapy, discusses details related to each endobronchial ablative therapy, complications of endobronchial ablative therapies, and briefly discusses practical consideration with endobronchial ablative therapies. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Family therapy for schizophrenia: cultural challenges and ...

    African Journals Online (AJOL)

    Family therapy for schizophrenia: cultural challenges and implementation barriers in the South African context. ... Additionally, in adapting models designed for first-world settings, consideration needs to be given to aspects such as language, educational level and accessibility of mental health care facilities. Family ...

  4. Challenges of implementation and implementation research: Learning from an intervention study designed to improve tumor registry reporting

    Directory of Open Access Journals (Sweden)

    Ann Scheck McAlearney

    2016-08-01

    Full Text Available Objectives: Implementation of interventions designed to improve the quality of medical care often proceeds differently from what is planned. Improving existing conceptual models to better understand the sources of these differences can help future projects avoid these pitfalls and achieve desired effectiveness. To inform an adaptation of an existing theoretical model, we examined unanticipated changes that occurred in an intervention designed to improve reporting of adjuvant therapies for breast cancer patients at a large, urban academic medical center. Methods: Guided by the complex innovation implementation conceptual framework, our study team observed and evaluated the implementation of an intervention designed to improve reporting to a tumor registry. Findings were assessed against the conceptual framework to identify boundary conditions and modifications that could improve implementation effectiveness. Results: The intervention successfully increased identification of the managing medical oncologist and treatment reporting. During implementation, however, unexpected external challenges including hospital acquisitions of community practices and practices’ responses to government incentives to purchase electronic medical record systems led to unanticipated changes and associated threats to implementation. We present a revised conceptual model that incorporates the sources of these unanticipated challenges. Conclusion: This report of our experience highlights the importance of monitoring implementation over time and accounting for changes that affect both implementation and measurement of intervention impact. In this article, we use our study to examine the challenges of implementation research in health care, and our experience can help future implementation efforts.

  5. Museum Education and Art Therapy: Exploring an Innovative Partnership

    Science.gov (United States)

    Peacock, Karen

    2012-01-01

    This report describes collaborations between the disciplines of museum education and art therapy, which inspired the implementation of a pilot art therapy program at the Memphis Brooks Museum of Art in Tennessee (USA). Because relatively limited research has been conducted on this trend, the author reviewed museum exhibits and programming, as well…

  6. Occupational Therapy in Preschools: A Synthesis of Current Knowledge

    Science.gov (United States)

    Jasmin, Emmanuelle; Gauthier, Anne; Julien, Marjorie; Hui, Caroline

    2018-01-01

    This paper presents a synthesis of current knowledge about occupational therapy in preschools (for 3-6 year olds) in order to provide a better understanding of this field of practice and to guide the implementation or programming of this service. In the literature, occupational therapy in preschools has been documented mainly in the USA. Results…

  7. Pharmacodynamic Effect of N-Acetylcysteine as Adjunctive Therapy ...

    African Journals Online (AJOL)

    Erah

    erythematosus (SLE) patients in order to implement NAC as adjunctive therapy in SLE population. Methods: Forty mild ... required in this regard. Keywords: Pharmacodynamics, N-Acetylcysteine, Systemic lupus erythematosus, Adjunctive therapy. ..... physical and mental health in women ages 60 to. 103 years. J Lab Clin ...

  8. Pharmacodynamic Effect of N-Acetylcysteine as Adjunctive Therapy ...

    African Journals Online (AJOL)

    Purpose: To evaluate the pharmacodynamic effect of N-acetylcysteine (NAC) in mild systemic lupus erythematosus (SLE) patients in order to implement NAC as adjunctive therapy in SLE population. Methods: Forty mild SLE patients were randomly allocated to receive 1800 mg of NAC with SLE standard therapy or receive ...

  9. Disseminating and Implementing Trauma-focused CBT in community settings.

    Science.gov (United States)

    Cohen, Judith; Mannarino, Anthony P

    2008-10-01

    Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based practice (EBP) for children. TF-CBT is being disseminated and implemented through a variety of strategies, including distance learning/ Internet training, live training + ongoing phone consultation, a learning collaborative model, and mixed models. Each dissemination and implementation model is described, examples are provided of how it has been used to spread the TF-CBT model among community clinicians treating traumatized children, and data regarding its use are presented. Quality and quantity of data from these dissemination/ implementation models varies, but overall they supports the effectiveness of both the TF-CBT model in treating traumatized children and a variety of dissemination and implementation models. More research is needed to learn about optimal strategies for disseminating and implementing EST for traumatized children, and to explore novel methodologies (e.g., including training in EST for traumatized children in graduate programs).

  10. Music therapy for palliative care: A realist review.

    Science.gov (United States)

    McConnell, Tracey; Porter, Sam

    2017-08-01

    Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation. We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works. A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation. Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.

  11. Improved Prescription of Intermittent Preventive Therapy for Malaria ...

    African Journals Online (AJOL)

    Intermittent preventive therapy for malaria in pregnancy (IPTp) is a key recommendation in the National guideline for malaria control in Nigeria. Previous data from this hospital reported a very low implementation of this guideline . Scale up of services and training were thereafter implemented. This study assessed the current ...

  12. Implementing the ICPD's message.

    Science.gov (United States)

    Jain, A

    1995-01-01

    The International Conference on Population and Development held in Cairo in September 1994 recognized the need for reducing unwanted fertility and promoting smaller families within reproductive health services along with improving women's equality in education, health, and economic opportunity. The implementation of the main message would require an ideological transformation both for the population and for the development establishments. The implementation of a broadened population policy must incorporate the reduction of gender disparities as the primary goal. The problem is that the UNFPA has no influence over resources allocated to child health, female education, economic opportunities for women, or empowerment of women. Reproductive health and family planning programs should be integrated within the broader health services; however, reproductive health may not receive the desired high priority. Family planning programs are also expected to solve two problems: to improve individual well-being and to reduce overall fertility. Managers are likely to implement the reproductive health approach if it is a cost-effective way of reducing total fertility. However, no evidence exists to show that treating reproductive tract infections is a cost-effective way of reducing fertility. The primary objective of family planning programs should be empowerment of individuals to achieve their own reproductive goals in a healthful manner. Fertility reduction should be linked to fertility reduction by focusing on unwanted childbirth and to reproductive health services. The redesign of contraceptive services from a reproductive health perspective would deal with the contraindications of each method by developing standards for screening and focusing as well on the diagnosis and treatment of these conditions. The suggested role of the population sector in the tasks of development and family planning lies in promoting the main message to a wider national and international audience

  13. Spatial grammar implementation

    DEFF Research Database (Denmark)

    McKay, Alison; Chase, Scott Curland; Shea, Kristina

    2012-01-01

    fluid, demands conceptual design tools that support designers’ ways of thinking and working, and enhance creativity, for example, by offering design alternatives, difficult or not, possible without the use of such tools. The potential of spatial grammars as a technology to support such design tools has...... been demonstrated through experimental research prototypes since the 1970s. In this paper, we provide a review of recent spatial grammar implementations, which were presented in the Design Computing and Cognition 2010 workshop on which this paper is based, in the light of requirements for conceptual...

  14. GOSIP implementation guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Van Norman, H.J.

    1996-07-01

    GOSIP (Government Open Systems Interconnection Profile) is a subset of ISO`s OSI protocol standards relevant to US Government operations. As a Federal Information Processing Standard (FIPS), GOSIP is required by law for all Federal agencies. Mandatory standards-based communications products are required when purchasing functionality equivalent to what is specified in GOSIP. This unprecedented requirement by the Federal government has caused considerable confusion concerning practical implementation of relatively immature and untested technologies. Many organizations already have substantial investment in one or more proprietary network architectures. This paper examines issues associated with conversion to the GOSIP system.

  15. Mobile Portal Implementation Strategy

    DEFF Research Database (Denmark)

    Gao, Ping; Damsgaard, Jan

    2005-01-01

    Mobile portal plays an important role in mobile commerce market. Current literature focuses on static analysis on the value chain of mobile portals. This article provides a dynamic perspective on mobile portal strategy. Drawing upon network economics, we describe mobile portal implementation...... as a fourphase process. In different phase, a portal provider has various challenges to overcome and adopt diverse strategies, and correspondingly the regulator has different foci. The conceptual framework proposed in this article offers a basis for further analyses on the market dynamics of mobile commerce......, and can be generalized to studying other networked technologies...

  16. Proton beam therapy control system

    Science.gov (United States)

    Baumann, Michael A.; Beloussov, Alexandre V.; Bakir, Julide; Armon, Deganit; Olsen, Howard B.; Salem, Dana

    2010-09-21

    A tiered communications architecture for managing network traffic in a distributed system. Communication between client or control computers and a plurality of hardware devices is administered by agent and monitor devices whose activities are coordinated to reduce the number of open channels or sockets. The communications architecture also improves the transparency and scalability of the distributed system by reducing network mapping dependence. The architecture is desirably implemented in a proton beam therapy system to provide flexible security policies which improve patent safety and facilitate system maintenance and development.

  17. Physical Therapy (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Physical Therapy KidsHealth / For Parents / Physical Therapy Print en español Terapia física Physical Therapy Basics Doctors often recommend physical therapy (PT) for ...

  18. Art Therapy Verses Psychotherapy

    Science.gov (United States)

    Del Giacco, Maureen

    2009-01-01

    The purpose of my paper is to identify the difference between psychotherapy and art therapy. Then to introduce a technique within the field of art therapy that is relevant to neuro-plasticity Del Giacco Neuro Art Therapy. The paper identifies the importance of the amygdala and the hippocampus within the role of art therapy. Supporting…

  19. Known TCP Implementation Problems

    Science.gov (United States)

    Paxson, Vern (Editor); Allman, Mark; Dawson, Scott; Fenner, William; Griner, Jim; Heavens, Ian; Lahey, K.; Semke, J.; Volz, B.

    1999-01-01

    This memo catalogs a number of known TCP implementation problems. The goal in doing so is to improve conditions in the existing Internet by enhancing the quality of current TCP/IP implementations. It is hoped that both performance and correctness issues can be resolved by making implementors aware of the problems and their solutions. In the long term, it is hoped that this will provide a reduction in unnecessary traffic on the network, the rate of connection failures due to protocol errors, and load on network servers due to time spent processing both unsuccessful connections and retransmitted data. This will help to ensure the stability of the global Internet. Each problem is defined as follows: Name of Problem The name associated with the problem. In this memo, the name is given as a subsection heading. Classification one or more problem categories for which the problem is classified: "congestion control", "performance", "reliability", "resource management". Description A definition of the problem, succinct but including necessary background material. Significance A brief summary of the sorts of environments for which the problem is significant.

  20. Iodine neutron capture therapy

    Science.gov (United States)

    Ahmed, Kazi Fariduddin

    A new technique, Iodine Neutron Capture Therapy (INCT) is proposed to treat hyperthyroidism in people. Present thyroid therapies, surgical removal and 131I treatment, result in hypothyroidism and, for 131I, involve protracted treatment times and excessive whole-body radiation doses. The new technique involves using a low energy neutron beam to convert a fraction of the natural iodine stored in the thyroid to radioactive 128I, which has a 24-minute half-life and decays by emitting 2.12-MeV beta particles. The beta particles are absorbed in and damage some thyroid tissue cells and consequently reduce the production and release of thyroid hormones to the blood stream. Treatment times and whole-body radiation doses are thus reduced substantially. This dissertation addresses the first of the several steps needed to obtain medical profession acceptance and regulatory approval to implement this therapy. As with other such programs, initial feasibility is established by performing experiments on suitable small mammals. Laboratory rats were used and their thyroids were exposed to the beta particles coming from small encapsulated amounts of 128I. Masses of 89.0 mg reagent-grade elemental iodine crystals have been activated in the ISU AGN-201 reactor to provide 0.033 mBq of 128I. This activity delivers 0.2 Gy to the thyroid gland of 300-g male rats having fresh thyroid tissue masses of ˜20 mg. Larger iodine masses are used to provide greater doses. The activated iodine is encapsulated to form a thin (0.16 cm 2/mg) patch that is then applied directly to the surgically exposed thyroid of an anesthetized rat. Direct neutron irradiation of a rat's thyroid was not possible due to its small size. Direct in-vivo exposure of the thyroid of the rat to the emitted radiation from 128I is allowed to continue for 2.5 hours (6 half-lives). Pre- and post-exposure blood samples are taken to quantify thyroid hormone levels. The serum T4 concentration is measured by radioimmunoassay at

  1. Implementation: Measuring and Explaining the Fidelity of CSR Implementation

    Science.gov (United States)

    Kurki, Anja; Boyle, Andrea; Aladjem, Daniel K.

    2006-01-01

    Comprehensive school reform (CSR) is only as effective as its implementation. By using data collected for the National Longitudinal Evaluation of Comprehensive School Reform (NLECSR), this article explores the factors that predict CSR model implementation and the ways that CSR model implementation varies. We found little difference in the fidelity…

  2. Multisystemic therapy in Chile: A public sector innovation case study

    Directory of Open Access Journals (Sweden)

    Rodrigo Pantoja

    2015-08-01

    Full Text Available This report describes the process that allowed the implementation of Multisystemic Therapy (MST in Chile. The case can be considered as innovative, due the little experience in the country about the implementation of high quality, evidence-based programs for crime prevention. The description of the process from the perspective of the author may provide useful information for policy makers interested in implementing evidence-based crime prevention practices.

  3. Music therapy in kindergarten

    OpenAIRE

    Šírová, Michaela

    2017-01-01

    This work deals with the subject of music therapy in a special kindergarten for the children with combined disabilities. In the theoretical part it clarifies the concept and principle of music therapy and characterizes the types of disabilities that occur at researched clients. As a research method were used observation and interviews with three music therapists from the institution. KEYWORDS Music therapy, preschool education, special pedagogy, group music therapy,individual music therapy, p...

  4. Cancer in pregnancy: safety and efficacy of systemic therapies.

    Science.gov (United States)

    Boere, Ingrid; Lok, Christianne; Vandenbroucke, Tineke; Amant, Frédéric

    2017-09-01

    Cancer in pregnancy has become increasingly frequent. It has become clear that for specific cancers under well defined circumstances, oncological treatment in pregnancy can be well tolerated and feasible for both mother and fetus. Continued critical assessment of the available literature and registration of cancer in pregnancy cases and outcomes for mother and child are necessary to work toward implementing optimal cancer treatment during pregnancy. Physiologic changes in pregnancy may alter distribution and efficacy of systemic therapy. Data on systemic therapy including, chemotherapy, hormonal therapy, and targeted therapy during pregnancy are available but incomplete. Outcomes of fetuses exposed to chemotherapy in utero are generally reassuring, but new targeted therapies are mostly discouraged in pregnancy. Cancer treatment during pregnancy is possible, depending on type and timing of systemic therapy and treatment modality. Available data are reassuring with a modest increase in complications such as growth restriction and preterm birth. The effect of new targeted therapies is often still unclear and therefore discouraged.

  5. Implementation-Oriented Secure Architectures

    National Research Council Canada - National Science Library

    Conte de Leon, Daniel; Alves-Foss, Jim; Oman, Paul W

    2006-01-01

    .... This framework is composed of an implementation-oriented formalization of a system's architecture, which we call the formal implementation model, along with a method for the construction of a system...

  6. Implementing New Ways of Working

    DEFF Research Database (Denmark)

    Granlien, Maren Sander; Hertzum, Morten

    2009-01-01

    Successful deployment of information technology (IT) involves implementation of new ways of working. Under-recognition of this organizational element of implementation entails considerable risk of not attaining the benefits that motivated deployment, yet knowledge of how to work systematically...

  7. A Pilot Evaluation of an Art Therapy Program for Refugee Youth from Burma

    Science.gov (United States)

    Kowitt, Sarah Dorothy; Emmerling, Dane; Gavarkavich, Diane; Mershon, Claire-Helene; Linton, Kristin; Rubesin, Hillary; Agnew-Brune, Christine; Eng, Eugenia

    2016-01-01

    Art therapy is a promising form of therapy to address mental health concerns for refugee youth. This article describes the development and implementation of a pilot evaluation of an art therapy program for refugee adolescents from Burma currently living in the United States. Evaluation activities were based on the Centers for Disease Control and…

  8. Occupational therapy students' perceptions of occupational therapy.

    Science.gov (United States)

    Turpin, Merrill June; Rodger, Sylvia; Hall, Anna R

    2012-10-01

    An understanding of students' perceptions of occupational therapy on entry is required to recognise how professional socialisation occurs through curriculum. Findings pertain to a qualitative study investigating students' perceptions of occupational therapy upon entry to two occupational therapy programmes in Australia. Students commencing Bachelor of Occupational Therapy and Masters of Occupational Therapy Studies programmes participated in the study (n = 462). A purpose-designed questionnaire was distributed to students in the first lecture of each programme. Preliminary analysis comprised identification of keywords/phrases and coding categories were generated from patterns of keywords. Frequency counts and percentages of keywords/phrases within categories were completed. Students' responses were categorised as 'what' occupational therapists do; 'how' they do it; 'why' they do it; and 'who' they work with. In 'what' occupational therapists do students frequently described 'helping' people. Both undergraduate and graduate entry masters students used the term 'rehabilitation' to describe how occupational therapy is done, with graduate entry students occasionally responding with 'through occupation' and 'modifying the environment'. Students perceived the 'why' of occupational therapy as getting back to 'everyday activities', with some students emphasising returning to 'normal' activities or life. Regarding the 'who' category, students also thought occupational therapists worked with people with an 'injury' or 'disability'. Students entered their occupational therapy programmes with perceptions consistent with the general public's views of occupational therapy. However, graduate entry students exposed to a pre-reading package prior to entry had more advanced occupational therapy concepts than undergraduate students. © 2011 The Authors. Australian Occupational Therapy Journal © 2011 Occupational Therapy Australia.

  9. Environmental Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    1993-03-15

    The purpose of the Environmental Implementation Plan (EIP) is to show the current and future (five years) environmental plans from individual site organizations and divisions, as well as site environmental programs and initiatives which are designed to protect the environment and meet or exceed changing environmental/regulatory requirements. Communicating with site organizations, departments, and committees is essential in making the site`s environmental-planning process work. The EIP gives the site the what, when, how, and why for environmental requirements. Through teamwork and proactive planning, a partnership for environmental excellence is formed to achieve the site vision for SRS to become the recognized model for Environmental Excellence in the Department of Energy`s Nuclear Weapons Complex.

  10. Environmental Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    1993-03-15

    The purpose of the Environmental Implementation Plan (EIP) is to show the current and future (five years) environmental plans from individual site organizations and divisions, as well as site environmental programs and initiatives which are designed to protect the environment and meet or exceed changing environmental/regulatory requirements. Communicating with site organizations, departments, and committees is essential in making the site's environmental-planning process work. The EIP gives the site the what, when, how, and why for environmental requirements. Through teamwork and proactive planning, a partnership for environmental excellence is formed to achieve the site vision for SRS to become the recognized model for Environmental Excellence in the Department of Energy's Nuclear Weapons Complex.

  11. Implementing Software Defined Radio

    CERN Document Server

    Grayver, Eugene

    2013-01-01

    Software Defined Radio makes wireless communications easier, more efficient, and more reliable. This book bridges the gap between academic research and practical implementation. When beginning a project, practicing engineers, technical managers, and graduate students can save countless hours by considering the concepts presented in these pages. The author covers the myriad options and trade-offs available when selecting an appropriate hardware architecture. As demonstrated here, the choice between hardware- and software-centric architecture can mean the difference between meeting an aggressive schedule and bogging down in endless design iterations. Because of the author’s experience overseeing dozens of failed and successful developments, he is able to present many real-life examples. Some of the key concepts covered are: Choosing the right architecture for the market – laboratory, military, or commercial Hardware platforms – FPGAs, GPPs, specialized and hybrid devices Standardization efforts to ens...

  12. Fama Architecture: Implementation Details

    Science.gov (United States)

    Alcolea, A.; Martinez, A.; Laguna, P.; Navarro, J.; Pollan, T.; Vicente, S. J.; Roy, A.

    1987-10-01

    The FAMA (Fine granularity Advanced Multiprocessor Architecture), currently being developed in the Department of Electrical Engineering and Computer Science of the University of Zaragoza, is an SIMD array architecture optimized for computer-vision applications. Because of its high cost-effectiveness, it is a very interesting alternative for industrial systems. Papers describing the processor element of FAMA have been submitted to several conferences; this paper focuses on the rest of components that complete the architecture: controller, I/O interface and software. The controller generates instructions at a 10MHz rate, allowing efficient access to bidimensional data structures. The I/O interface is capable of reordering information for efficient I/O operations. Development tools and modules for classical computer-vision tasks are being worked on in a first stage, the implementation of models based on existing theories on human vision will follow.

  13. Implementing AIDS Education

    Directory of Open Access Journals (Sweden)

    Grace C. Huerta

    1996-08-01

    Full Text Available The world has been challenged by the AIDS epidemic for 15 years. In 1985, the U.S. Department of Health and Human Services, Centers for Disease Control, allocated funds to all state departments of education to assist schools in the development of AIDS education policies and programs. Yet, these policies do not ensure that all students receive effective AIDS education. On September 21, 1991, the Arizona Legislature passed Senate Bill 1396, which requires public schools to annually provide AIDS education in grades K-12. The bill was rescinded in 1995. With prohibitive curriculum guidelines, limited teacher training opportunities and tremendous instructional demands, this educational policy was implemented in disparate forms. By examining the perspectives of the Arizona educators (representing three school districts, this qualitative study reveals how teachers ultimately controlled the delivery and nature of AIDS instruction based upon personal values, views of teacher roles, and their interpretation of the mandate itself.

  14. Implementing Demons and Ratchets

    Directory of Open Access Journals (Sweden)

    Peter M. Orem

    2017-01-01

    Full Text Available Experimental results show that ratchets may be implemented in semiconductor and chemical systems, bypassing the second law and opening up huge gains in energy production. This paper summarizes or describes experiments and results on systems that effect demons and ratchets operating in chemical or electrical domains. One creates temperature differences that can be harvested by a heat engine. A second produces light with only heat input. A third produces harvestable electrical potential directly. These systems share creating particles in one location, destroying them in another and moving them between locations by diffusion (Brownian motion. All absorb ambient heat as they produce other energy forms. None requires an external hot and cold side. The economic and social impacts of these conversions of ambient heat to work are, of course, well-understood and huge. The experimental results beg for serious work on the chance that they are valid.

  15. [Therapy of tic disorders].

    Science.gov (United States)

    Roessner, Veit; Schoenefeld, Katia; Buse, Judith; Wanderer, Sina; Rothenberger, Aribert

    2012-07-01

    Tremendous progress has taken place in the last 8 years since the publication of our review on «Therapy of Tic Disorders» in the Zeitschrift für Kinder- und Jugendpsychiatrie. Several steps in treatment have been specified. For example, consensus-based indications for treatment have been published, and a detailed manual for a so-called habit-reversal training program has been developed and evaluated. In addition, new treatment options such as aripiprazole and deep-brain stimulation have been implemented. Increasing attention is being given to the disabling consequences of the commonly co-occurring psychiatric conditions known as ADHD or OCD. Nevertheless, there is still much to be learned about the treatment of tic disorders; standardized and sufficiently large drug trials in patients with tic disorders fulfilling evidence-based medicine standards are still scarce. The same is true for direct comparisons of different agents as well as of medication versus behavioral treatment. Finally, the question of how to predict the individual course of tics and how best to deal with the problems of waxing and waning of tics in this context still limits evidence base for treatment decisions. Large clinical experience is still a pre-requisite for making optimal decisions for the treatment of individual patients suffering from a tic disorder.

  16. Families and family therapy in Hong Kong.

    Science.gov (United States)

    Tse, Samson; Ng, Roger M K; Tonsing, Kareen N; Ran, Maosheng

    2012-04-01

    Family therapy views humans not as separate entities, but as embedded in a network of relationships, highlighting the reciprocal influences of one's behaviours on one another. This article gives an overview of family demographics and the implementation of family therapy in Hong Kong. We start with a review of the family demographics in Hong Kong and brief notes on families in mainland China. Demographics show that the landscape has changed markedly in the past decade, with more cross-border marriages, an increased divorce rate, and an ageing overall population - all of which could mean that there is increasing demand for professional family therapy interventions. However, only a limited number of professionals are practising the systems-based approach in Hong Kong. Some possible reasons as to why family therapy is not well disseminated and practised are discussed. These reasons include a lack of mental health policy to support family therapy, a lack of systematic family therapy training, and a shortage of skilled professionals. Furthermore, challenges in applying the western model in Chinese culture are also outlined. We conclude that more future research is warranted to investigate how family therapy can be adapted for Chinese families.

  17. [Multi-family group therapy in Germany].

    Science.gov (United States)

    Born, Anja

    2012-01-01

    Multi-family therapy, common group therapy with several families per one index patient, has been gaining popularity recently. This has occasioned an exploratory study of the status of implementation and common factors in all multi-family therapy programs in Germany. In a survey conducted across Germany, all providers of multi-family therapy interventions were requested to give a detailed description of their intervention. Quantitative data were analyzed with descriptive statistics, and verbal data were summarized categorically with qualitative content analysis. Of the 25 intervention programs examined 21 are directed at emotionally disturbed children and young people and their families; mainly with disturbances in social behavior. Over 4,000 families per year are treated in multi-family therapy, and five programs were systematically evaluated. MFT is characterized by systematically oriented group therapy methods. Those surveyed traced the effect of this form of intervention back to activating problems in the group, activating resources, changing perspective, learning models, experiencing self-efficacy, and the therapeutic relationship. Systematic studies of multi-family therapy in evaluations and in random controlled study designs are recommended.

  18. Implementation of a proton pump inhibitor stewardship program.

    Science.gov (United States)

    Davis, Kelly W; Hanners, Rachel E; Lockwood, Sean M

    2017-06-15

    The development and implementation of a proton pump inhibitor (PPI) stewardship program at a single institution are described. Due to the overuse of PPIs and the increasing awareness of the adverse drug events associated with long-term PPI therapy, the pharmacy and internal medicine services of a medical center implemented a PPI stewardship program. All patients admitted to the internal medicine service were evaluated by the PPI stewardship team to determine if they had an appropriate indication for PPI continuation in the hospital as well as after discharge. If patients did not meet specified criteria for continuation of PPI use during hospitalization, PPI therapy was suspended and replaced by as-needed acid suppressive therapy, and the patients received discharge counseling regarding the implemented medication regimen changes. Challenges encountered during program development included establishing appropriate criteria for PPI continuation and determining the best method for discontinuing PPIs in order to reduce the risk of rebound hyperacidity. In an effort to reduce unnecessary PPI use, a PPI stewardship program was developed and implemented to ensure appropriate continuation of PPIs for patients admitted and discharged from an internal medicine service. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  19. Subspace Detectors: Efficient Implementation

    Energy Technology Data Exchange (ETDEWEB)

    Harris, D B; Paik, T

    2006-07-26

    The optimum detector for a known signal in white Gaussian background noise is the matched filter, also known as a correlation detector [Van Trees, 1968]. Correlation detectors offer exquisite sensitivity (high probability of detection at a fixed false alarm rate), but require perfect knowledge of the signal. The sensitivity of correlation detectors is increased by the availability of multichannel data, something common in seismic applications due to the prevalence of three-component stations and arrays. When the signal is imperfectly known, an extension of the correlation detector, the subspace detector, may be able to capture much of the performance of a matched filter [Harris, 2006]. In order to apply a subspace detector, the signal to be detected must be known to lie in a signal subspace of dimension d {ge} 1, which is defined by a set of d linearly-independent basis waveforms. The basis is constructed to span the range of signals anticipated to be emitted by a source of interest. Correlation detectors operate by computing a running correlation coefficient between a template waveform (the signal to be detected) and the data from a window sliding continuously along a data stream. The template waveform and the continuous data stream may be multichannel, as would be true for a three-component seismic station or an array. In such cases, the appropriate correlation operation computes the individual correlations channel-for-channel and sums the result (Figure 1). Both the waveform matching that occurs when a target signal is present and the cross-channel stacking provide processing gain. For a three-component station processing gain occurs from matching the time-history of the signals and their polarization structure. The projection operation that is at the heart of the subspace detector can be expensive to compute if implemented in a straightforward manner, i.e. with direct-form convolutions. The purpose of this report is to indicate how the projection can be

  20. [Implementing evidence and implementation research: two different and prime realities].

    Science.gov (United States)

    Rumbo Prieto, José María; Martínez Ques, Ángel Alfredo; Sobrido Prieto, María; Raña Lama, Camilo Daniel; Vázquez Campo, Miriam; Braña Marcos, Beatriz

    Scientific research can contribute to more efficient health care, enhance care quality and safety of persons. In order for this to happen, the knowledge gained must be put into practice. Implementation is known as the introduction of a change or innovation to daily practice, which requires effective communication and the elimination of barriers that hinder this process. Best practice implementation experiences are being used increasingly in the field of nursing. The difficulty in identifying the factors that indicate the success or failure of implementation has led to increased studies to build a body of differentiated knowledge, recognized as implementation science or implementation research. Implementation research is the scientific study whose objective is the adoption and systematic incorporation of research findings into clinical practice to improve the quality and efficiency of health services. The purpose of implementation research is to improve the health of the population through equitable and effective implementation of rigorously evaluated scientific knowledge, which involves gathering the evidence that has a positive impact on the health of the community. In this text, we set out the characteristics of nursing implementation research, providing a synthesis of different methods, theories, key frameworks and implementation strategies, along with the terminology proposed for greater conceptual clarity. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  1. Factors Affecting Poor Strategy Implementation

    Directory of Open Access Journals (Sweden)

    Muh. Darmin Ahmad Pella

    2013-06-01

    Full Text Available Research on strategy implementation has been developed for three decades, yet only a few studies focus on factors affecting poor strategy implementation. This research evaluates the influence of strategy implementation problems on strategy implementation success and firm performance. This survey was conducted in 60 Indonesian companies and the data were statistically analysed using Structural Equation Modeling Partial Least Square (SEM PLS. The results show significant influence of strategy implementation problems on the degree of successful strategy implementation and perceived firm performance. The seven major obstacles that have impact on poor strategy implementation are: problems related to corporate scorecard, key performance indicators, information technology, competence, performance appraisal, strategy management office, and financial support.

  2. Music Therapy and Music Therapy Research. Response

    DEFF Research Database (Denmark)

    Pedersen, Inge Nygaard

    2002-01-01

    This response to Keynote by Prof. Even Ruud (N)"Music Education and Music Therapy seeks to define these two areas with specific focus on tools and methods for analysis of music as these methods are developed in music therapy. This includes that the music therapist, the music and the client create...

  3. Environmental Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    The Environmental Implementation Plan (EIP) is a dynamic long-range environmental-protection plan for SRS. The EIP communicates the current and future (five year) environmental plans from individual organizations and divisions as well as site environmental initiatives which are designed to protect the environment and meet or exceed compliance with changing environmental/ regulatory requirements. Communication with all site organizations is essential for making the site environmental planning process work. Demonstrating environmental excellence is a high priority embodied in DOE and WSRC policy. Because of your support and participation in the three EIP initiatives; Reflections, Sectional Revision, and Integrated Planning, improvements are being made to the EIP and SRS environmental protection programs. I appreciate the ``Partnership in Environmental Excellence`` formed by the environmental coordinators and professionals who work daily toward our goal of compliance and environmental excellence. I look forward to seeing continued success and improvement in our environmental protection programs through combined efforts of all site organizations to protect our employees, the public health, and the environment. Together, we will achieve our site vision for SRS to be the recognized model for Environmental Excellence in the DOE Nuclear Weapons Complex.

  4. Implementing Target Value Design.

    Science.gov (United States)

    Alves, Thais da C L; Lichtig, Will; Rybkowski, Zofia K

    2017-04-01

    An alternative to the traditional way of designing projects is the process of target value design (TVD), which takes different departure points to start the design process. The TVD process starts with the client defining an allowable cost that needs to be met by the design and construction teams. An expected cost in the TVD process is defined through multiple interactions between multiple stakeholders who define wishes and others who define ways of achieving these wishes. Finally, a target cost is defined based on the expected profit the design and construction teams are expecting to make. TVD follows a series of continuous improvement efforts aimed at reaching the desired goals for the project and its associated target value cost. The process takes advantage of rapid cycles of suggestions, analyses, and implementation that starts with the definition of value for the client. In the traditional design process, the goal is to identify user preferences and find solutions that meet the needs of the client's expressed preferences. In the lean design process, the goal is to educate users about their values and advocate for a better facility over the long run; this way owners can help contractors and designers to identify better solutions. This article aims to inform the healthcare community about tools and techniques commonly used during the TVD process and how they can be used to educate and support project participants in developing better solutions to meet their needs now as well as in the future.

  5. Calibration and intercomparison methods of dose calibrators used in nuclear medicine facilities; Metodos de calibracao e de intercomparacao de calibradores de dose utilizados em servicos de medicina nuclear

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Alessandro Martins da

    1999-07-01

    Dose calibrators are used in most of the nuclear medicine facilities to determine the amount of radioactivity administered to a patient in a particular investigation or therapeutic procedure. It is therefore of vital importance that the equipment used presents good performance and is regular;y calibrated at a authorized laboratory. This occurs of adequate quality assurance procedures are carried out. Such quality control tests should be performed daily, other biannually or yearly, testing, for example, its accuracy and precision, the reproducibility and response linearity. In this work a commercial dose calibrator was calibrated with solution of radionuclides used in nuclear medicine. Simple instrument tests, such as response linearity and the response variation of the source volume increase at a constant source activity concentration, were performed. This instrument can now be used as a working standard for calibration of other dose calibrators/ An intercomparison procedure was proposed as a method of quality control of dose calibrators used in nuclear medicine facilities. (author)

  6. Aroma therapy and medfly SIT

    Energy Technology Data Exchange (ETDEWEB)

    Shelly, Todd E., E-mail: todd.e.shelly@aphis.usda.go [U.S. Department of Agriculture (USDA-APHIS), HI (United States). Animal and Plant Health Inspection

    2006-07-01

    A summary of the main findings of the research program on the biological competence of mass-reared, sterile males of the Mediterranean fruit fly (med fly), Ceratitis capitata (Wied.) and the development and implementation of the sterile insect technique (SIT) against this pest is presented. The potential application of aroma therapy to improve the mating success of sterile med fly males is studied. The report assumes a loosely chronological framework as it documents progression along two experimental scales: the number of males simultaneously exposed to ginger root oil, starting with small groups of 25 males and ending with rooms with nearly 200 million males; the experimental arena used to test the effects of aroma therapy, progressing from standard field-cages to large field enclosures to the open field. In addition, brief comments are offered regarding the potential negative effects of GRO exposure, the mechanisms underlying GRO-mediated improvement in male mating success, and the financial costs of GRO aroma therapy. (MAC)

  7. Brief Therapy: Ronny G.

    Science.gov (United States)

    Chandler, Louis A.

    1983-01-01

    Uses a case study to illustrate brief therapy with a parent and presents some implications for the school psychologist. Brief therapy is an active, focused, incisive intervention especially useful with children referred because of emotional adjustment problems. (Author/JAC)

  8. Virtual particle therapy centre

    CERN Multimedia

    2015-01-01

    Particle therapy is an advanced technique of cancer radiation therapy, using protons or other ions to target the cancerous mass. This advanced technique requires a multi-disciplinary team working in a specialised centre. 3D animation: Nymus3D

  9. Adlerian Play Therapy.

    Science.gov (United States)

    Kottman, Terry; Warlick, Jayne

    1990-01-01

    Describes Adlerian method of play therapy. Claims Adlerian therapy represents an integration of the concepts and techniques of individual psychology into a method of using play to help troubled children. (Author/ABL)

  10. Targeted therapies for cancer

    Science.gov (United States)

    ... so they cannot spread. How Does Targeted Therapy Work? Targeted therapy drugs work in a few different ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  11. Genes and Gene Therapy

    Science.gov (United States)

    ... correctly, a child can have a genetic disorder. Gene therapy is an experimental technique that uses genes to ... or prevent disease. The most common form of gene therapy involves inserting a normal gene to replace an ...

  12. Depigmentation therapies in vitiligo

    National Research Council Canada - National Science Library

    Gupta, Divya; Kumari, Rashmi; Thappa, Devinder Mohan

    2012-01-01

    Depigmentation therapy in vitiligo is an option in those with extensive vitiligo who have failed to respond to medical therapy and have obvious cosmetic disfigurement due to intervening patchy pigmented areas...

  13. Immune Therapies for Neuroblastoma

    OpenAIRE

    Navid, Fariba; Armstrong, Michael; Barfield, Raymond C

    2009-01-01

    Neuroblastoma, a solid tumor arising from developing cells of the sympathetic nervous system, is the most common extracranial tumor in children. The prognosis for high-risk neuroblastoma remains poor with conventional treatment, and new approaches are therefore being explored to treat this disease. One such alternative therapy that holds promise is immune therapy. We review here the recent advances in 4 types of immune therapy – cytokine, vaccine, antibody, and cellular therapy – to treat neu...

  14. Implementing the Cairo agenda.

    Science.gov (United States)

    Johnson, B R

    1995-04-08

    If the current rate of contraceptive prevalence holds constant, the global population will double in 43 years, with almost all of the anticipated growth in developing countries. Over the past two decades, understanding has increased of the relationships among population, the environment, and sustainable economic development. This better understanding has led to a focus of attention upon human development and reproductive health, especially women's health and status. By improving people's lives through better education, health, economic opportunities, and the protection of their reproductive rights, it is assumed that people will want and have fewer children. These concepts were widely debated during the 1994 International Conference on Population and Development (ICPD) in Cairo and were eventually embraced by most of the participating delegations. Women's health advocates, physicians, social scientists, family planning managers, and health policymakers have worked hard since the ICPD to bring an high level of global attention and acceptance to the ideals articulated in the final ICPD document. Acceptance represents progress and a certain degree of global consensus on population and development issues, but difficult and costly efforts to realize the goals of the ICPD remain to be implemented. Countries should focus upon the achievable. Salient issues in developing countries will likely be the cost and sustainability of new human development/reproductive health programs, program effectiveness in reducing continued high levels of fertility, and the social and cultural appropriateness of new programs. With regard to this latter concern, most ideals of women's health, adolescent sexuality, empowerment, and rights are decidedly Western. Developing countries, however, are already dealing with a wide range of Western-oriented social, political, and economic reforms. They must now face the concept of empowering women and re-examining their approach to adolescent sexuality

  15. Evaluation of Inter Therapy

    DEFF Research Database (Denmark)

    Pedersen, Inge Nygaard

    2002-01-01

    This article (revised conference lecture from the 10th World Congress of Music Therapy, Oxford July 2002)) emphasizes the evaluation of the training of Inter Therapy for music therapy students at the MA training at Aalborg University. The students take turns in being client and therapist within...

  16. Aquatic Therapy for Children

    Science.gov (United States)

    Kucher, Greta; Moore, Kelsey; Rodia, Rachel; Moser, Christy Szczech

    2015-01-01

    Aquatic therapy has long been highlighted in the literature as a potentially powerful therapeutic intervention. This review will highlight basic definitions of aquatic therapy, review salient research, and identify specific diagnoses that may benefit from aquatic therapy. Online resources, blogs, and books that occupational therapists may find…

  17. Music therapy in the psychosocial rehabilitation of people with epilepsy

    Directory of Open Access Journals (Sweden)

    Abramaviciute Z.

    2012-10-01

    Full Text Available The article presents a pilot study analysing the application of music therapy in the today’s psychosocial rehabilitation of people with epilepsy. The study is based on the analysis of the up-to-date application of music therapy in psychosocial rehabilitation, outcomes of epilepsy and special needs of people with this disorder. The analysis serves as a basis for making the assumption that music therapy is an effective measure addressing psychosocial issues of patients suffering from epilepsy. To achieve the objective set, an on-line survey method was used. A questionnaire was sent to the European Confederation of Music Therapy, the International Fellowship in Music Therapy for Neuro-disability, and several members of the World Federation of Music Therapy. It is difficult to formulate final conclusions about the today’s role of music therapy in the psychosocial rehabilitation of people suffering from epilepsy on the basis of this study as the sample is not representative. The analysis of literature and the results of the survey prove the issue of the role of music therapy in the psychosocial rehabilitation of epileptic people to be complex. The service of music therapy should be integrated into health promotion programmes focused on meeting special needs of people with epilepsy and implemented by an interdisciplinary team. Music therapy is applied specifically and diversely subject to symptoms of the disorder and the therapeutic objectives set. Crystallising the specificity of the application of music therapy in this context requires further research.

  18. Implementing the Exercise Guidelines for Cancer Survivors

    Science.gov (United States)

    Wolin, Kathleen Y.; Schwartz, Anna L.; Matthews, Charles E.; Courneya, Kerry S.; Schmitz, Kathryn H.

    2013-01-01

    In 2009, the American College of Sports Medicine convened an expert roundtable to issue guidelines on exercise for cancer survivors. This multidisciplinary group evaluated the strength of the evidence for the safety and benefits of exercise as a therapeutic intervention for survivors. The panel concluded that exercise is safe and offers myriad benefits for survivors including improvements in physical function, strength, fatigue, quality of life (QOL), and possibly recurrence and survival. Recommendations for situations in which deviations from the US Physical Activity Guidelines for Americans are appropriate were provided. Here, we outline a process for implementing the guidelines in clinical practice, and provide recommendations for how the oncology care provider can interface with the exercise and physical therapy community. PMID:22579268

  19. Proton therapy - Present and future.

    Science.gov (United States)

    Mohan, Radhe; Grosshans, David

    2017-01-15

    evaluation of PSPT and IMPT require special considerations compared to the processes used for photon treatment planning. The differences in techniques arise from the unique physical properties of protons but are also necessary because of the greater vulnerability of protons to uncertainties, especially from inter- and intra-fractional variations in anatomy. These factors must be considered in designing as well as evaluating treatment plans. In addition to anatomy variations, other sources of uncertainty in dose delivered to the patient include the approximations and assumptions of models used for computing dose distributions for planning of treatments. Furthermore, the relative biological effectiveness (RBE) of protons is simplistically assumed to have a constant value of 1.1. In reality, the RBE is variable and a complex function of the energy of protons, dose per fraction, tissue and cell type, end point, etc. These uncertainties, approximations and current technological limitations of proton therapy may limit the achievement of its true potential. Ongoing research is aimed at better understanding the consequences of the various uncertainties on proton therapy and reducing the uncertainties through image-guidance, adaptive radiotherapy, further study of biological properties of protons and the development of novel dose computation and optimization methods. However, residual uncertainties will remain in spite of the best efforts. To increase the resilience of dose distributions in the face of uncertainties and improve our confidence in dose distributions seen on treatment plans, robust optimization techniques are being developed and implemented. We assert that, with such research, proton therapy will be a commonly applied radiotherapy modality for most types of solid cancers in the near future. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Implementing custom graphics in Stata

    OpenAIRE

    Sergiy Radyakin

    2009-01-01

    Stata provides a fairly extensive set of graphs. However sometimes users need to implement custom graphs, which are not yet available. In some cases it is possible to “tweak” a standard graph so that it results in the desired image; in other cases it is not possible. Stata uses complex system of objects implemented as classes and heavily relies on inheritance, polymorphism and overriding to implement its graphics. While standard class programming is well described in the Stata manuals, the pa...

  1. Conduct of operations implementation plan

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, C.K.; Hall, R.L.

    1991-02-20

    This implementation plan describes the process and provides information and schedules that are necessary to implement and comply with the Department of Energy (DOE) Order 5480.19, {open_quotes}Conduct of Operations{close_quotes} (CoOp). This plan applies to all Pinellas Plant operations and personnel. Generally, this Plan discusses how DOE Order 5480.19 will be implemented at the Pinellas Plant.

  2. "Implementation and Preference for Honesty"

    OpenAIRE

    2003-01-01

    We investigate implementation of social choice functions that map states to lotteries, where agents have preferences not only for consequences but also for 'honesty'. We show that in the complete information environments with three or more agents, every social choice function is implementable in Nash equilibrium. This is in contrast with the standard implementation models where agents have preferences only for consequences and no social choice function depending on factors other than agents' ...

  3. Implementing Sustainable Supply Chain Management

    DEFF Research Database (Denmark)

    Schulze, Heike; Bals, Lydia

    2017-01-01

    these in practice is much less understood. Purchasing & Supply Management (PSM) stands out as a function with particular influence on the global supply base. Thus, there is a central connection between SSCM implementation and PSM as a function. While the organizational level has usually been in focus of research......Implementing social and environmental dimensions in global supply chains remains a major challenge in practice. While processes and actions needed to implement sustainable supply chain management (SSCM) have been subject to more research in the last years, the question who implements...

  4. User Participation in Pilot Implementation

    DEFF Research Database (Denmark)

    Torkilsheyggi, Arnvør Martinsdóttir á; Hertzum, Morten

    2014-01-01

    Pilot implementations provide users with real-work experiences of how a system will affect their daily work before the design of the system is finalized. On the basis of a pilot implementation of a system for coordinating the transport of patients by hospital porters, we investigate pilot...... implementation as a method for participatory design. We find that to foster participation and learning about user needs a pilot implementation must create a space for reflecting on use, in addition to the space for using the pilot system. The space for reflection must also exist during the activities preparing...

  5. Does Music Therapy Improve Anxiety and Depression in Alzheimer's Patients?

    Science.gov (United States)

    de la Rubia Ortí, José Enrique; García-Pardo, María Pilar; Iranzo, Carmen Cabañés; Madrigal, José Joaquin Cerón; Castillo, Sandra Sancho; Rochina, Mariano Julián; Gascó, Vicente Javier Prado

    2018-01-01

    To evaluate the effectiveness of the implementation of a short protocol of music therapy as a tool to reduce stress and improve the emotional state in patients with mild Alzheimer's disease. A sample of 25 patients with mild Alzheimer's received therapy based on the application of a music therapy session lasting 60 min. Before and after the therapy, patient saliva was collected to quantify the level of salivary cortisol using the Enzyme-Linked ImmunoSorbent Assay (ELISA) immunoassay technique and a questionnaire was completed to measure anxiety and depression (Hospital Anxiety and Depression Scale). The results show that the application of this therapy lowers the level of stress and decreases significantly depression and anxiety, establishing a linear correlation between the variation of these variables and the variation of cortisol. A short protocol of music therapy can be an alternative medicine to improve emotional variables in Alzheimer patients.

  6. Homework Assignments in Cognitive Behavioral Therapy

    Directory of Open Access Journals (Sweden)

    Cem Soylu

    2015-09-01

    Full Text Available Homeworks have been considered as an important aspect of cognitive behavioral therapy. Generally aimed to get and give information with homework in the initial sessions while it is aimed to transfer into everyday life of the skills and techniques which were taught in therapy session in the further sessions. Activity planning, self-monitoring, cognition and behavior rating scales, and exposure can be shown among commonly used homeworks. Many studies indicated that patients who adapt and regularly doing their homework showed more improvement than patients who don't. In addition, studies indicated that homework is an important factor for the effectiveness of therapy and has a positive impact on the results of treatment. For this reason, it is important that therapists who working with the techniques of cognitive behavioral therapy to know details related to application of homeworks and to application the techniques in right time and in the correct way. Aim of this review is to describe homeworks which are particularly used in the cognitive behavioral therapy frame, explain implementation of the processes and commonly used homeworks types. Also describes factors which influencing compliance against homework, finally examined the effectiveness of homework in the process of cognitive behavioral therapy in this article. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(3.000: 280-288

  7. Music Therapy for Seniors

    OpenAIRE

    SLUNEČKOVÁ, Petra

    2014-01-01

    This bachelor thesis deals with the use of music therapy in the lives of seniors. The target of this thesis is to map the possibilities of using music therapy ways with seniors and to recommend a suitable music therapy resources on the basis of the research and evaluation of obtained dates. The theoretical part describes the term "the music therapy", e.g. concept, definition, types and forms, the development of music therapy, the history, methods and techniques. This age group is defined in t...

  8. Empirically Based Psychosocial Therapies for Schizophrenia: The Disconnection between Science and Practice

    Directory of Open Access Journals (Sweden)

    Glenn D. Shean

    2013-01-01

    Full Text Available Empirically validated psychosocial therapies for individuals diagnosed with schizophrenia were described in the report of the Schizophrenia Patient Outcomes Research Team (PORT, 2009. The PORT team identified eight psychosocial treatments: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. PORT listings of empirically validated psychosocial therapies provide a useful template for the design of effective recovery-oriented mental health care systems. Unfortunately, surveys indicate that PORT listings have not been implemented in clinical settings. Obstacles to the implementation of PORT psychosocial therapy listings and suggestions for changes needed to foster implementation are discussed. Limitations of PORT therapy listings that are based on therapy outcome efficacy studies are discussed, and cross-cultural and course and outcome studies of correlates of recovery are summarized.

  9. [Music therapy and depression].

    Science.gov (United States)

    Van Assche, E; De Backer, J; Vermote, R

    2015-01-01

    Music therapy is a predominantly non-verbal psychotherapy based on music improvisation, embedded in a therapeutic relationship. This is the reason why music therapy is also used to treat depression. To examine the efficacy of music therapy and to report on the results of recent research into the value of music therapy as a treatment for depression. We reviewed the literature on recent research into music therapy and depression, reporting on the methods used and the results achieved, and we assessed the current position of music therapy for depression in the context of evidence-based scientific research. A wide variety of research methods was used to investigate the effects of using music therapy as a psychotherapy. Most studies focused usually on the added value that music therapy brings to the standard form of psychiatric treatment, when administered with or without psychopharmacological support. Music therapy produced particularly significant and favourable results when used to treat patients with depression. Current research into music therapy and depression points to a significant and persistent reduction in patients' symptoms and to improvements in their quality of life. However, further research is needed with regard to the best methods of illustrating the effects of music therapy.

  10. Hendee's radiation therapy physics

    CERN Document Server

    Pawlicki, Todd; Starkschall, George

    2016-01-01

    The publication of this fourth edition, more than ten years on from the publication of Radiation Therapy Physics third edition, provides a comprehensive and valuable update to the educational offerings in this field. Led by a new team of highly esteemed authors, building on Dr Hendee’s tradition, Hendee’s Radiation Therapy Physics offers a succinctly written, fully modernised update. Radiation physics has undergone many changes in the past ten years: intensity-modulated radiation therapy (IMRT) has become a routine method of radiation treatment delivery, digital imaging has replaced film-screen imaging for localization and verification, image-guided radiation therapy (IGRT) is frequently used, in many centers proton therapy has become a viable mode of radiation therapy, new approaches have been introduced to radiation therapy quality assurance and safety that focus more on process analysis rather than specific performance testing, and the explosion in patient-and machine-related data has necessitated an ...

  11. Radiation Therapy: Professions in Radiation Therapy

    Science.gov (United States)

    ... Resources Professions Site Index A-Z Professions in Radiation Therapy Radiation Oncologist Therapeutic Medical Physicist Radiation Therapist Dosimetrist Radiation Oncology Nurse Social Worker Dietitian Radiation Oncologist Radiation oncologists are physicians who oversee the ...

  12. Radon therapy; Radon in der Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Spruck, Kaija [Technische Hochschule Mittelhessen, Giessen (Germany). Inst. fuer Medizinische Physik und Strahlenschutz

    2017-04-01

    Radon therapies are used since more than 100 years in human medicine. Today this method is controversially discussed due to the possible increase of ionizing radiation induced tumor risk. Although the exact mode of biological radiation effect on the cell level is still not known new studies show the efficiency of the radon therapy without side effect for instance for rheumatic/inflammatory or respiratory disorders.

  13. Korttidsbehandling af depressioner. Implementering af gruppebaseret kognitiv adfaerdsterapi

    DEFF Research Database (Denmark)

    Lau, Marianne Engelbrecht; Calmer, Juno Berit; Bramsen, J.

    2008-01-01

    INTRODUCTION: Psychotherapy of depressive conditions is more and more in demand by patients. The effect of individual cognitive behavioral therapy (CBT) on depression is well-documented, and foreign studies indicate that group CBT also works well. There was no Danish manual on group CBT...... with a large Effect Size (ES) on psychiatric/depression symptoms (SCL-90R) and function level (GAF), as well as moderate ES on the degree of hopelessness (BHS). CONCLUSION: The development and clinical implementation of a manual in cognitive behavioral group therapy has resulted in this treatment now being...... of the clinical effect was 10 group courses with a total of 51 consecutively referred patients with a non-psychotic depression requiring treatment. RESULTS: On the basis of clinical experience, the manual has been revised and is now ready for publication. 80% of the patients completed the therapy course...

  14. Will nanotechnology influence targeted cancer therapy?

    Science.gov (United States)

    Grimm, Jan; Scheinberg, David A

    2011-04-01

    The rapid development of techniques that enable synthesis (and manipulation) of matter on the nanometer scale and the development of new nanomaterials will play a large role in disease diagnosis and treatment, specifically in targeted cancer therapy. Targeted nanocarriers are an intriguing means to selectively deliver high concentrations of cytotoxic agents or imaging labels directly to the cancer site. Often, solubility issues and an unfavorable biodistribution can result in a suboptimal response of novel agents even though they are very potent. New nanoparticulate formulations allow simultaneous imaging and therapy ("theranostics"), which can provide a realistic means for the clinical implementation of such otherwise suboptimal formulations. In this review, we did not attempt to provide a complete overview of the rapidly enlarging field of nanotechnology in cancer; rather, we presented properties specific to nanoparticles and examples of their uses, which show their importance for targeted cancer therapy. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. [Animal- assisted therapy in health care facilities].

    Science.gov (United States)

    Jofré M, Leonor

    2005-09-01

    Animal-assisted therapy is a novel interventional program with important benefits in the management of patients with chronic diseases and prolonged hospitalization. The relationship between animals and patients facilitates adaptation to a new, stressing hospital environment, helps in diminishing anxiety, stress, pain and blood pressure and increases mobility and muscular strength. This therapy can be developed by pets themselves or by specially trained animals. Dogs are the most frequently used animals because of their training and sociability skills. Patients and animals participating in these programs require special care in order to avoid transmission of infectious diseases associated with pets, hypersensitivity and accidents during their visits. Implementation of animal - assisted therapy in care centers requires a permanent revision of suggested guidelines and program objectives.

  16. Psychomotoric therapy in patients with dementia

    Directory of Open Access Journals (Sweden)

    Jitka Suchá

    2016-11-01

    Full Text Available Background: Dementia syndrome is a significant psychosocial and public health problem with important societal impact. It is important for us to learn more about methods of dementia management. Objective: To discuss principles and basic measures of psychomotor therapy in patients with dementia as well as the implementation of movement therapy and the lifestyle of patients with dementia. Methods: This research presents experience with psychomotor therapy of patients with dementia from the Centre of Gerontology - a day care unit for patients with dementia. Results: Physical activity is an important component in the management of dementia. Implementation of movement should be based on individual needs of persons with dementia and on their abilities. Individual programs and regular training have been pointed out as important principles in care and implementation of physical activity. Other physical activities could be included in the daily programme as well such as different sports and other movements if appropriate to the status of patients and advancement of the dementia syndrome. Conclusion: Regular structured physical activities should be a regular part of the daily programme in the care of patients with dementia.

  17. Global alignment algorithms implementations | Fatumo ...

    African Journals Online (AJOL)

    In this paper, we implemented the two routes for sequence comparison, that is; the dotplot and Needleman-wunsch algorithm for global sequence alignment. Our algorithms were implemented in python programming language and were tested on Linux platform 1.60GHz, 512 MB of RAM SUSE 9.2 and 10.1 versions.

  18. Implementation Science and School Psychology

    Science.gov (United States)

    Forman, Susan G.; Shapiro, Edward S.; Codding, Robin S.; Gonzales, Jorge E.; Reddy, Linda A.; Rosenfield, Sylvia A.; Sanetti, Lisa M. H.; Stoiber, Karen C.

    2013-01-01

    The APA Division 16 Working Group on Translating Science to Practice contends that implementation science is essential to the process of translating evidence-based interventions (EBIs) into the unique context of the schools, and that increasing attention to implementation will lead to the improvement of school psychological services and school…

  19. LXG Compiler - Design and Implementation

    OpenAIRE

    Vassev, Emil

    2010-01-01

    LXG is a simple Pascal-like language. It is a functional programming language developed for studying compiler design and implementation. The language supports procedure and variable declarations, but no classes. This paper reports the design and implementation of an LXG compiler. Test results are presented as well.

  20. RTI Fidelity of Implementation Rubric

    Science.gov (United States)

    National Center on Response to Intervention, 2014

    2014-01-01

    The Response to Intervention (RTI) Fidelity Rubric is for use by individuals who are responsible for monitoring school-level fidelity of RTI implementation. The rubric is aligned with the essential components of RTI and the infrastructure that is necessary for successful implementation. It is accompanied by a worksheet with guiding questions and…

  1. COMPARATIVE ANALYSIS AND IMPLEMENTATION OF ...

    African Journals Online (AJOL)

    TransRoute: a web-based vehicle route planning application is proposed in this paper. This application leverages existing input-output (I/O) efficient implementations of shortest path algorithms (SPAs) to implement the proposed system that will fundamentally address the problems experienced in moving people, goods and ...

  2. Guiding healthcare technology implementation: a new integrated technology implementation model.

    Science.gov (United States)

    Schoville, Rhonda R; Titler, Marita G

    2015-03-01

    Healthcare technology is used to improve delivery of safe patient care by providing tools for early diagnosis, ongoing monitoring, and treatment of patients. This technology includes bedside physiologic monitors, pulse oximetry devices, electrocardiogram machines, bedside telemetry, infusion pumps, ventilators, and electronic health records. Healthcare costs are a challenge for society, and hospitals are pushed to lower costs by discharging patients sooner. Healthcare technology is being used to facilitate these early discharges. There is little understanding of how healthcare facilities purchase, implement, and adopt technology. There are two areas of theories and models currently used when investigating technology: technology adoption and implementation science. Technology adoption focuses mainly on how the end users adopt technology, whereas implementation science describes methods, interventions, and variables that promote the use of evidence-based practice. These two approaches are not well informed by each other. In addition, amplifying the knowledge gap is the limited conceptualization of healthcare technology implementation frameworks. To bridge this gap, an all-encompassing model is needed. To understand the key technology implementation factors utilized by leading healthcare facilities, the prevailing technology adoption and implementation science theories and models were reviewed. From this review, an integrated technology implementation model will be set forth.

  3. Animal-Assisted Therapy in Pediatric Palliative Care.

    Science.gov (United States)

    Gilmer, Mary Jo; Baudino, Marissa N; Tielsch Goddard, Anna; Vickers, Donna C; Akard, Terrah Foster

    2016-09-01

    Animal-assisted therapy is an emerging complementary strategy with an increasing presence in the literature. Limited studies have been conducted with children, particularly those with life-threatening and life-limiting conditions. Although outcomes show promise in decreasing suffering of children receiving palliative care services, more work is needed to validate evidence to support implementation of animal-assisted therapy with this vulnerable population. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. [Evaluation of the animal-assisted therapy in Alzheimer's disease].

    Science.gov (United States)

    Quibel, Clémence; Bonin, Marie; Bonnet, Magalie; Gaimard, Maryse; Mourey, France; Moesch, Isabelle; Ancet, Pierre

    Animal-assisted therapy sessions have been set up in a protected unit for patients with a dementia-related syndrome. The aim is to measure the effects of animal-assisted therapy on behavioural disorders in daily life and care. The results obtained provided some interesting areas to explore and recommendations with a view to optimising the implementation of such a system. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. [Physical therapy in osteoarthritis].

    Science.gov (United States)

    Gnjidić, Zoja

    2010-01-01

    Physical therapy has an important role in treating rheumatic diseases; its goal is to reduced pain, swelling and to keep joints mobile. The properly manage osteoarthritis is nonpharmacological and pharmacological modalities. Physical therapy applied as a remedy for osteoarthritis is a part of multimodal therapy. The basis for physical therapy management is determined by the recommendation of the physical therapeutic science and evidence-based medicine. When making a decision about application of different methods of treatment in physical therapy, it is important to correctly diagnose a structural transformation and functional problem. Systematic review of the scientific, evidence-based, international concensus recommendations for the management of the osteoarthritis published between 2000 and 2010 were identified high-quality evidence therapy practice that is efficient and effective in increasing movement capability function, and reduce pain, disability, medical intake and improved physical function for patients with osteoarthritis

  6. Lessons in implementing infection prevention.

    Science.gov (United States)

    Holmes, Alison; Ahmad, Raheelah; Kiernan, Martin

    2016-03-01

    This paper has been developed from a conference presentation given by Professor Alison Holmes at the IPS Learning Labs launch event (2015). In it the implementation of research into clinical practice is discussed with reference to the upcoming Health Foundation Spotlight Report. The difficulties of engaging those in clinical practice are discussed with the importance of involvement of clinical leaders being highlighted. The importance of recognising that implementation science as a social process to bring credibility and legitimacy is also stressed. Following this, the Spotlight Report that is focused on strengthening implementation in the UK is discussed. There remains considerable scope for improvement and the impact of surveillance, targets and fatigue are considered. The tension between top-down and bottom-up approaches to implementation are discussed and a recommendation for a blended approach when implementing measures that are the components of an organisational infection prevention and control strategy is proposed. There also needs to be more scrutiny of the reasons for the failure of research implementation through an examination of the 'soft periphery' that comprises the organisational structure, systems and people that will be responsible for implementing and sustaining an intervention.

  7. Theoretical and practical outline of the Copenhagen PACT narrative-based exercise counselling manual to promote physical activity in post-therapy cancer survivors

    National Research Council Canada - National Science Library

    Midtgaard, Julie

    2013-01-01

    ... & Epston's Narrative Therapy to develop and implement intervention efforts centered on promotion of long-term physical activity behaviour, while at the same time increasing the individual cancer...

  8. Nuclear medicine therapy

    CERN Document Server

    Eary, Janet F

    2013-01-01

    One in three of the 30 million Americans who are hospitalized are diagnosed or treated with nuclear medicine techniques. This text provides a succinct overview and detailed set of procedures and considerations for patient therapy with unsealed radioactivity sources.  Serving as a complete literature reference for therapy with radiopharmaceuticals currently utilized in practice, this source covers the role of the physician in radionuclide therapy, and essential procedures and protocols required by health care personnel.

  9. Electroconvulsive therapy revisited.

    Science.gov (United States)

    Atkinson, S D; Smith, C; Smith, E M; Miller, J M

    1991-05-01

    Electroconvulsive therapy (ECT) remains an extremely valuable tool in the treatment of certain psychiatric disorders. Despite the sensationalism of the past decade, ECT is the treatment of choice in severe depression that is unresponsive to other therapies or in patients who are overtly suicidal. In addition, ECT is particularly valuable in the elderly population, who are at risk for serious complications from the side effects associated with drug therapy. This report describes a case of recurrent depression in which ECT was successfully used.

  10. Hyperbaric Oxygen Therapy

    Science.gov (United States)

    ... ulcers Heart disease Heatstroke Hepatitis Migraine Multiple sclerosis Parkinson's disease Spinal cord injury Sports injury Stroke Hyperbaric oxygen therapy is generally a safe procedure. Complications are rare. ...

  11. [Morita therapy over history].

    Science.gov (United States)

    Usa, Shinichi

    2003-01-01

    At Sansei Hospital in Kyoto we performed Morita Therapy not only for Japanese clients but also foreign clients from several countries, like Germany, Switzerland, U.S.A., China, Korea, India and Indonesia. We could treat those foreign clients using Morita Therapy with good success although they came from various cultural backgrounds. One of the characteristic Approaches of Morita Therapy was that it avoided the conceptualization of self-consciousness and self image as a subjective fiction established by abstract and logical thinking. Secondary Morita Therapy moves clients to deal with activities in real life. These 2 approaches help clients not to be involved in symptom development or fixation mechanisms and break through self-centeredness. At the first stage of Morita Therapy, namely in the bed rest period clients can experience his psychic state as if he were a just born baby. The founder of Gestalt Therapy, Frederick S. Perls experienced by himself Morita Therapy. During bed rest therapy he behaved as if he were a baby. This behavior came out not from conscious abstract and logical thinking but from spontaneous "pre-conscious" state of mind. Morita called this "Jun-na-kokoro" (Pure mind). Morita knew that neurotic symptoms come out from those abstract and logical thinking which could lead to fixation of symptoms so that therapy principle might be the de-centralization of self and the pure mind experience which is found in our daily life and also in daily life of foreign people from various cultural backgrounds.

  12. Photodynamic therapy: an update.

    Science.gov (United States)

    Dima, V F; Vasiliu, V; Dima, S V

    1998-01-01

    Photodynamic therapy (PDT) is a promising local treatment modality based on the selective accumulation of a photosensitizer in malignant tissues and the subsequent irradiation with laser light. Photodynamic therapy of malignant tumors includes biological, photochemical and photophysical processes. These processes involve: (a) absorption of photosensitizing agent; (b) selective retention of the photosensitizer in tumors and (c) irradiation of sensitized tumor by laser radiation. This report provides a review of photosensitizers, photochemistry, subcellular targets, side effects and laser involved in photodynamic therapy. In addition, gradual increase in knowledge related to in vitro and in vivo mechanisms of action of PDT, as well as some clinical applications of photodynamic therapy are presented.

  13. Neutron Therapy Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Neutron Therapy Facility provides a moderate intensity, broad energy spectrum neutron beam that can be used for short term irradiations for radiobiology (cells)...

  14. Medical Art Therapy

    Directory of Open Access Journals (Sweden)

    Birgul Aydin

    2012-03-01

    Full Text Available Art therapy is a form of expressive therapy that uses art materials. Art therapy combines traditional psychotherapeutic theories and techniques with an understanding of the psychological aspects of the creative process, especially the affective properties of the different art materials. Medical art therapy has been defined as the clinical application of art expression and imagery with individuals who are physically ill, experiencing physical trauma or undergoing invasive or aggressive medical procedures such as surgery or chemotherapy and is considered as a form of complementary or integrative medicine. Several studies have shown that patients with physical illness benefit from medical art therapy in different aspects. Unlike other therapies, art therapy can take the patients away from their illness for a while by means of creative activities during sessions, can make them forget the illness or lost abilities. Art therapy leads to re-experiencing normality and personal power even with short creative activity sessions. In this article definition, influence and necessity of medical art therapy are briefly reviewed.

  15. Therapy with radionuclides. Radionuklid-Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Biersack, H.J.; Hotze, A.L. (Bonn Univ. (Germany). Klinik fuer Nuklearmedizin)

    1992-12-01

    Radioiodine therapy of benign and malignant thyroid diseases is a well-established procedure in Nuclear Medicine. However, the therapeutic use of radioisotopes in other diseases is relatively unknown among our refering physicians. The therapeutic effects of intraarticular (rheumatoid arthritis) and intracavitary (pleural and peritoneal carcinosis) applications yields good results. The radiophosphorus therapy in polycythemia vera rubra has always to be considered as an alternative to chemotherapy. The use of analgetics may be reduced by pain therapy of bone metastasis by injection of bone-seeking beta emitters like Rh-186 HEDP. Other procedures like therapeutic application of meta-iodo-benzylguanidine in neuroblastoma and malignant pheochromocytoma resulted in at least remissions of the disease. Radioimmunotherapy needs further evaluation before it can be recommended as a routine procedure. (orig.).

  16. Managing Air Quality - Program Implementation

    Science.gov (United States)

    Describes elements for the set of activities to ensure that control strategies are put into effect and that air quality goals and standards are fulfilled, permitting programs, and additional resources related to implementation under the Clean Air Act.

  17. Neural Networks: Implementations and Applications

    NARCIS (Netherlands)

    Vonk, E.; Veelenturf, L.P.J.; Jain, L.C.

    1996-01-01

    Artificial neural networks, also called neural networks, have been used successfully in many fields including engineering, science and business. This paper presents the implementation of several neural network simulators and their applications in character recognition and other engineering areas

  18. Coral Reef Protection Implementation Plan

    National Research Council Canada - National Science Library

    Lobel, Lisa

    2000-01-01

    This document identify policies and actions to implement the Department of Defense's responsibilities under Executive Order 13089 on Coral Reef Protection, and are a requirement of the interim Task...

  19. IMPLEMENTATION OF MULTISIDED WAN ARCHITECTURE

    OpenAIRE

    Sushil Kumar*, Raman Bhanot, Shaina

    2016-01-01

    This paper proposes a method for implementing of Multisided WAN Architecture in which different colleges were attached with ISP and then create a VLAN for a switch and transfer VLAN to other switches.

  20. Nurses' experiences of guideline implementation

    DEFF Research Database (Denmark)

    Alanen, Seija; Välimäki, Marita; Kaila, Minna

    2009-01-01

    to local circumstances, seems to be crucial for successful implementation. CONCLUSIONS: Clinical guidelines can be promising tools in enhancing evidence-based nursing practice, as nurses see them as practical work tools in patient care and so are willing to adopt them. However, support from management......AIMS: The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines? BACKGROUND: The implementation of clinical guidelines seems...... to be dependent on multiple context-specific factors. This study sets out to explore the experiences of primary care nurses concerning guideline implementation. DESIGN: Qualitative interview. METHODS: Data were generated by four focus group interviews involving nurses working in out-patient services in primary...

  1. Treating Child Disruptive Behavior in High-Risk Families: A Comparative Effectiveness Trial from a Community-Based Implementation

    NARCIS (Netherlands)

    Abrahamse, Mariëlle; Junger, Marianne; van Wouwe, Mirjam A.M.M.; Boer, Frits; Lindauer, Ramon J.L.

    2015-01-01

    Parent management training programs have proven the most effective way to treat child behavior problems. This study reports on an effectiveness trial of a community-based implementation of Parent–Child Interaction Therapy (PCIT) in comparison with the Dutch-developed Family Creative Therapy (FCT).

  2. Implementation of a dosimetric system based on detectors of to AL{sub 2}O{sub 3}:C and its use in radiation therapy; Implementacion de un sistema dosimetrico basdo en detectores de Al{sub 2}O{sub 3}: C y su uso en radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Marquez, P. J. F.; Guzman, C. C. S.; Pico, C. C.; Aymar, A. J. A.

    2013-07-01

    In this work is proposed to implement an alternative dosimetric system, based on OSL technology of crystals of oxide doped aluminum with carbon, to the AL{sub 2}O{sub 3}:C which do not possess the drawbacks of traditional detectors and possess the advantage for re-reading processes, allowing the storage of the detector as a record of delivered adsorbed dose which may be retested if required. (Author)

  3. Auditing Marketing Strategy Implementation Success

    OpenAIRE

    Herhausen, Dennis; Egger, Thomas; Oral, Cansu

    2014-01-01

    What makes a marketing strategy implementation successful and how can managers measure this success? To answer these questions, we developed a two-step audit approach. First, managers should measure the implementation success regarding effectiveness, efficiency, performance outcomes, and strategic embeddedness. Second, they should explore the reasons that have led to success or failure by regarding managerial, leadership, and environmental traps. Doing so will also provide corrective action p...

  4. [Realist evaluation for implementation research].

    Science.gov (United States)

    Dupin, Cécile Marie

    2017-04-01

    The realist approach to evaluation can be useful faced with the complexity of health interventions in populations. Implementation is the process by which these interventions are put into practice. Scientific realism can provide an important contribution to the development of programme theories through implementation research, and help to reveal the distal and proximal mechanisms of programmes aimed at combatting social inequalities in healthcare. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Music therapy in critical care: indications and guidelines for intervention.

    Science.gov (United States)

    Chlan, L; Tracy, M F

    1999-06-01

    Music therapy is an effective intervention for critically ill patients for such purposes as anxiety reduction and stress management. The therapy is readily accepted by patients and is an intervention patients thoroughly enjoy. The MAIT is one resource that nurses caring for critically ill patients can use to implement music therapy in clinical practice. Patients can be given the opportunity to select a musical tape they prefer and to negotiate with the nurse for uninterrupted music-listening periods. Allowing patients control over music selection and providing uninterrupted time for music listening gives the patients an enhanced sense of control in an environment that often controls them.

  6. Gamification in Physical Therapy: More Than Using Games.

    Science.gov (United States)

    Janssen, Joep; Verschuren, Olaf; Renger, Willem Jan; Ermers, Jose; Ketelaar, Marjolijn; van Ee, Raymond

    2017-01-01

    The implementation of computer games in physical therapy is motivated by characteristics such as attractiveness, motivation, and engagement, but these do not guarantee the intended therapeutic effect of the interventions. Yet, these characteristics are important variables in physical therapy interventions because they involve reward-related dopaminergic systems in the brain that are known to facilitate learning through long-term potentiation of neural connections. In this perspective we propose a way to apply game design approaches to therapy development by "designing" therapy sessions in such a way as to trigger physical and cognitive behavioral patterns required for treatment and neurological recovery. We also advocate that improving game knowledge among therapists and improving communication between therapists and game designers may lead to a novel avenue in designing applied games with specific therapeutic input, thereby making gamification in therapy a realistic and promising future that may optimize clinical practice.

  7. Pediatric Music Therapy.

    Science.gov (United States)

    Lathom-Radocy, Wanda B.

    This book on music therapy includes relevant medical, psychological, and developmental information to help service providers, particularly music therapists, and parents to understand children with disabilities. The first two chapters describe the process of assessment and delineation of goals in music therapy that leads to the design of the music…

  8. Boganmeldelse - Music Therapy Research

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    2006-01-01

    . Alligevel følger her en anbefaling af bogen: for musikterapeuter er det en bog, man ikke kommer uden om. Music Therapy Research, på dansk Musikterapiforskning, er en gennemrevideret, ja faktisk nyudgivelse, af bogen Music Therapy Research: Quantitative and Qualitative Perspectives, som udkom i 1995. Også...

  9. Therapy in Motion.

    Science.gov (United States)

    Costonis, Maureen Needham, Ed.

    This book contains a collection of articles on the subject of movement therapy. It can be used as a set of supplementary readings for an academic course in dance therapy or a psychiatric residency program. It includes an exhaustive bibliography on this field for students and practioners in this field. Four principal themes have been selected as a…

  10. [Dance/Movement Therapy.

    Science.gov (United States)

    Fenichel, Emily, Ed.

    1994-01-01

    This newsletter theme issue focuses on dance, play, and movement therapy for infants and toddlers with disabilities. Individual articles are: "Join My Dance: The Unique Movement Style of Each Infant and Toddler Can Invite Communication, Expression and Intervention" (Suzi Tortora); "Dynamic Play Therapy: An Integrated Expressive Arts Approach to…

  11. History of gene therapy.

    Science.gov (United States)

    Wirth, Thomas; Parker, Nigel; Ylä-Herttuala, Seppo

    2013-08-10

    Two decades after the initial gene therapy trials and more than 1700 approved clinical trials worldwide we not only have gained much new information and knowledge regarding gene therapy in general, but also learned to understand the concern that has persisted in society. Despite the setbacks gene therapy has faced, success stories have increasingly emerged. Examples for these are the positive recommendation for a gene therapy product (Glybera) by the EMA for approval in the European Union and the positive trials for the treatment of ADA deficiency, SCID-X1 and adrenoleukodystrophy. Nevertheless, our knowledge continues to grow and during the course of time more safety data has become available that helps us to develop better gene therapy approaches. Also, with the increased understanding of molecular medicine, we have been able to develop more specific and efficient gene transfer vectors which are now producing clinical results. In this review, we will take a historical view and highlight some of the milestones that had an important impact on the development of gene therapy. We will also discuss briefly the safety and ethical aspects of gene therapy and address some concerns that have been connected with gene therapy as an important therapeutic modality. Copyright © 2013 Elsevier B.V. All rights reserved.

  12. Speech therapy after thyroidectomy.

    Science.gov (United States)

    Yu, Wing-Hei Viola; Wu, Che-Wei

    2017-10-01

    Common complaints of patients who have received thyroidectomy include dysphonia (voice dysfunction) and dysphagia (difficulty swallowing). One cause of these surgical outcomes is recurrent laryngeal nerve paralysis. Many studies have discussed the effectiveness of speech therapy (e.g., voice therapy and dysphagia therapy) for improving dysphonia and dysphagia, but not specifically in patients who have received thyroidectomy. Therefore, the aim of this paper was to discuss issues regarding speech therapy such as voice therapy and dysphagia for patients after thyroidectomy. Another aim was to review the literature on speech therapy for patients with recurrent laryngeal nerve paralysis after thyroidectomy. Databases used for the literature review in this study included, PubMed, MEDLINE, Academic Search Primer, ERIC, CINAHL Plus, and EBSCO. The articles retrieved by database searches were classified and screened for relevance by using EndNote. Of the 936 articles retrieved, 18 discussed "voice assessment and thyroidectomy", 3 discussed "voice therapy and thyroidectomy", and 11 discussed "surgical interventions for voice restoration after thyroidectomy". Only 3 studies discussed topics related to "swallowing function assessment/treatment and thyroidectomy". Although many studies have investigated voice changes and assessment methods in thyroidectomy patients, few recent studies have investigated speech therapy after thyroidectomy. Additionally, some studies have addressed dysphagia after thyroidectomy, but few have discussed assessment and treatment of dysphagia after thyroidectomy.

  13. Narrative Family Therapy.

    Science.gov (United States)

    Walsh, William M.; Keenan, Robert

    1997-01-01

    States that narrative family therapy is informed by social constructionism and postmodern worldviews, and is a relatively significant departure from mainstream psychotherapy. Discusses the use of narrative family therapy. Uses the story of Adam and Eve in the Garden of Eden as an example. (MKA)

  14. Therapy of Lies

    Science.gov (United States)

    Price, Sean

    2012-01-01

    Conversion therapy comes in many forms, ranging from informal chats with counselors to aggressive physical coercion, but all are based on the belief that a gay male or a lesbian can be changed "back" to heterosexual behavior. It is not just alarmed parents who turn to this therapy. Many LGBT individuals seek out such treatment in an effort to…

  15. Art Therapy: A Bibliography.

    Science.gov (United States)

    Gantt, Linda, Comp.; Schmal, Marilyn Strauss, Comp.

    The bibliography on art therapy presents 1175 citations (1940-1973) drawn from searches of the medical indexes, computer systems of the National Library of Medicine and the National Institute of Mental Health, other bibliographies, Centre International de Documentation Concernant les Expressions Plastiques, and the American Journal of Art Therapy.…

  16. Radiation Therapy - Multiple Languages

    Science.gov (United States)

    ... W XYZ List of All Topics All Radiation Therapy - Multiple Languages To use the sharing features on this page, ... Information Translations Vietnamese (Tiếng Việt) Expand Section Radiation Therapy - Tiếng Việt (Vietnamese) ... Health Information Translations Characters not displaying correctly on this page? See language display issues . Return to the MedlinePlus Health Information ...

  17. Social Action Art Therapy

    Science.gov (United States)

    Golub, Deborah

    2005-01-01

    This paper explores intersections among art, action, and community. It describes sociopolitical aspects of the author's art therapy work with survivors of repressive regimes living in Brazil, China, and Denmark and considers ways that unique historical and social processes influenced her conceptualization and practice of social action art therapy.

  18. Effectiveness of a positive psychology intervention combined with cognitive behavioral therapy in university students

    National Research Council Canada - National Science Library

    Rosario Josefa Marrero; Mónica Carballeira; Sabrina Martín; Miriam Mejías

    2016-01-01

      The aim of this study was to design and implement a positive intervention combined with cognitive-behavioral therapy to enhance subjective and psychological well-being and other positive functioning...

  19. Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based?

    NARCIS (Netherlands)

    Oudemans-van Straaten, H. M.; Wester, J. P. J.; de Pont, A. C. J. M.; Schetz, M. R. C.

    2006-01-01

    Critical illness increases the tendency to both coagulation and bleeding, complicating anticoagulation for continuous renal replacement therapy (CRRT). We analyzed strategies for anticoagulation in CRRT concerning implementation, efficacy and safety to provide evidence-based recommendations for

  20. Animal-Assisted Therapy and Occupational Therapy

    Science.gov (United States)

    Andreasen, Gena; Stella, Tiffany; Wilkison, Megan; Szczech Moser, Christy; Hoelzel, Allison; Hendricks, Laura

    2017-01-01

    The use of animals for therapeutic purposes has been documented in the literature for centuries. This review will highlight evidence of the benefits of animal-assisted therapy as well as provide a plethora of resources for therapists interested in learning more about how animals can provide restorative benefits for their clients.

  1. The use of art and music therapy in substance abuse treatment programs.

    Science.gov (United States)

    Aletraris, Lydia; Paino, Maria; Edmond, Mary Bond; Roman, Paul M; Bride, Brian E

    2014-01-01

    Although the implementation of evidence-based practices in the treatment of substance use disorders has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs' use of Motivational Enhancement Therapy was positively related to offering art therapy, whereas use of contingency management was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents.

  2. The Use of Art and Music Therapy in Substance Abuse Treatment Programs

    Science.gov (United States)

    Aletraris, Lydia; Paino, Maria; Edmond, Mary Bond; Roman, Paul M.; Bride, Brian E.

    2014-01-01

    While the implementation of evidence-based practices (EBPs) in the treatment of substance use disorders (SUD) has attracted substantial research attention, little consideration has been given to parallel implementation of complementary and alternative medical (CAM) practices. Using data from a nationally representative sample (N = 299) of U.S. substance abuse treatment programs, this study modeled organizational factors falling in the domains of patient characteristics, treatment ideologies, and structural characteristics, associated with the use of art therapy and music therapy. We found that 36.8% of treatment programs offered art therapy and 14.7% of programs offered music therapy. Programs with a greater proportion of women were more likely to use both therapies, and programs with larger proportions of adolescents were more likely to offer music therapy. In terms of other treatment ideologies, programs’ use of Motivational Enhancement Therapy (MET) was positively related to offering art therapy, while use of Contingency Management (CM) was positively associated with offering music therapy. Finally, our findings showed a significant relationship between requiring 12-step meetings and the use of both art therapy and music therapy. With increasing use of CAM in a diverse range of medical settings, and recent federal legislation likely to reduce barriers in accessing CAM, the inclusion of CAM in addiction treatment is growing in importance. Our findings suggest treatment programs may be utilizing art and music therapies to address unique patient needs of women and adolescents. PMID:25514689

  3. Perceptions of music therapy for older people among healthcare professionals.

    Science.gov (United States)

    Khan, Waqas Ullah; Mohamad Onn Yap, Irin Arina; O'Neill, Desmond; Moss, Hilary

    2016-03-01

    To investigate the perceptions of healthcare providers on music therapy and their recommendations on wider adoption in a hospital setting. A qualitative exploratory study employing short semistructured interviews using a thematic analysis method of data analysis. A qualitative exploratory study, employing short semistructured interviews was conducted in March 2015 in an urban teaching hospital to explore healthcare providers' attitudes towards and recommendations on music therapy. Convenience sampling was used for recruitment of hospital staff from a multidisciplinary geriatric unit. Only staff who had exposure, awareness, or participated in the hospital music therapy programme were asked to partake in an in-depth qualitative interview. Themes emerging reflected a belief among hospital staff that music therapy was of benefit to patients and staff; perceptions of how a hospital music therapy programme should be implemented and a desire for expansion of the music therapy programme throughout the hospital setting. Music therapy is of great importance to patients and healthcare professionals, and thus more attention is warranted to better integrate and advance this programme. This study is important because although numerous studies have examined music therapy from a patient health perspective, no report has analysed the perceptions of healthcare providers on this intervention and their recommendations on further development of music therapy services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Music therapy in dementia

    DEFF Research Database (Denmark)

    McDermott, Orii; Crellin, Nadia; Ridder, Hanne Mette Ochsner

    2013-01-01

    Objective Recent reviews on music therapy for people with dementia have been limited to attempting to evaluate whether it is effective, but there is a need for a critical assessment of the literature to provide insight into the possible mechanisms of actions of music therapy. This systematic review......, five studies investigated hormonal and physiological changes, and five studies focused on social and relational aspects of music therapy. The musical interventions in the studies were diverse, but singing featured as an important medium for change. Conclusions Evidence for short-term improvement...... in mood and reduction in behavioural disturbance was consistent, but there were no high-quality longitudinal studies that demonstrated long-term benefits of music therapy. Future music therapy studies need to define a theoretical model, include better-focused outcome measures, and discuss how the findings...

  5. Music therapy improvisation

    Directory of Open Access Journals (Sweden)

    Mira Kuzma

    2001-09-01

    Full Text Available In this article, the technique of music therapy – music therapy improvisation is introduced. In this form of music therapy the improvising partners share meaning through the improvisation: the improvisation is not an end in itself: it portrays meaning that is personal, complex and can be shared with the partner. The therapeutic work, then, is meeting and matching the client's music in order to give the client an experience of "being known", being responded through sounds and being able to express things and communicate meaningfully. Rather than the client playing music, the therapy is about developing the engagement through sustained, joint improvisations. In music therapy, music and emotion share fundamental features: one may represent the other, i.e., we hear the music not as music but as dynamic emotional states. The concept of dynamic structure explains why music makes therapeutic sense.

  6. [Navigated retinal laser therapy].

    Science.gov (United States)

    Kernt, M; Ulbig, M; Kampik, A; Neubauer, A S

    2013-08-01

    Navigated laser therapy introduces for the first time computerized assistance systems for retinal laser therapy. The Navilas system offers high precision and safety and provides additional benefits regarding standardization of planning, execution, documentation and quality assurance. The current focus of clinical application for navigated laser therapy besides laser treatment after retinal vein occlusion and panretinal laser photocoagulation in proliferative diabetic retinopathy (PDR) is diabetic macular edema. Recent data indicate that combined initial anti-vascular endothelial growth factor (anti-VEGF) and navigated macular laser therapy allows achievement and maintenance of treatment success with a minimum number of interventions. Despite very promising results the current assessment of navigated laser therapy is still limited by the evidence available worldwide.

  7. Pharmacological therapy for amblyopia

    Science.gov (United States)

    Singh, Anupam; Nagpal, Ritu; Mittal, Sanjeev Kumar; Bahuguna, Chirag; Kumar, Prashant

    2017-01-01

    Amblyopia is the most common cause of preventable blindness in children and young adults. Most of the amblyopic visual loss is reversible if detected and treated at appropriate time. It affects 1.0 to 5.0% of the general population. Various treatment modalities have been tried like refractive correction, patching (both full time and part time), penalization and pharmacological therapy. Refractive correction alone improves visual acuity in one third of patients with anisometropic amblyopia. Various drugs have also been tried of which carbidopa & levodopa have been popular. Most of these agents are still in experimental stage, though levodopa-carbidopa combination therapy has been widely studied in human amblyopes with good outcomes. Levodopa therapy may be considered in cases with residual amblyopia, although occlusion therapy remains the initial treatment choice. Regression of effect after stoppage of therapy remains a concern. Further studies are therefore needed to evaluate the full efficacy and side effect profile of these agents. PMID:29018759

  8. Pain in photodynamic therapy

    Directory of Open Access Journals (Sweden)

    Mircea Tampa

    2016-04-01

    Full Text Available Photodynamic therapy is a modern treatment with applications in several medical specialties, which has been intensely studied in the last years. The main indications in dermatology are actinic keratosis, superficial basal cell carcinoma and Bowen's disease- common skin disorders in which photodynamic therapy proved its efficacy. At present, the use of photodynamic therapy for the treatment of other skin disorders is profoundly researched. Pain is the most common and redoubtable adverse effect of photodynamic therapy and it is the most important factor affecting the patient's adherence to treatment. The aim of this article is to look over the most recent medical studies regarding pain in PDT, with emphasis on the factors affecting the occurrence of pain and the most recent strategies for controlling photodynamic therapy- related pain.

  9. Medical therapy in acromegaly.

    LENUS (Irish Health Repository)

    Sherlock, Mark

    2011-05-01

    Acromegaly is a rare disease characterized by excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations. The disease is associated with increased morbidity and premature mortality, but these effects can be reduced if GH levels are decreased to <2.5 μg\\/l and IGF-1 levels are normalized. Therapy for acromegaly is targeted at decreasing GH and IGF-1 levels, ameliorating patients\\' symptoms and decreasing any local compressive effects of the pituitary adenoma. The therapeutic options for acromegaly include surgery, radiotherapy and medical therapies, such as dopamine agonists, somatostatin receptor ligands and the GH receptor antagonist pegvisomant. Medical therapy is currently most widely used as secondary treatment for persistent or recurrent acromegaly following noncurative surgery, although it is increasingly used as primary therapy. This Review provides an overview of current and future pharmacological therapies for patients with acromegaly.

  10. Proton therapy physics

    CERN Document Server

    2012-01-01

    Proton Therapy Physics goes beyond current books on proton therapy to provide an in-depth overview of the physics aspects of this radiation therapy modality, eliminating the need to dig through information scattered in the medical physics literature. After tracing the history of proton therapy, the book summarizes the atomic and nuclear physics background necessary for understanding proton interactions with tissue. It describes the physics of proton accelerators, the parameters of clinical proton beams, and the mechanisms to generate a conformal dose distribution in a patient. The text then covers detector systems and measuring techniques for reference dosimetry, outlines basic quality assurance and commissioning guidelines, and gives examples of Monte Carlo simulations in proton therapy. The book moves on to discussions of treatment planning for single- and multiple-field uniform doses, dose calculation concepts and algorithms, and precision and uncertainties for nonmoving and moving targets. It also exami...

  11. Accelerators for Cancer Therapy

    Science.gov (United States)

    Lennox, Arlene J.

    2000-05-30

    The vast majority of radiation treatments for cancerous tumors are given using electron linacs that provide both electrons and photons at several energies. Design and construction of these linacs are based on mature technology that is rapidly becoming more and more standardized and sophisticated. The use of hadrons such as neutrons, protons, alphas, or carbon, oxygen and neon ions is relatively new. Accelerators for hadron therapy are far from standardized, but the use of hadron therapy as an alternative to conventional radiation has led to significant improvements and refinements in conventional treatment techniques. This paper presents the rationale for radiation therapy, describes the accelerators used in conventional and hadron therapy, and outlines the issues that must still be resolved in the emerging field of hadron therapy.

  12. Immune Therapies for Neuroblastoma

    Science.gov (United States)

    Navid, Fariba; Armstrong, Michael; Barfield, Raymond C.

    2009-01-01

    Neuroblastoma, a solid tumor arising from developing cells of the sympathetic nervous system, is the most common extracranial tumor in children. The prognosis for high-risk neuroblastoma remains poor with conventional treatment, and new approaches are therefore being explored to treat this disease. One such alternative therapy that holds promise is immune therapy. We review here the recent advances in 4 types of immune therapy – cytokine, vaccine, antibody, and cellular therapy – to treat neuroblastoma. We present preclinical research and clinical trials on several promising candidates such as IL-12, dendritic cell vaccines, anti-GD2 antibodies, and allogeneic hematopoietic stem cell transplant. An optimal treatment plan for neuroblastoma will most likely involve multimodal approaches and combinations of immune therapies. PMID:19342881

  13. Systemic Cancer Therapy:

    Directory of Open Access Journals (Sweden)

    Michael Ostario Palumbo

    2013-05-01

    Full Text Available In the last half of the century, advances in the systemic therapy of cancer, including chemotherapy, hormonal therapy, targeted therapy and immunotherapy have been responsible for improvements in cancer related mortality in developed countries even as the population continues to age. Although such advancements have yet to benefit all cancer types, systemic therapies have led to an improvement in overall survival in both the adjuvant and metastatic setting for many cancers. With the pressure to make therapies available as soon as possible, the side-effects of systemic therapies, in particular long-term side-effects are not very well characterized and understood. Increasingly, a number of cancer types are requiring long-term and even lifelong systemic therapy. This is true for both younger and older patients with cancer and has important implications for each subset. Younger patients have an overall greater expected life-span, and as a result may suffer a greater variety of treatment related complications in the long-term, whereas older patients may develop earlier side-effects as a result of their frailty. Because the incidence of cancer in the world will increase over the next several decades and there will be more people living with cancer, it is important to have an understanding of the potential side effects of new systemic therapies. As an introductory article, in this review series, we begin by describing some of the major advances made in systemic cancer therapy along with some of their known side-effects and we also make an attempt to describe the future of systemic cancer therapy.

  14. Physical therapy in a peacekeeping operation: Operation Joint Endeavor/Operation Joint Guard.

    Science.gov (United States)

    Teyhen, D S

    1999-08-01

    This article describes the deployment and utilization of physical therapy services at a combat support hospital during a recent peacekeeping mission in Bosnia. Approximately 17% of all soldiers reporting to the 21st Combat Support Hospital were evaluated and treated by physical therapy. Physical therapy services provided musculoskeletal evaluations, developed field-expedient rehabilitative programs for the deployed soldiers, and provided injury prevention programs for the peace implementation and sustainment forces. Physical therapy helped to provide a high return to duty status and a low rate of air evacuation for deployed troops. The lessons learned from this deployment can help clarify the role of physical therapy in future support operations and sustainment operations.

  15. Supportive therapy for schizophrenia.

    Science.gov (United States)

    Buckley, Lucy A; Maayan, Nicola; Soares-Weiser, Karla; Adams, Clive E

    2015-04-14

    Supportive therapy is often used in everyday clinical care and in evaluative studies of other treatments. To review the effects of supportive therapy compared with standard care, or other treatments in addition to standard care for people with schizophrenia. For this update, we searched the Cochrane Schizophrenia Group's register of trials (November 2012). All randomised trials involving people with schizophrenia and comparing supportive therapy with any other treatment or standard care. We reliably selected studies, quality rated these and extracted data. For dichotomous data, we estimated the risk ratio (RR) using a fixed-effect model with 95% confidence intervals (CIs). Where possible, we undertook intention-to-treat analyses. For continuous data, we estimated the mean difference (MD) fixed-effect with 95% CIs. We estimated heterogeneity (I(2) technique) and publication bias. We used GRADE to rate quality of evidence. Four new trials were added after the 2012 search. The review now includes 24 relevant studies, with 2126 participants. Overall, the evidence was very low quality.We found no significant differences in the primary outcomes of relapse, hospitalisation and general functioning between supportive therapy and standard care.There were, however, significant differences favouring other psychological or psychosocial treatments over supportive therapy. These included hospitalisation rates (4 RCTs, n = 306, RR 1.82 CI 1.11 to 2.99, very low quality of evidence), clinical improvement in mental state (3 RCTs, n = 194, RR 1.27 CI 1.04 to 1.54, very low quality of evidence) and satisfaction of treatment for the recipient of care (1 RCT, n = 45, RR 3.19 CI 1.01 to 10.7, very low quality of evidence). For this comparison, we found no evidence of significant differences for rate of relapse, leaving the study early and quality of life.When we compared supportive therapy to cognitive behavioural therapy CBT), we again found no significant differences in primary

  16. Implementation of intensity modulated radiotherapy for prostate cancer in a private radiotherapy service in Mexico

    Science.gov (United States)

    Poitevin-Chacón, María Adela; Reséndiz González, Gabriel; Alvarado Zermeño, Adriana; Flores Castro, Jesús Manuel; Flores Balcázar, Christian Haydée; Rosales Pérez, Samuel; Pérez Pastenes, Miguel Angel; Rodríguez Laguna, Alejandro; Vázquez Fernández, Patricio; Calvo Fernández, Alejandro; Bastida Ventura, Jorge

    2014-01-01

    Intensity modulated radiation therapy (IMRT) allows physicians to deliver higher conformal doses to the tumour, while avoiding adjacent structures. As a result the probability of tumour control is higher and toxicity may be reduced. However, implementation of IMRT is highly complex and requires a rigorous quality assurance (QA) program both before and during treatment. The present article describes the process of implementing IMRT for localized prostate cancer in a radiation therapy department. In our experience, IMRT implementation requires careful planning due to the need to simultaneously implement specialized software, multifaceted QA programs, and training of the multidisciplinary team. Establishing standardized protocols and ensuring close collaboration between a multidisciplinary team is challenging but essential. PMID:25535587

  17. Implementation of integrated management system

    Energy Technology Data Exchange (ETDEWEB)

    Gaspar Junior, Joao Carlos A.; Fonseca, Victor Zidan da [Industrias Nucleares do Brasil (INB-RJ) Resende, RJ (Brazil)]. E-mail: joaojunior@inb.gov.br; victorfonseca@inb.gov.br

    2007-07-01

    In present day exist quality assurance system, environment, occupational health and safety such as ISO9001, ISO14001 and OHSAS18001 and others standards will can create. These standards can be implemented and certified they guarantee one record system, quality assurance, documents control, operational control, responsibility definition, training, preparing and serve to emergency, monitoring, internal audit, corrective action, continual improvement, prevent of pollution, write procedure, reduce costs, impact assessment, risk assessment , standard, decree, legal requirements of municipal, state, federal and local scope. These procedure and systems when isolate applied cause many management systems and bureaucracy. Integration Management System reduce to bureaucracy, excess of documents, documents storage and conflict documents and easy to others standards implementation in future. The Integrated Management System (IMS) will be implemented in 2007. INB created a management group for implementation, this group decides planing, works, policy and advertisement. Legal requirements were surveyed, internal audits, pre-audits and audits were realized. INB is partially in accordance with ISO14001, OSHAS18001 standards. But very soon, it will be totally in accordance with this norms. Many studies and works were contracted to deal with legal requirements. This work have intention of show implementation process of ISO14001, OHSAS18001 and Integrated Management System on INB. (author)

  18. Medical Physics Challenges for the Implementation of Quality Assurance Programmes in Radiation Oncology.

    Science.gov (United States)

    Meghzifene, A

    2017-02-01

    The importance of quality assurance in radiation therapy, as well as its positive consequences on patient treatment outcome, is well known to radiation therapy professionals. In low- and middle-income countries, the implementation of quality assurance in radiation therapy is especially challenging, due to a lack of staff training, a lack of national guidelines, a lack of quality assurance equipment and high patient daily throughput. According to the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres, the proportion of linear accelerators compared with Co-60 machines has increased significantly in recent years in low- and middle-income countries. However, this increase in the proportion of relatively more demanding technology is not always accompanied with the necessary investment in staff training and quality assurance. The IAEA provides supports to low- and middle-income countries to develop and strengthen quality assurance programmes at institutional and national level. It also provides guidance, through its publications, on quality assurance and supports implementation of comprehensive clinical audits to identify gaps and makes recommendations for quality improvement in radiation therapy. The new AAPM TG100 report suggests a new approach to quality management in radiation therapy. If implemented, it will lead to improved cost-effectiveness of radiation therapy in all income settings. Low- and middle-income countries could greatly benefit from this new approach as it will help direct their scarce resources to areas where they can produce the optimum impact on patient care, without compromising patient safety. Copyright © 2016. Published by Elsevier Ltd.

  19. 75 FR 50880 - TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy

    Science.gov (United States)

    2010-08-18

    ..., Occupational Therapy, and Speech Therapy AGENCY: Office of the Secretary, Department of Defense. ACTION: Final... engage in referrals of beneficiaries to the Military Health System for physical therapy, occupational..., occupational therapy, and speech therapy without having the patient see a physician. This rule will align...

  20. Massage therapy research review.

    Science.gov (United States)

    Field, Tiffany

    2016-08-01

    In this review, massage therapy has been shown to have beneficial effects on varying conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia. Although many of the studies have involved comparisons between massage therapy and standard treatment control groups, several have compared different forms of massage (e.g. Swedish versus Thai massage), and different active therapies such as massage versus exercise. Typically, the massage therapy groups have experienced more positive effects than the control or comparison groups. This may relate to the massage therapy providing more stimulation of pressure receptors, in turn enhancing vagal activity and reducing cortisol levels. Some of the researchers have assessed physical, physiological and biochemical effects, although most have relied exclusively on self-report measures. Despite these methodological problems and the dearth of research from the U.S., the massage therapy profession has grown significantly and massage therapy is increasingly practiced in traditional medical settings, highlighting the need for more rigorous research. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. The Process of Change in Cognitive Therapy for Depression: Predictors of Early Inter-Session Symptom Gains

    OpenAIRE

    Strunk, Daniel R.; Brotman, Melissa A.; DeRubeis, Robert J.

    2010-01-01

    Although Cognitive Therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 Cognitive Therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to Cognitive Therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the ...

  2. Roadmap for Peridynamic Software Implementation

    Energy Technology Data Exchange (ETDEWEB)

    Littlewood, David John [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-10-01

    The application of peridynamics for engineering analysis requires an efficient and robust software implementation. Key elements include processing of the discretization, the proximity search for identification of pairwise interactions, evaluation of the con- stitutive model, application of a bond-damage law, and contact modeling. Additional requirements may arise from the choice of time integration scheme, for example esti- mation of the maximum stable time step for explicit schemes, and construction of the tangent stiffness matrix for many implicit approaches. This report summaries progress to date on the software implementation of the peridynamic theory of solid mechanics. Discussion is focused on parallel implementation of the meshfree discretization scheme of Silling and Askari [33] in three dimensions, although much of the discussion applies to computational peridynamics in general.

  3. Advanced compiler design and implementation

    CERN Document Server

    Muchnick, Steven S

    1997-01-01

    From the Foreword by Susan L. Graham: This book takes on the challenges of contemporary languages and architectures, and prepares the reader for the new compiling problems that will inevitably arise in the future. The definitive book on advanced compiler design This comprehensive, up-to-date work examines advanced issues in the design and implementation of compilers for modern processors. Written for professionals and graduate students, the book guides readers in designing and implementing efficient structures for highly optimizing compilers for real-world languages. Covering advanced issues in fundamental areas of compiler design, this book discusses a wide array of possible code optimizations, determining the relative importance of optimizations, and selecting the most effective methods of implementation. * Lays the foundation for understanding the major issues of advanced compiler design * Treats optimization in-depth * Uses four case studies of commercial compiling suites to illustrate different approache...

  4. Implementing guidelines in nursing homes

    DEFF Research Database (Denmark)

    Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte

    2016-01-01

    BACKGROUND: Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects...... of interventions to improve the implementation of guidelines in nursing homes. METHODS: A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation...... search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted...

  5. Helicobacter pylori: Novel Therapies

    Directory of Open Access Journals (Sweden)

    Eric Drouin

    1999-01-01

    Full Text Available The ideal therapy for Helicobacter pylori would cure the infection without resulting in the development of antibiotic resistance. Current therapies have variable cure rates; the reasons for treatment failure include bacterial resistance and poor compliance. Some antibiotics, such as furazolidone, may be affordable agents to treat this infection worldwide. New proton pump inhibitors, such as rabeprazole, can potentiate antibiotics. Nutriceuticals and probiotics demonstrate interesting in vitro activity against H pylori. Children rarely have symptoms to this infection and, therefore, are a suitable group in which to assess different nonaggressive therapies.

  6. Medical Therapy of Acromegaly

    Directory of Open Access Journals (Sweden)

    U. Plöckinger

    2012-01-01

    Full Text Available This paper outlines the present status of medical therapy of acromegaly. Indications for permanent postoperative treatment, postirradiation treamtent to bridge the interval until remission as well as primary medical therapy are elaborated. Therapeutic efficacy of the different available drugs—somatostatin receptor ligands (SRLs, dopamine agonists, and the GH antagonist Pegvisomant—is discussed, as are the indications for and efficacy of their respective combinations. Information on their mechanism of action, and some pharmakokinetic data are included. Special emphasis is given to the difficulties to define remission criteria of acromegaly due to technical assay problems. An algorithm for medical therapy in acromegaly is provided.

  7. Radiation therapy in horses.

    Science.gov (United States)

    Fidel, Janean L

    2010-04-01

    Although the diagnosis of cancer is relatively uncommon in horses, tumors do occur in this species. Surgery, radiation, and chemotherapy are traditional cancer treatments in all species. In equine patients, surgery has often been the only treatment offered; however, not all tumors can be controlled with surgery alone. In small animal oncology, newer and better therapies are in demand and available. Radiation therapy is often used to control or palliate tumors locally, especially to satisfy clients who demand sophisticated treatments. The large size of equine patients can make radiation therapy difficult, but it is a valuable tool for treating cancer and should not be overlooked when treating horses.

  8. Feminist music therapy pedagogy

    DEFF Research Database (Denmark)

    Hahna, Nicole; Swantes, Melody

    2011-01-01

    This study surveyed 188 music therapy educators regarding their views and use of feminist pedagogy and feminist music therapy. The purpose of this study was two-fold: (a) to determine how many music therapy educators used feminist pedagogy and (b) to determine if there was a relationship between......) participatory learning, (b) validation of personal experience/development of confidence, (c) political/social activism, and (d) critical thinking/ open-mindedness. The results revealed that 46% (n = 32) of participants identified as feminist music therapists and 67% (n = 46) of participants identified as using...

  9. Implementing NetScaler VPX

    CERN Document Server

    Sandbu, Marius

    2014-01-01

    An easy-to-follow guide with detailed step-by step-instructions on how to implement the different key components in NetScaler, with real-world examples and sample scenarios.If you are a Citrix or network administrator who needs to implement NetScaler in your virtual environment to gain an insight on its functionality, this book is ideal for you. A basic understanding of networking and familiarity with some of the different Citrix products such as XenApp or XenDesktop is a prerequisite.

  10. Microsoft Dynamics GP 2013 implementation

    CERN Document Server

    Yudin, Victoria

    2013-01-01

    A step-by-step guide for planning and carrying out your Microsoft Dynamics GP 2013 implementation. Detailed descriptions and illustrations of setup screens and practical examples and advice are included for the Dynamics GP system and core modules.If you are a new or existing Microsoft Dynamics GP consultant or an end user who wants to implement, install, and set up core modules of Dynamics GP 2013, then this book is for you. A basic understanding of business management systems and either Dynamics GP or a similar application is recommended.

  11. CONDITIONS FOR IMPLEMENTING ORGANIZATIONAL CHANGES

    Directory of Open Access Journals (Sweden)

    Renata Winkler

    2015-12-01

    Full Text Available Changes are one of the most typical phenomena experienced by contemporary organizations and are an inherent element of their functioning. The change introduction process is complex and it is often accompanied by a phenomenon of resistance to change on the part of the employees in an organization, which is considered as the main cause of failure in the change implementation process. The purpose of the article is to discuss the basic conditions for implementing changes related both to their adequate defining and overcoming resistance to change.

  12. GPU implementation of JPEG XR

    Science.gov (United States)

    Che, Ming-Chao; Liang, Jie

    2010-01-01

    JPEG XR (formerly Microsoft Windows Media Photo and HD Photo) is the latest image coding standard. By integrating various advanced technologies such as integer hierarchical lapped transform, context adaptive Huffman coding, and high dynamic range coding, it achieves competitive performance to JPEG-2000, but with lower computational complexity and memory requirement. In this paper, the GPU implementation of the JPEG XR codec using NVIDIA CUDA (Compute Unified Device Architecture) technology is investigated. Design considerations to speed up the algorithm are discussed, by taking full advantage of the properties of the CUDA framework and JPEG XR. Experimental results are presented to demonstrate the performance of the GPU implementation.

  13. Implementation of Summon at KAUST

    KAUST Repository

    Buck, Stephen

    2017-03-09

    Web discovery services has evolved tremendously from the time of its introduction to present day. Their technology has enabled library users to obtain a variety of materials in different format and type faster and farther. Coupled with a myriad of features, users are ‘pampered’ with the options to email, download citations, full text articles, book chapters on different devices such as laptops, desktops and mobile devices (among others). In this session, the speaker will highlight KAUST library’s new discovery service (KORAL powered by Summon) launched in June 2016. Topics include the implementation project, its challenges and lessons learnt and the after-implementation initiatives.

  14. Land Use Control Implementation Plan

    Science.gov (United States)

    Starr, Andrew Scott

    2015-01-01

    This Land Use Control Implementation Plan (LUCIP) has been prepared to inform current and potential future users of Building M7-505 of institutional controls that have been implemented at the site. Although there are no current unacceptable risks to human health or the environment associated with Building M7-505, institutional land use controls (LUCs) are necessary to prohibit the use of groundwater from the site. LUCs are also necessary to prevent access to soil under electrical equipment in the northwest portion of the site. Controls necessary to prevent human exposure will include periodic inspection, condition certification, and agency notification.

  15. VLSI implementations for image communications

    CERN Document Server

    Pirsch, P

    1993-01-01

    The past few years have seen a rapid growth in image processing and image communication technologies. New video services and multimedia applications are continuously being designed. Essential for all these applications are image and video compression techniques. The purpose of this book is to report on recent advances in VLSI architectures and their implementation for video signal processing applications with emphasis on video coding for bit rate reduction. Efficient VLSI implementation for video signal processing spans a broad range of disciplines involving algorithms, architectures, circuits

  16. Consent procedures and electroconvulsive therapy in South Africa ...

    African Journals Online (AJOL)

    Electroconvulsive Therapy (ECT) is a controversial treatment modality hence consent procedures for its use are particularly important. The use of ECT is a highly regulated and legislated treatment in most countries, but not in South Africa. Up until the introduction of the MHCA, and its implementation in December of 2004, ...

  17. Therapy Dogs on Campus: Recommendations for Counseling Center Outreach

    Science.gov (United States)

    Daltry, Rachel M.; Mehr, Kristin E.

    2015-01-01

    This article describes the design and implementation of a dog therapy outreach program through the counseling center at West Chester University in Pennsylvania. Two main goals were identified for this program: (a) provide stress relief and comfort to students across campus, and (b) increase potential access to counseling services and improve…

  18. Strengthening Foster Parent-Adolescent Relationships through Filial Therapy

    Science.gov (United States)

    Capps, Jennifer E.

    2012-01-01

    The purpose of this article is to explore the application of filial therapy as a means of strengthening relationships between foster parents and adolescent foster children. Adolescents in foster care experience a number of placement disruptions and while a number of therapeutic interventions are implemented to assist adolescents in foster care,…

  19. Non-adherence to highly active antiretroviral therapy in children ...

    African Journals Online (AJOL)

    Background: Non-adherence reduces the effectiveness of antiretroviral therapy. Knowledge of factors associated with non-adherence would assist clinicians and program planners to design and implement interventions to improve adherence and therefore treatment outcomes. Objective: To determine the prevalence and ...

  20. Improving proton therapy by metal-containing nanoparticles : Nanoscale insights

    NARCIS (Netherlands)

    Schlathölter, Thomas; Eustache, Pierre; Porcel, Erika; Salado, Daniela; Stefancikova, Lenka; Tillement, Olivier; Lux, Francois; Mowat, Pierre; Biegun, Aleksandra; van Goethem, Marc-Jan; Remita, Hynd; Lacombe, Sandrine

    2016-01-01

    The use of nanoparticles to enhance the effect of radiation-based cancer treatments is a growing field of study and recently, even nanoparticle-induced improvement of proton therapy performance has been investigated. Aiming at a clinical implementation of this approach, it is essential to

  1. Effectiveness of Isoniazid Preventive Therapy on Incidence of ...

    African Journals Online (AJOL)

    Background. Tuberculosis is a major cause of death in people living with HIV. Despite available evidence suggesting that. Isoniazid Preventive Therapy (IPT) reduces the incidence of tuberculosis among people living with HIV, its implementation is low. The present study intended to establish whether Isoniazid reduced the ...

  2. Antiretroviral therapy programme on control of HIV transmission in ...

    African Journals Online (AJOL)

    This paper examines the role of antiretroviral therapy (ART) programme on control of HIV transmission in order to assist and inform policy makers to design and implement effective ART programmes.The study used a crosssectional design involving ninety-three people living with HIV and AIDS (PLHIV). Descriptive statistics ...

  3. Effects of Horticulture Therapy on Engagement and Affect

    Science.gov (United States)

    Gigliotti, Christina M.; Jarrott, Shannon E.

    2005-01-01

    Implementing generationally appropriate activities for persons with dementia is a challenging task. Horticulture therapy (HT) addresses this challenge through the use of plants to facilitate holistic outcomes. Utilizing the model of environmental press, the current study sought to analyse adult day service (ADS) participants' responses to HT as…

  4. Isoniazid preventive therapy for tuberculosis in South Africa: An ...

    African Journals Online (AJOL)

    physiological and post-treatment reversions.[21] ... [28] Rationale for the reticence to implement IPT include: that short-term trial efficacy. REVIEW. Isoniazid preventive therapy for tuberculosis in South. Africa: An assessment of the local evidence base .... the post hoc analysis were attributed to a temporary benefit of IPT.

  5. Factors influencing hospital implementation of acute pain management practice guidelines.

    Science.gov (United States)

    Jiang, H J; Lagasse, R S; Ciccone, K; Jakubowski, M S; Kitain, E M

    2001-06-01

    To identify factors that may influence the implementation of acute pain management guidelines in hospital settings. Two questionnaire surveys. Healthcare Association of New York State, Albany, NY. The surveys were administered to 220 hospitals in New York State regarding their acute pain management practices and resources available. One survey was addressed to each hospital's chief executive officer (CEO) and the second survey was addressed to the clinical director of the Department of Anesthesiology or Acute Pain Service. The barriers and incentives to guideline implementation identified by CEOs were analyzed using factor analysis. Logistic regression was employed to determine predictors of guideline implementation by linking the CEOs' survey data with the clinical directors' report of guideline usage. According to clinical directors, only 27% of the responding hospitals were using a published pain management practice guideline. Factors predictive of guideline implementation include resource availability and belief in the benefits of using guidelines to improve quality of care or to achieve economic/legal advantages. Guideline implementation, however, does not necessarily include applying all key elements recommended by the federal Agency for Healthcare Research and Quality (formerly Agency for Health Care Policy and Research) guideline. For example, a collaborative, interdisciplinary approach to pain control was used in only 42% of the hospitals, and underutilization of nonpharmacologic therapies to control pain was widespread. Resource availability, particularly staff with expertise in pain management and existence of a formal quality assurance program to monitor pain management, was significantly predictive of compliance with key guideline elements. Resource availability significantly influences the implementation of pain management practice guidelines in hospital settings. Implementation is often incomplete because various factors affect the feasibility of

  6. Feasibility of a Trial on Improvisational Music Therapy for Children with Autism Spectrum Disorder

    DEFF Research Database (Denmark)

    Geretsegger, Monika; Holck, Ulla; Bieleninik, Łucja

    2016-01-01

    and strategies to facilitate study implementation is available in the music therapy literature. Objective: Using data from a subsample of a multi-center RCT on improvisational music therapy (IMT) for autism spectrum disorder (ASD), this study aims to evaluate feasibility of study procedures, evaluate safety...

  7. The burden of chronic pain after major head and neck tumor therapy

    Directory of Open Access Journals (Sweden)

    Abdullah Sulieman Terkawi

    2017-01-01

    Conclusion: Our study highlighted the high burden of chronic pain after therapy for major head and neck tumors. We identified demographic and clinical factors that are associated with the presence of chronic pain. Further studies are required to better understand the risk factors to implement strategies to prevent, alleviate, and treat chronic pain associated with major head and neck tumor therapies.

  8. [Assessment of the use of music therapy with nursing home residents].

    Science.gov (United States)

    Sanchez, Stéphane; Le Guillou, Adrien; Messaoudi, Yasmine; Letty, Aude; Denormandie, Philippe

    A study analysed, on the one hand, the efficacy of the use of music therapy with residents and, on the other, the feasibility of the implementation of such a technique in nursing homes and in follow-up and rehabilitation units. In this context, music therapy seems to be an effective alternative to traditional approaches. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Process and Outcome Evaluation of an Art Therapy Program for People Living with HIV/AIDS

    Science.gov (United States)

    Feldman, Matthew B.; Betts, Donna J.; Blausey, Daniel

    2014-01-01

    Program evaluation offers an opportunity for improving the implementation and impact of art therapy. This article describes a process and outcomes evaluation of an art therapy program within the mental health services unit of a community-based organization for people living with HIV/AIDS. The aims were to assess utilization patterns and program…

  10. Integrating Therapy Dog Teams in a Physical Activity Program for Children with Autism Spectrum Disorders

    Science.gov (United States)

    Obrusnikova, Iva; Bibik, Janice M.; Cavalier, Albert R.; Manley, Kyle

    2012-01-01

    The use of therapy-dog teams in programs for children with disabilities is becoming increasingly popular in school and therapeutic settings and has been shown to provide physical, social, and emotional benefits for the children. This article describes the basic steps for implementing therapy dog-assisted activities in physical activity programs…

  11. Observation of Classroom Performance Using Therapy Balls as a Substitute for Chairs in Elementary School Children

    Science.gov (United States)

    Burgoyne, Molly E.; Ketcham, Caroline J.

    2015-01-01

    Many classrooms are beginning to substitute standard chairs with therapy balls, which help to improve students' focus and classroom performance, according to teacher and student reports. Researchers conducted an observational study in a classroom at a local elementary school that implemented therapy balls. For each hour-long observation, three…

  12. [Nationwide implementation of stereotactic radiotherapy: the challenges of initial training and continuing professional education].

    Science.gov (United States)

    Bibault, J-E; Denis, F; Marchesi, V; Lisbona, A; Noël, G; Mahé, M A

    2014-10-01

    Stereotactic body radiation therapy is a rapidly growing advanced treatment technique that delivers high radiation dose with great precision. The implementation of stereotactic body radiation therapy should be associated with a specific initial training and continuing professional education for radiation oncologists and medical physicists. The creation of a French stereotactic body radiation therapy group gathering radiation oncologists (SFRO and AFCOR) and medical physicists (SFPM) is mandatory in order to create dedicated national guidelines, prospective databases and to promote clinical trials in this field. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  13. A systematic review of the implementation of recommended psychological interventions for schizophrenia: Rates, barriers, and improvement strategies.

    Science.gov (United States)

    Ince, Paul; Haddock, Gillian; Tai, Sara

    2016-09-01

    A systematic review of the literature exploring if the UK recommendations for psychological interventions for schizophrenia were being met was carried out. Rates of implementation for cognitive behavioural therapy (CBT) and family intervention (FI) were compared. The barriers against implementation and described strategies aimed at improving implementation were reviewed. A literature search of electronic bibliography databases (Psychinfo, Medline, Pubmed, AMED, CINHAL, and EMBASE), reference and citation lists, the Evaluation and Review of NICE Implementation (ERNIE) database, a manual search of Clinical Psychology Forum, governmental reports, charity, and service user group reports was conducted. Twenty-six articles met the inclusion criteria, 11 provided data on implementation rates, 13 explored the barriers to implementation, and 10 gave information about improvement strategies. Rates of implementation varied from 4% to 100% for CBT and 0% to 53% for FI, and studies varied in the methodology used and quality of the articles. Previously reported barriers to implementation were found, with organisational barriers being most commonly followed by barriers met by staff members and service users. Implementation strategies discovered included training packages for CBT, FI, and psychosocial interventions as well as empirical evidence suggesting methods for engagement with service users. Rates of implementation for CBT and FI are still below recommended levels with wide variation of rates found. This suggests inequalities in the provision of psychological interventions for schizophrenia are still present. Previously identified barriers to implementation were confirmed. Attempted implementation strategies have been met with modest success. Inequalities in the provision of psychological therapies for schizophrenia persist. Good quality cognitive behavioural therapy and FI training do not ensure implementation. Collaboration at all levels of healthcare is needed for

  14. Individual stepwise intensification of insulin analogue therapy in type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Aleksandr Sergeevich Ametov

    2012-12-01

    Full Text Available Article reviews basic steps and regimens of insulin analogue therapy intensification in patients with type 2 diabetes mellitus (T2DM. Intensification of insulin therapy is commonly implemented by supplementation of basal insulin with prandial before breakfast, lunch and dinner. Updated EASD/ADA guidelines (August 2012 recommend individual stepwise intensification of T2DM insulin therapy. Application of insulin analogues simplifies diabetes training and patient self-monitoring.

  15. Solution Focused Financial Therapy: A Brief Report of a Pilot Study

    OpenAIRE

    Kristy L. Archuleta; Emily A. Burr; Mary Bell Carlson; Jurdene Ingram; Laura Irwin Kruger; John Grable; Megan Ford

    2015-01-01

    The financial counseling, financial planning, and financial therapy fields are hampered by a conceptual and empirical paucity of clinical and experimental evidence-based research. In an attempt to decrease this gap in the literature, a pilot study was developed to test the implementation of a solution-focused financial therapy client intervention approach, in which solution-focused therapy techniques were applied in a financial counseling setting. This paper reports findings from a clinical i...

  16. Matrimonial therapy as a mean of assistance to the institution of family within modern conditions

    OpenAIRE

    Staniszewska Alisandra

    2017-01-01

    The article discusses the value of matrimonial therapy in the context of domestic conflicts and in prevention of the mass disintegration of marriages. The author describes the basic methods of psychological assistance to spouses and analyzes the core principles of the therapist’s work with married couples. The main task of the work is to underline the value of matrimonial therapy in solving the problems between married couples. The implementation and the spreading of matrimonial therapy may h...

  17. Therapy and Counseling

    Science.gov (United States)

    ... system of rewards and reinforcement of positive behavior.Psychoanalysis. This type of treatment encourages you to think ... work, marriage and family therapy, rehabilitation counseling, and psychoanalysis. Your family doctor can help you choose the ...

  18. Music therapy in pediatrics.

    Science.gov (United States)

    Avers, Laura; Mathur, Ambika; Kamat, Deepak

    2007-09-01

    The soothing effects of music have been well described over the centuries and across cultures. In more recent times, studies have shown the beneficial effects of music in alleviating symptoms in a wide variety of clinical and psychologic conditions. Music therapy has been primarily used as an intervention to control emotional states, in pain management, cognitive processing, and stress management. Stress is associated with increased production of the stress hormone cortisol, which is known to suppress immune responses. Several studies in the past few decades have demonstrated a positive effect of music therapy on reducing stress or increasing immune responses, or both. Music therapy should therefore be considered as a valuable addition to standard pharmacologic therapeutic modalities in enhancing the immune response and lowering stress levels in such conditions. This article reviews the role of music as a therapeutic modality and the future for music therapy, particularly in pediatrics.

  19. Therapy Provider Phase Information

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Therapy Provider Phase Information dataset is a tool for providers to search by their National Provider Identifier (NPI) number to determine their phase for...

  20. Botulinum Toxin Therapy

    Science.gov (United States)

    ... AADA Health System Reform Principles Drug pricing and availability CVS dermatologic formulary restrictions Access to compounded medications ... Botulinum toxin therapy: Overview Also called botulinum rejuvenation Brand names: Botox® Cosmetic, Dysport®, MYOBLOC®, and XEOMIN® When ...