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Sample records for usual care psychotherapeutic

  1. Clinical Research: A Psychotherapeutic Assessment Model for Siblings in Care

    Science.gov (United States)

    Hindle, Debbie

    2007-01-01

    This paper focuses on the aspects of a qualitative research project that examines an assessment protocol for the placement of siblings in foster care and/or future adoption. A brief description of the background to the study and the research design is given. Evaluating the material from the quantitative instruments used and the psychotherapeutic…

  2. Improving Access to Mental Health Care by Delivering Psychotherapeutic Care in the Workplace: A Cross-Sectional Exploratory Trial.

    Directory of Open Access Journals (Sweden)

    Eva Rothermund

    Full Text Available Common mental disorders like mood and anxiety disorders and somatoform disorders have high costs, yet under-treatment is still frequent. Many people with common mental disorders are employed, so the workplace is potentially a suitable context in which to provide early treatment. Our study investigates whether a change of setting (workplace versus standard care improves access to treatment for common mental disorders.Conditional latent profile analysis was applied to identify user profiles for work ability (WAI, clinical symptoms like depression (patient health questionnaire depression, PHQ-9, health-related quality of life (QoL, SF-12, and work-related stress (Maslach Burnout Inventory, irritation scale. Patients were recruited consecutively, via psychotherapeutic consultation in the workplace (n = 174 or psychotherapeutic consultation in outpatient care (n = 193.We identified four user profiles in our model: 'severe' (n = 99, 'moderate I-low QoL' (n = 88, 'moderate II-low work ability' (n = 83, and 'at risk' (n = 97. The 'at risk' profile encompassed individuals with reduced work ability (36.0, 34.73 to 37.37, only mild clinical symptoms (PHQ-9 5.7, 4.92 to 6.53, no signs of work-related stress and good quality of life. A higher proportion of the 'at risk' group than of the 'severe' group sought help via the psychotherapeutic consultation in the workplace (OR 0.287, P < 0.01; this effect remained after controlling for gender.Offering secondary mental health care in the workplace is feasible and accepted by users. Offering treatment in the workplace as an alternative to standard outpatient settings is a viable strategy for improving access to treatment for common mental disorders.

  3. Costs of terminal patients who receive palliative care or usual care in different hospital wards.

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    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2010-11-01

    In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

  4. Telephone versus usual care in management of acute whiplash ...

    African Journals Online (AJOL)

    Whiplash associated disorder (WAD) is a common and costly condition, and recommended management includes advice to “act as usual” and exercise. Providing this treatment through a telephonic intervention may help to improve access to care, and reduce costs. This pilot study assessed: (1) the effectiveness of a ...

  5. The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualised homeopathy, in children requiring secondary care for asthma.

    Science.gov (United States)

    Thompson, E A; Shaw, A; Nichol, J; Hollinghurst, S; Henderson, A J; Thompson, T; Sharp, D

    2011-07-01

    To test the feasibility of a pragmatic trial design with economic evaluation and nested qualitative study, comparing usual care (UC) with UC plus individualised homeopathy, in children requiring secondary care for asthma. This included recruitment and retention, acceptability of outcome measures patients' and health professionals' views and experiences and a power calculation for a definitive trial. In a pragmatic parallel group randomised controlled trial (RCT) design, children on step 2 or above of the British Thoracic Society Asthma Guidelines (BTG) were randomly allocated to UC or UC plus a five visit package of homeopathic care (HC). Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire. Qualitative interviews were used to gain families' and health professionals' views and experiences. 226 children were identified from hospital clinics and related patient databases. 67 showed an interest in participating, 39 children were randomised, 18 to HC and 21 to UC. Evidence in favour of adjunctive homeopathic treatment was lacking. Economic evaluation suggests that the cost of additional consultations was not offset by the reduced cost of homeopathic remedies and the lower use of primary care by children in the homeopathic group. Qualitative data gave insights into the differing perspectives of families and health care professionals within the research process. A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma. Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  6. Parent and child usual source of care and children's receipt of health care services.

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    DeVoe, Jennifer E; Tillotson, Carrie J; Wallace, Lorraine S; Angier, Heather; Carlson, Matthew J; Gold, Rachel

    2011-01-01

    PURPOSE In the United States, children who have a usual source of care (USC) have better access to health care than those who do not, but little is known about how parental USC affects children's access. We examined the association between child and parent USC patterns and children's access to health care services. METHODS We undertook a secondary analysis of nationally representative, cross-sectional data from children participating in the 2002-2007 Medical Expenditure Panel Survey (n = 56,302). We assessed 10 outcome measures: insurance coverage gaps, no doctor visits in the past year, less than yearly dental visits, unmet medical and prescription needs, delayed care, problems getting care, and unmet preventive counseling needs regarding healthy eating, regular exercise, car safety devices, and bicycle helmets. RESULTS Among children, 78.6% had a USC and at least 1 parent with a USC, whereas 12.4% had a USC but no parent USC. Children with a USC but no parent USC had a higher likelihood of several unmet needs, including an insurance coverage gap (adjusted risk ratio [aRR] 1.33; 95% confidence interval [CI], 1.21-1.47), an unmet medical or prescription need (aRR 1.70; 95% CI 1.09-2.65), and no yearly dental visits (aRR 1.12; 95% CI 1.06-1.18), compared with children with a USC whose parent(s) had a USC. CONCLUSIONS Among children with a USC, having no parent USC was associated with a higher likelihood of reporting unmet needs when compared with children whose parent(s) had a USC. Policy reforms should ensure access to a USC for all family members.

  7. Dancing for Parkinson Disease: A Randomized Trial of Irish Set Dancing Compared With Usual Care.

    Science.gov (United States)

    Shanahan, Joanne; Morris, Meg E; Bhriain, Orfhlaith Ni; Volpe, Daniele; Lynch, Tim; Clifford, Amanda M

    2017-09-01

    To examine the feasibility of a randomized controlled study design and to explore the benefits of a set dancing intervention compared with usual care. Randomized controlled design, with participants randomized to Irish set dance classes or a usual care group. Community based. Individuals with idiopathic Parkinson disease (PD) (N=90). The dance group attended a 1.5-hour dancing class each week for 10 weeks and undertook a home dance program for 20 minutes, 3 times per week. The usual care group continued with their usual care and daily activities. The primary outcome was feasibility, determined by recruitment rates, success of randomization and allocation procedures, attrition, adherence, safety, willingness of participants to be randomized, resource availability, and cost. Secondary outcomes were motor function (motor section of the Unified Parkinson's Disease Rating Scale), quality of life (Parkinson's Disease Questionnaire-39), functional endurance (6-min walk test), and balance (mini-BESTest). Ninety participants were randomized (45 per group). There were no adverse effects or resource constraints. Although adherence to the dancing program was 93.5%, there was >40% attrition in each group. Postintervention, the dance group had greater nonsignificant gains in quality of life than the usual care group. There was a meaningful deterioration in endurance in the usual care group. There were no meaningful changes in other outcomes. The exit questionnaire showed participants enjoyed the classes and would like to continue participation. For people with mild to moderately severe PD, set dancing is feasible and enjoyable and may improve quality of life. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Risom, Signe S; Zwisler, Ann-Dorthe; Rasmussen, Trine Bernholdt

    2016-01-01

    ) versus 20.7mL kg(-1) min(-1), p of main effect=0.003, p of interaction between time and intervention=0.020). No significant difference between groups on Short Form-36 was found (53.8 versus 51.9 points, P=.20). Two serious adverse events (atrial fibrillation in relation to physical exercise and death...... unrelated to rehabilitation) occurred in the cardiac rehabilitation group versus one in the usual care group (death unrelated to intervention) (P=.56). In the cardiac rehabilitation group 16 patients versus 7 in the usual care group reported non-serious adverse events (P=.047). CONCLUSION: Comprehensive...

  9. Secondary prevention after minor stroke and TIA - usual care and development of a support program.

    Directory of Open Access Journals (Sweden)

    Stefanie Leistner

    Full Text Available Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program.Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU. Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed.168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP: 155/84 mmHg and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01. LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12. Proportions of patients who stopped smoking were 50 versus 79% (p<0.01. 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09.Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-vascular recurrence rates are going to be assessed in a multicenter randomized trial.

  10. Effects of Structured Versus Usual Care on Renal Endpoint in Type 2 Diabetes: The SURE Study

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    Chan, Juliana C.; So, Wing-Yee; Yeung, Chun-Yip; Ko, Gary T.; Lau, Ip-Tim; Tsang, Man-Wo; Lau, Kam-Piu; Siu, Sing-Chung; Li, June K.; Yeung, Vincent T.; Leung, Wilson Y.; Tong, Peter C.

    2009-01-01

    OBJECTIVE Multifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150–350 μmol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure triglyceride 500 μmol/l or dialysis). RESULTS Of these 205 patients (mean ± SD age 65 ± 7.2 years; disease duration 14 ± 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 ± 12 vs. 71 ± 12 mmHg, respectively, P = 0.02; A1C 7.3 ± 1.3 vs. 8.0 ± 1.6%, P structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained ≥3 treatment goals (61%, n = 63, vs. 28%, n = 28; P < 0.001). Patients who attained ≥3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21–0.86] compared with that of those who attained ≤2 targets (n = 114). CONCLUSIONS Attainment of multiple treatment targets reduced the renal end point and death in type 2 diabetes. In addition to protocol, audits and feedback are needed to improve outcomes. PMID:19460913

  11. Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: study protocol for a randomised controlled feasibility study.

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    Armour, Mike; Smith, Caroline A; Schabrun, Siobhan; Steiner, Genevieve Z; Zhu, Xiaoshu; Lawson, Kenny; Song, Jing

    2018-01-01

    Endometriosis is the most common cause of chronic pelvic pain worldwide. Non-surgical treatments are effective for only 30-50% of women and have a significant side effect burden that leads to high discontinuation rates. Surgery can be effective but is expensive and invasive, and symptoms tend to recur within 5 years. There is early evidence that acupuncture may be effective in treating endometriosis-related chronic pelvic pain, showing clinically significant analgesia. Both levels of inflammation and pain processing have been shown to be altered in women with chronic pelvic pain. Acupuncture has been shown to reduce inflammation and change central pain processing in other conditions, but research on women with endometriosis is currently lacking. The aim of this feasibility study is to provide data on recruitment rates, retention, appropriateness of outcome measures, minimal clinically important difference in numeric rated scales for pain and the potential effect of acupuncture on pain processing and markers of inflammation in endometriosis-related CPP. We will include women aged 18-45 years with a diagnosis of endometriosis via laparoscopy in the past 5 years. A total of 30 participants will be recruited and randomly allocated in a 1:1 ratio to receive acupuncture or usual care. Women in the acupuncture group will receive two 45-min treatment sessions per week for 8 weeks (total of 16 sessions). Women in the usual care group will continue with their current treatment regimen. The primary feasibility outcomes are recruitment rates, retention rates and the safety and acceptability of the intervention; secondary patient-centred outcomes include a change in 0-10 daily pelvic pain ratings, the Endometriosis Health Profile 30 (EHP-30) and changes in conditioned pain modulation, resting and task-related EEG activity and inflammatory markers. Analyses will be performed blind to group allocation. This is a two-armed, assessor blind, randomised controlled feasibility

  12. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema

    DEFF Research Database (Denmark)

    Ibler, K.S.; Jemec, G.B.E.; Thomsen, S.F.

    2012-01-01

    Objective: To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Design: Randomised, observer blinded parallel group superiority clinical trial. Setting: Three hospitals...... in Denmark. Participants: 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Interventions: Education in skin care...

  13. Acupuncture, Counseling, and Usual care for Depression (ACUDep: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    MacPherson Hugh

    2012-11-01

    Full Text Available Abstract Background The evidence on the effect of acupuncture or counseling for depression is not conclusive yet is sufficient to warrant further research. Our aim is to conduct a full-scale RCT to determine the clinical and cost effectiveness of acupuncture and counseling compared to usual care alone. We will explore the experiences and perspectives of patients and practitioners. Methods/Design Randomized controlled trial with three parallel arms: acupuncture plus usual care, counseling plus usual care, and usual care alone, in conjunction with a nested qualitative study using in-depth interviews with purposive samples of trial participants. Participants: Patients aged over 18 years diagnosed with depression or mood disorder by their GP and with a score of 20 or above on the Beck Depression Inventory (BDI-II. Randomization: Computer randomization by York Trials Unit to acupuncture, counseling, and usual care alone in proportions of 2:2:1, respectively, with secure allocation concealment. Interventions: Patients allocated to acupuncture and counseling groups receive the offer of up to 12 weekly sessions. Both interventions allow flexibility to address patient variation, yet are constrained within defined protocols. Acupuncture is based on traditional Chinese medicine and counseling is non-directive within the humanistic tradition. Outcome: The PHQ-9 is the primary outcome measure, collected at baseline, 3, 6, 9, and 12 months. Also measured is BDI-II, SF-36 Bodily pain subscale, and EQ-5D. Texted mood scores are collected weekly over the first 15 weeks. Health-related resource use is collected over 12 months. Analysis: The sample size target was for 640 participants, calculated for an effect size of 0.32 on the PHQ-9 when comparing acupuncture with counseling given 90% power, 5% significance, and 20% loss to follow-up. Analysis of covariance will be used on an intention-to-treat basis. Thematic analysis will be used for qualitative data. We will

  14. Electronic Health Record for Intensive Care based on Usual Windows Based Software.

    Science.gov (United States)

    Reper, Arnaud; Reper, Pascal

    2015-08-01

    In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed an EHR based on usual software and components. The software was designed as a client-server architecture running on the Windows operating system and powered by the access data base system. The client software was developed using Visual Basic interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in September 2004, the EHR was used to care more than five thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of basic functionalities communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on usual software components was able to respond to the medical needs of the local ICU environment. The use of Windows for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

  15. Youth Psychotherapy Change Trajectories and Outcomes in Usual Care: Community Mental Health versus Managed Care Settings

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    Warren, Jared S.; Nelson, Philip L.; Mondragon, Sasha A.; Baldwin, Scott A.; Burlingame, Gary M.

    2010-01-01

    Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome…

  16. PRECISE - pregabalin in addition to usual care for sciatica: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Mathieson, Stephanie; Maher, Christopher G; McLachlan, Andrew J; Latimer, Jane; Koes, Bart W; Hancock, Mark J; Harris, Ian; Day, Richard O; Pik, Justin; Jan, Stephen; Billot, Laurent; Lin, Chung-Wei Christine

    2013-07-11

    Sciatica is a type of neuropathic pain that is characterised by pain radiating into the leg. It is often accompanied by low back pain and neurological deficits in the lower limb. While this condition may cause significant suffering for the individual, the lack of evidence supporting effective treatments for sciatica makes clinical management difficult. Our objectives are to determine the efficacy of pregabalin on reducing leg pain intensity and its cost-effectiveness in patients with sciatica. PRECISE is a prospectively registered, double-blind, randomised placebo-controlled trial of pregabalin compared to placebo, in addition to usual care. Inclusion criteria include moderate to severe leg pain below the knee with evidence of nerve root/spinal nerve involvement. Participants will be randomised to receive either pregabalin with usual care (n = 102) or placebo with usual care (n = 102) for 8 weeks. The medicine dosage will be titrated up to the participant's optimal dose, to a maximum 600 mg per day. Follow up consultations will monitor individual progress, tolerability and adverse events. Usual care, if deemed appropriate by the study doctor, may include a referral for physical or manual therapy and/or prescription of analgesic medication. Participants, doctors and researchers collecting participant data will be blinded to treatment allocation. Participants will be assessed at baseline and at weeks 2, 4, 8, 12, 26 and 52. The primary outcome will determine the efficacy of pregabalin in reducing leg pain intensity. Secondary outcomes will include back pain intensity, disability and quality of life. Data analysis will be blinded and by intention-to-treat. A parallel economic evaluation will be conducted from health sector and societal perspectives. This study will establish the efficacy of pregabalin in reducing leg pain intensity in patients with sciatica and provide important information regarding the effect of pregabalin treatment on disability and quality of life

  17. A medical home versus temporary housing: the importance of a stable usual source of care.

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    DeVoe, Jennifer E; Saultz, John W; Krois, Lisa; Tillotson, Carrie J

    2009-11-01

    Little is known about how the stability of a usual source of care (USC) affects access to care. We examined the prevalence of USC changes among low-income children and how these changes were associated with unmet health care need. We conducted a cross-sectional survey of Oregon's food stamp program in 2005. We analyzed primary data from 2681 surveys and then weighted results to 84087 families, adjusting for oversampling and nonresponse. We then ascertained the percentage of children in the Oregon population who had ever changed a USC for insurance reasons, which characteristics were associated with USC change, and how USC change was associated with unmet need. We also conducted a posthoc analysis of data from the Medical Expenditure Panel Survey to confirm similarities between the Oregon sample and a comparable national sample. Children without a USC in the Oregon population had greater odds of reporting an unmet health care need than those with a USC. This pattern was similar in national estimates. Among the Oregon sample, 23% had changed their USC because of insurance reasons, and 10% had no current USC. Compared with children with a stable USC, children who had changed their USC had greater odds of reporting unmet medical need, unmet prescription need, delayed care, unmet dental need, and unmet counseling need. This study highlights the importance of ensuring stability with a USC. Moving low-income children into new medical homes could disturb existing USC relationships, thereby merely creating "temporary housing."

  18. A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain

    Science.gov (United States)

    Cherkin, Daniel C.; Sherman, Karen J.; Avins, Andrew L.; Erro, Janet H.; Ichikawa, Laura; Barlow, William E.; Delaney, Kristin; Hawkes, Rene; Hamilton, Luisa; Pressman, Alice; Khalsa, Partap S.; Deyo, Richard A.

    2009-01-01

    Background Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. Methods 638 adults with chronic mechanical low back pain were randomized to: individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland Disability score, range: 0 to 23) and symptom bothersomeness (0 to 10 scale). Outcomes were assessed at baseline and after 8, 26 and 52 weeks. Results At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P0.05). Conclusions Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture, or our simulated method of acupuncture, provide physiologically important stimulation or represent placebo or non-specific effects. PMID:19433697

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

    Directory of Open Access Journals (Sweden)

    Laura Kivelitz

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

  20. Supervised progressive cross-continuum strength training compared with usual care in older medical patients

    DEFF Research Database (Denmark)

    Pedersen, Mette Merete; Petersen, Janne; Beyer, Nina

    2016-01-01

    Background: Hospitalization in older adults is characterized by physical inactivity and a risk of losing function and independence. Systematic strength training can improve muscle strength and functional performance in older adults. Few studies have examined the effect of a program initiated during...... hospitalization and continued after discharge. We conducted a feasibility study prior to this trial and found a progression model for loaded sit-to-stands feasible in older medical patients. This study aims to determine whether a simple supervised strength training program for the lower extremities (based...... on the model), combined with post-training protein supplementation initiated during hospitalization and continued at home for 4 weeks, is superior to usual care on change in mobility 4 weeks after discharge in older medical patients. Methods: Eighty older medical patients (65 years or older) acutely admitted...

  1. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi

    2008-01-01

    and lowest remission rates was >/=15% in 10 countries, 5-14% in 7 countries, and definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular......OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5......,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR...

  2. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi

    2008-01-01

    and lowest remission rates was >/=15% in 10 countries, 5-14% in 7 countries, and generally low remission rates [definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular......OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5......,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR...

  3. Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD.

    Science.gov (United States)

    Ong, Stephanie W; Jassal, Sarbjit V; Miller, Judith A; Porter, Eveline C; Cafazzo, Joseph A; Seto, Emily; Thorpe, Kevin E; Logan, Alexander G

    2016-06-06

    Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters. We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. In total, 47 patients (26 men; mean age =59 years old; 33% were ≥65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (>80% performed ≥80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, -3.4 mmHg; 95% confidence interval, -5.0 to -1.8 and diastolic BP, -2.1 mmHg; 95% confidence interval, -2.9 to -1.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged. Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide

  4. [Guideline-oriented inpatient psychiatric psychotherapeutic/psychosomatic treatment of anxiety disorders : How many personnel are need?].

    Science.gov (United States)

    Bandelow, B; Lueken, U; Wolff, J; Godemann, F; Menzler, C W; Deckert, J; Ströhle, A; Beutel, M; Wiltink, J; Domschke, K; Berger, M

    2016-03-01

    The reimbursement of inpatient psychiatric psychotherapeutic/psychosomatic hospital treatment in Germany is regulated by the German personnel ordinance for psychiatric hospitals (Psych-PV), which has remained unchanged since 1991. The aim of this article was to estimate the personnel requirements for guideline-adherent psychiatric psychotherapeutic hospital treatment. A normative concept for the required psychotherapeutic "dose" for anxiety disorders was determined based on a literature review. The required staffing contingent was compared to the resources provided by the Psych-PV based on category A1. According to the German policy guidelines for outpatient psychotherapy, a quota of 25 sessions of 50 min each (as a rule plus 5 probatory sessions) is reimbursed. This approach is supported by studies on dose-response relationships. As patients undergoing inpatient treatment for anxiety disorders are usually more severely ill than outpatients, a contingent of 30 sessions for the average treatment duration of 5 weeks seems appropriate in order to fully exploit the costly inpatient treatment time (300 min per patient and week). In contrast, only 70 min are reimbursed according to the Psych-PV. The total personnel requirement for the normative concept is 624 min per patient and week. The Psych-PV only covers 488 min (78 %). Currently, the time contingents for evidence-based psychiatric psychotherapeutic/psychosomatic hospital care are nowhere near sufficient. In the development of future reimbursement systems this needs to be corrected.

  5. Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

    Directory of Open Access Journals (Sweden)

    Sonia A. Duffy

    2016-11-01

    Full Text Available Abstract Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services, adoption (nurse participation rates and characteristics, implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls, and maintenance (continuation of the intervention once the study ended. Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001. Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028 of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05 and reported decreased barriers to implementing smoking cessation services (p < 0.001. Qualitative comments were very

  6. End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

    Science.gov (United States)

    Keim-Malpass, Jessica; Lindley, Lisa C

    2017-08-01

    Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15-20 years with a life-limiting illness. A retrospective cohort design used 2007-2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

  7. Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

    Science.gov (United States)

    Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen; Wells, Kenneth B; Kominski, Gerald; Mays, Vickie M

    2015-12-01

    The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI

  8. Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study).

    Science.gov (United States)

    Wylie, Gavin; Menz, Hylton B; McFarlane, Sarah; Ogston, Simon; Sullivan, Frank; Williams, Brian; Young, Zoe; Morris, Jacqui

    2017-07-12

    Common foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents. Informed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength. 474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses 'all or most of the time'. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group. A podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised

  9. Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

    NARCIS (Netherlands)

    Hendriks, Jeroen; Tomini, Florian; van Asselt, Thea; Crijns, Harry; Vrijhoef, Hubertus

    AIMS: A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess

  10. Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

    NARCIS (Netherlands)

    Hendriks, J.M.L.; Tomini, F.; van Asselt, A.D.I.; Crijns, H.J.G.M.; Vrijhoef, H.J.M.

    2013-01-01

    Aims A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess

  11. Joint recovery programme versus usual care - An economic evaluation of a clinical pathway for joint replacement surgery

    NARCIS (Netherlands)

    Brunenberg, DE; van Steyn, MJ; Sluimer, JC; Bekebrede, LL; Bulstra, SK; Joore, MA

    2005-01-01

    Objective: The objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement, the Joint Recovery Programme (JRP), as compared with usual care. The existing care process was revised to contain costs and shorten

  12. Cost-effectiveness of cognitive behaviour therapy versus talking and usual care for depressed older people in primary care

    Directory of Open Access Journals (Sweden)

    Leurent Baptiste E

    2011-02-01

    Full Text Available Abstract Background Whilst evidence suggests cognitive behaviour therapy (CBT may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT, a talking control (TC and treatment as usual (TAU, delivered in a primary care setting, for older people with depression. Methods Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up. Results Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference £427, 95% CI: £56 - £787, p Conclusions CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than £115. Trial Registration isrctn.org Identifier: ISRCTN18271323

  13. Association Between Parental Barriers to Accessing a Usual Source of Care and Children's Receipt of Preventive Services.

    Science.gov (United States)

    Bellettiere, John; Chuang, Emmeline; Hughes, Suzanne C; Quintanilla, Isaac; Hofstetter, C Richard; Hovell, Melbourne F

    Preventive health services are important for child development, and parents play a key role in facilitating access to services. This study examined how parents' reasons for not having a usual source of care were associated with their children's receipt of preventive services. We used pooled data from the 2011-2014 National Health Interview Survey (n = 34 843 participants). Parents' reasons for not having a usual source of care were framed within the Penchansky and Thomas model of access and measured through 3 dichotomous indicators: financial barriers (affordability), attitudes and beliefs about health care (acceptability), and all other nonfinancial barriers (accessibility, accommodation, and availability). We used multivariable logistic regression models to test associations between parental barriers and children's receipt of past-year well-child care visits and influenza vaccinations, controlling for other child, family, and contextual factors. In 2014, 14.3% (weighted percentage) of children had at least 1 parent without a usual source of care. Children of parents without a usual source of care because they "don't need a doctor and/or haven't had any problems" or they "don't like, trust, or believe in doctors" had 35% lower odds of receiving well-child care (adjusted odds ratio = 0.65; 95% CI, 0.56-0.74) and 23% lower odds of receiving influenza vaccination (adjusted odds ratio = 0.77; 95% CI, 0.69-0.86) than children of parents without those attitudes and beliefs about health care. Financial and other nonfinancial parental barriers were not associated with children's receipt of preventive services. Results were independent of several factors relevant to children's access to preventive health care, including whether the child had a usual source of care. Parents' attitudes and beliefs about having a usual source of care were strongly associated with their children's receipt of recommended preventive health services. Rates of receipt of child preventive

  14. Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial.

    Science.gov (United States)

    Klemperer, Elias M; Hughes, John R; Solomon, Laura J; Callas, Peter W; Fingar, James R

    2017-01-01

    To test whether, in comparison to usual care, brief motivational or reduction interventions increase quit attempts (QA) or abstinence among smokers who are not ready to quit. A parallel-group randomized controlled trial of brief motivational (n = 185), reduction (n = 186) or usual care (n = 189) telephone interventions delivered over the course of 4 weeks. Outcomes were assessed at 6- and 12-month follow-ups. No medication was provided. United States. A total of 560 adult smokers of ≥ 10 cigarettes per day who were not ready to quit in the next 30 days. The primary outcomes were whether participants made a QA that lasted ≥ 24 hours and whether they made a QA of any length between baseline and 6 months. Secondary outcomes included 7-day point-prevalence abstinence at 6 and 12 months. The 12-month follow-up was added after the study began. A priori-defined comparisons were between motivational versus usual care and reduction versus usual care conditions. The probability of making a QA that lasted ≥ 24 hours was not significantly different between the motivational (38%) or the reduction (31%) conditions and the usual care (34%) condition [motivational versus usual care odds ratio (OR) = 1.19, 95% confidence interval (CI) = 0.78-1.82; reduction versus usual care OR = 0.89, 95% CI = 0.57-1.36]. Bayes factors ranged from 0.13 to 0.18. Findings regarding a QA of any length were similar. At 6 months, the motivational condition had marginally more abstinence than usual care (11 versus 5%, OR = 2.17, 95% CI = 0.99-4.77), but the reduction condition was not significantly different from usual care (8 versus 5%, OR = 1.57, 95% CI = 0.69-3.59). At 12 months, the motivational condition had significantly more abstinence than usual care (10 versus 4%, OR = 2.80, 95% CI = 1.14-6.88) and the reduction condition had marginally more abstinence than usual care (9 versus 4%, OR = 2.45, 95% CI = 0.98-6.09). Among adult smokers who are not ready

  15. Psychotherapeutic intervention by telephone

    Directory of Open Access Journals (Sweden)

    Erika Mozer

    2008-06-01

    Full Text Available Erika Mozer1,2, Bethany Franklin1,3, Jon Rose11Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA; 2PGSP Stanford PsyD Consortium Palo Alto, CA, USA; 3Pacific Graduate School of Psychology Palo Alto, California, USAAbstract: Psychotherapy conducted over the telephone has received increasing amounts of empirical attention given practical advantages that side-step treatment barriers encountered in traditional office-based care. The utility and efficacy of telephone therapy appears generalizable across diverse clinical populations seeking care in community-based hospital settings. Treatment barriers common to older adults suggest that telephone therapy may be an efficient and effective mental health resource for this population. This paper describes empirical studies of telehealth interventions and case examples with psychotherapy conducted via telephone on the Spinal Cord Injury Unit of the Palo Alto Veterans’ Administration. Telephone therapy as appears to be a viable intervention with the aging population.Keywords: telehealth, rural mental health, psychotherapy, healthcare delivery, telecare

  16. Psychotherapeutic Counseling and Pregnancy Rates in In Vitro Fertilization

    OpenAIRE

    Poehl, Michaela; Bichler, Katherina; Wicke, Veronika; Dörner, Veronika; Feichtinger, Wilfried

    1999-01-01

    Purpose:Since the Austrian propagation bill of July 1, 1992, was passed into law, Austrian physicians are committed to offer psychological counseling to women before performing assisted reproductive techniques, unless refused by the patient. The acceptance of psychotherapeutic counseling (PSITCO) and its influence on pregnancy rate were carefully reviewed.

  17. Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes

    Science.gov (United States)

    Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.

    2011-01-01

    Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…

  18. Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain

    NARCIS (Netherlands)

    van der Roer, N.; van Tulder, M.; van Mechelen, W.; de Vet, H.C.W.

    2008-01-01

    STUDY DESIGN. Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. OBJECTIVE. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with

  19. Treating Anxiety Disorders in Inner City Schools: Results from a Pilot Randomized Controlled Trial Comparing CBT and Usual Care

    Science.gov (United States)

    Ginsburg, Golda S.; Becker, Kimberly D.; Drazdowski, Tess K.; Tein, Jenn-Yun

    2012-01-01

    Background: The effectiveness of cognitive-behavioral treatment (CBT) in inner city schools, when delivered by novice CBT clinicians, and compared to usual care (UC), is unknown. Objective: This pilot study addressed this issue by comparing a modular CBT for anxiety disorders to UC in a sample of 32 volunteer youth (mean age 10.28 years, 63%…

  20. Costs and financial benefits of video communication compared to usual care at home: a systematic review.

    NARCIS (Netherlands)

    Peeters, J.M.; Mistiaen, P.; Francke, A.L.

    2011-01-01

    We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home

  1. Gratitude as a psychotherapeutic intervention.

    Science.gov (United States)

    Emmons, Robert A; Stern, Robin

    2013-08-01

    Gratitude practice can be a catalyzing and relational healing force, often untapped in clinical practice. In this article, we provide an overview of current thinking about gratitude's defining and beneficial properties, followed by a brief review of the research on mental health outcomes that result from gratitude practice. Following an analysis of our case study of the use of gratitude as a psychotherapeutic intervention, we present various self-strategies and techniques for consciously choosing and cultivating gratitude. We conclude by describing ways in which gratitude might be capitalized upon for beneficial outcomes in therapeutic settings. © 2013 Wiley Periodicals, Inc.

  2. Effectiveness of a multifaceted implementation strategy compared to usual care on low back pain guideline adherence among general practitioners.

    Science.gov (United States)

    Suman, Arnela; Schaafsma, Frederieke G; van de Ven, Peter M; Slottje, Pauline; Buchbinder, Rachelle; van Tulder, Maurits W; Anema, Johannes R

    2018-05-11

    To improve patient care, and to reduce unnecessary referrals for diagnostic imaging and medical specialist care for low back pain, an evidence-based guideline for low back pain was developed in the Netherlands in 2010. The current study evaluated the effect of a multifaceted implementation strategy on guideline adherence among Dutch general practitioners. The implementation strategy included a multidisciplinary training, provision of educational material and an interactive website for healthcare professionals, supported by a multimedia eHealth intervention for patients with low back pain. Adherence was measured using performance indicators based on 3 months data extracted from the contacts with patients with low back pain recorded in the electronic medical records of participating general practitioners. Performance indicators were compared between two groups: a usual care group and an implementation group. Performance indicators were referrals to consultations with medical specialists, to diagnostic imaging, and to psychosocial and/or occupational physician consultations, and inquiries about psychosocial and occupational risk factors. The electronic medical records of 5130 patient contacts for LBP were analysed; 2453 patient contacts in the usual care group and 2677 patient contacts in the implementation group. Overall, rates of referral and of recorded inquiries regarding psychosocial and occupational risk factors remained low in both groups over time. The only statistically significant difference found was a reduction in the number of referrals to neurologists in the implementation group (from 100 (7%) to 50 (4%)) compared to the usual care group (from 48 (4%) to 50 (4%), (p strategy did not result in improved guideline adherence among general practitioners, and it is not recommended for widespread use. However, baseline referral rates in participating practices were already low, possibly leaving only little room for improvement. Inquiries for psychosocial and

  3. Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial.

    Science.gov (United States)

    Sciurba, Frank C; Criner, Gerard J; Strange, Charlie; Shah, Pallav L; Michaud, Gaetane; Connolly, Timothy A; Deslée, Gaëtan; Tillis, William P; Delage, Antoine; Marquette, Charles-Hugo; Krishna, Ganesh; Kalhan, Ravi; Ferguson, J Scott; Jantz, Michael; Maldonado, Fabien; McKenna, Robert; Majid, Adnan; Rai, Navdeep; Gay, Steven; Dransfield, Mark T; Angel, Luis; Maxfield, Roger; Herth, Felix J F; Wahidi, Momen M; Mehta, Atul; Slebos, Dirk-Jan

    Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation. To determine the effectiveness and safety of endobronchial coil treatment. Randomized clinical trial conducted among 315 patients with emphysema and severe air trapping recruited from 21 North American and 5 European sites from December 2012 through November 2015. Participants were randomly assigned to continue usual care alone (guideline based, including pulmonary rehabilitation and bronchodilators; n = 157) vs usual care plus bilateral coil treatment (n = 158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung. The primary effectiveness outcome was difference in absolute change in 6-minute-walk distance between baseline and 12 months (minimal clinically important difference [MCID], 25 m). Secondary end points included the difference between groups in 6-minute walk distance responder rate, absolute change in quality of life using the St George's Respiratory Questionnaire (MCID, 4) and change in forced expiratory volume in the first second (FEV1; MCID, 10%). The primary safety analysis compared the proportion of participants experiencing at least 1 of 7 prespecified major complications. Among 315 participants (mean age, 64 years; 52% women), 90% completed the 12-month follow-up. Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs -7.6 m with usual care, with a between-group difference of 14.6 m (Hodges-Lehmann 97.5% CI, 0.4 m to ∞; 1-sided P = .02). Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (odds ratio, 1.8 [97.5% CI, 1.1 to ∞]; unadjusted between-group difference, 11.8% [97.5% CI, 1.0% to ∞]; 1-sided P = .01). The between-group difference in

  4. Comparative Effectiveness of Usual Source of Care Approaches to Improve End-of-Life Outcomes for Children With Intellectual Disability.

    Science.gov (United States)

    Lindley, Lisa C; Cozad, Melanie J

    2017-09-01

    Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. We used longitudinal California Medicaid claims data. Children were included who were 21 years with fee-for-service Medicaid claims, died between January 1, 2007, and December 31, 2010, and had a moderate-to-profound ID diagnosis. End-of-life outcomes (i.e., hospice enrollment, emergency room utilization, hospital readmissions) were measured via claims data. Our treatments were usual source of care (USC) only vs. usual source of care plus targeted case management (USC plus TCM). Using instrumental variable analysis, we compared the effectiveness of treatments on end-of-life outcomes. Ten percent of children with ID enrolled in hospice, 73% used the emergency room, and 20% had three or more hospital admissions in their last year of life. USC plus TCM relative to USC only had no effect on hospice enrollment; however, it significantly reduced the probability of emergency room utilization (B = -1.29, P life outcomes for children with ID. Further study of the extent of UCS and TCM involvement in reducing emergency room utilization and hospital readmissions at end of life is needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  5. Preventive Dental Checkups and Their Association With Access to Usual Source of Care Among Rural and Urban Adult Residents.

    Science.gov (United States)

    Khan, Aishah; Thapa, Janani R; Zhang, Donglan

    2017-09-01

    This study aimed to assess the relationship between rural or urban residence and having a usual source of care (USC), and the utilization of preventive dental checkups among adults. Cross-sectional analysis was conducted using data from the Medical Expenditure Panel Survey 2012. We performed a logit regression on the relationship between rural and urban residence, having a USC, and having at least 1 dental checkup in the past year, adjusting for sociodemographic characteristics and health status. After controlling for covariates, rural adult residents had significantly lower odds of having at least 1 dental checkup per year compared to their urban counterparts (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.62-0.86, P rural and urban residents, having a USC was significantly associated with an 11% (95% CI = 9%-13%) increase in the probability of having a preventive dental checkup within a year. Individuals with a USC were more likely to obtain a preventive dental visit, with similar effects in rural and urban settings. We attributed the lower odds of having a checkup in rural regions to the lower density of oral health care providers in these areas. Integration of rural oral health care into primary care may help mitigate the challenges due to a shortage of oral health care providers in rural areas. © 2017 National Rural Health Association.

  6. Study protocol: Cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care

    Directory of Open Access Journals (Sweden)

    van Bokhorst-de van der Schueren Marian AE

    2010-02-01

    Full Text Available Abstract Background Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients, starting at hospital admission until three months after discharge. Methods This study is a randomized controlled trial. Patients are included at hospital admission and followed until three months after discharge. Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective standards: Body Mass Index (BMI in kg/m2 Conclusion In this randomized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge, compared to usual care. Primary endpoints of the study are changes in activities of daily living, body weight, body composition, quality of life, and muscle strength. An economic evaluation will be performed to evaluate the cost-effectiveness of the intervention in comparison with usual care. Trial registration Netherlands Trial Register (ISRCTN29617677, registered 14-Sep-2005

  7. Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people.

    Science.gov (United States)

    Fairhall, Nicola; Sherrington, Catherine; Kurrle, Susan E; Lord, Stephen R; Lockwood, Keri; Howard, Kirsten; Hayes, Alison; Monaghan, Noeline; Langron, Colleen; Aggar, Christina; Cameron, Ian D

    2015-01-01

    To compare the costs and cost-effectiveness of a multifactorial interdisciplinary intervention versus usual care for older people who are frail. Cost-effectiveness study embedded within a randomized controlled trial. Community-based intervention in Sydney, Australia. A total of 241 community-dwelling people 70 years or older who met the Cardiovascular Health Study criteria for frailty. A 12-month multifactorial, interdisciplinary intervention targeting identified frailty characteristics versus usual care. Health and social service use, frailty, and health-related quality of life (EQ-5D) were measured over the 12-month intervention period. The difference between the mean cost per person for 12 months in the intervention and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated. A total of 216 participants (90%) completed the study. The prevalence of frailty was 14.7% lower in the intervention group compared with the control group at 12 months (95% CI 2.4%-27.0%; P = .02). There was no significant between-group difference in EQ-5D utility scores. The cost for 1 extra person to transition out of frailty was $A15,955 (at 2011 prices). In the "very frail" subgroup (participants met >3 Cardiovascular Health Study frailty criteria), the intervention was both more effective and less costly than the control. A cost-effectiveness acceptability curve shows that the intervention would be cost-effective with 80% certainty if decision makers were willing to pay $A50,000 per extra person transitioning from frailty. In the very frail subpopulation, this reduced to $25,000. For frail older people residing in the community, a 12-month multifactorial intervention provided better value for money than usual care, particularly for the very frail, in whom it has a high probability of being cost saving, as well as effective. Trial registration: ACTRN12608000250336. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care

  8. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul Dlpm; Frith, Peter A; Zwerink, Marlies; Monninkhof, Evelyn M; van der Palen, Job; Effing, Tanja W

    2017-08-04

    Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary

  9. Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain.

    Science.gov (United States)

    van der Roer, Nicole; van Tulder, Maurits; van Mechelen, Willem; de Vet, Henrica

    2008-02-15

    Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with nonspecific chronic low back pain. The intensive group training protocol combines exercise therapy, back school, and behavioral principles. Two studies found a significant reduction in absenteeism for a graded activity program in occupational health care. This program has not yet been evaluated in a primary care physiotherapy setting. Participating physical therapists in primary care recruited 114 patients with chronic nonspecific low back pain. Eligible patients were randomized to either the protocol group or the guideline group. Outcome measures included functional status (Roland Morris Disability Questionnaire), pain intensity (11-point numerical rating scale), general perceived effect and quality of life (EuroQol-5D). Cost data were measured with cost diaries and included direct and indirect costs related to low back pain. After 52 weeks, the direct health care costs were significantly higher for patients in the protocol group, largely due to the costs of the intervention. The mean difference in total costs amounted to [Euro sign] 233 (95% confidence interval: [Euro sign] -2.185; [Euro sign] 2.764). The cost-effectiveness planes indicated no significant differences in cost effectiveness between the 2 groups. The results of this economic evaluation showed no difference in total costs between the protocol group and the guideline group. The differences in effects were small and not statistically significant. At present, national implementation of the protocol is not recommended.

  10. Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN)

    DEFF Research Database (Denmark)

    Neupane, Dinesh; McLachlan, Craig S; Mishra, Shiva Raj

    2018-01-01

    ). In the intervention group, 43 FCHVs provided home visits every 4 months for lifestyle counselling and blood pressure monitoring. Eligible participants had been involved in a previous population-based survey, were aged 25–65 years, did not have plans to migrate outside the study area, and were not severely ill......-income population. Methods We did a community-based, open-label, two-group, cluster-randomised controlled trial in Nepal. Using computer-generated codes, we randomly assigned (1:1) 14 clusters to a lifestyle intervention led by female community health volunteers (FCHVs) or usual care (control group...... participants (939 assigned to intervention; 699 assigned to control). At 1 year, 855 participants remained in the intervention group (425 were normotensive, 175 were prehypertensive, and 255 had hypertension) and 613 remained in the control group (305 were normotensive, 128 were prehypertensive, and 180 had...

  11. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial.

    Science.gov (United States)

    Ibler, Kristina Sophie; Jemec, Gregor B E; Diepgen, Thomas L; Gluud, Christian; Lindschou Hansen, Jane; Winkel, Per; Thomsen, Simon Francis; Agner, Tove

    2012-12-12

    To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Randomised, observer blinded parallel group superiority clinical trial. Three hospitals in Denmark. 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up. Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted -3.56 (95% confidence interval -4.92 to -2.14); adjusted -3.47 (-4.80 to -2.14), both Pgroup at follow-up: difference of means: unadjusted -0.78, non-parametric test P=0.003; adjusted -0.92, -1.48 to -0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema. A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves. ClinicalTrials.gov NCT01012453.

  12. Semi-Individualized Homeopathy Add-On Versus Usual Care Only for Premenstrual Disorders: A Randomized, Controlled Feasibility Study.

    Science.gov (United States)

    Klein-Laansma, Christien T; Jong, Mats; von Hagens, Cornelia; Jansen, Jean Pierre C H; van Wietmarschen, Herman; Jong, Miek C

    2018-03-22

    Premenstrual syndrome and premenstrual dysphoric disorder (PMS/PMDD) bother a substantial number of women. Homeopathy seems a promising treatment, but it needs investigation using reliable study designs. The feasibility of organizing an international randomized pragmatic trial on a homeopathic add-on treatment (usual care [UC] + HT) compared with UC alone was evaluated. A multicenter, randomized, controlled pragmatic trial with parallel groups. The study was organized in general and private homeopathic practices in the Netherlands and Sweden and in an outpatient university clinic in Germany. Women diagnosed as having PMS/PMDD, based on prospective daily rating by the daily record of severity of problems (DRSP) during a period of 2 months, were included and randomized. Women were to receive UC + HT or UC for 4 months. Homeopathic medicine selection was according to a previously tested prognostic questionnaire and electronic algorithm. Usual care was as provided by the women's general practitioner according to their preferences. Before and after treatment, the women completed diaries (DRSP), the measure yourself concerns and well-being, and other questionnaires. Intention-to-treat (ITT) and per protocol (PP) analyses were performed. In Germany, the study could not proceed because of legal limitations. In Sweden, recruitment proved extremely difficult. In the Netherlands and Sweden, 60 women were randomized (UC + HT: 28; UC: 32), data of 47/46 women were analyzed (ITT/PP). After 4 months, relative mean change of DRSP scores in the UC + HT group was significantly better than in the UC group (p = 0.03). With respect to recruitment and different legal status, it does not seem feasible to perform a larger, international, pragmatic randomized trial on (semi-)individualized homeopathy for PMS/PMDD. Since the added value of HT compared with UC was demonstrated by significant differences in symptom score changes, further studies are warranted.

  13. Trends in the Types of Usual Sources of Care: A Shift from People to Places or Nothing at All.

    Science.gov (United States)

    Liaw, Winston; Jetty, Anuradha; Petterson, Stephen; Bazemore, Andrew; Green, Larry

    2017-08-31

    (1) To examine usual source of care (USC) trends across four categories (No USC, Person USC, Person, in Facility USC, and Facility USC), and (2) to determine whether USC types are associated with emergency department (ED) visits and hospital admissions. 1996-2014 Medical Expenditure Panel Surveys. We stratified each USC category, by age, region, gender, poverty, insurance, race/ethnicity, and education and used regression to determine the characteristics associated with USC types, ED visits, and hospital admissions. Those with No USC and Facility USCs increased 10 and 18 percent, respectively, while those with Person USCs decreased by 43 percent. Compared to those in the lowest income bracket, those in the highest income bracket were less likely to have a Facility USC. Among those with low incomes, individuals with No USC, Person, in Facility, and Facility USCs were more likely to have ED visits than those with Person USCs. A growing number are reporting facilities as their USCs or none at all. The impact of these trends is uncertain, although we found that some USC types are associated with ED visits and hospital admissions. Tracking USCs will be crucial to measuring progress toward enhanced care efficiency. © Health Research and Educational Trust.

  14. Multistrategy childcare-based intervention to improve compliance with nutrition guidelines versus usual care in long day care services: a study protocol for a randomised controlled trial

    Science.gov (United States)

    Seward, Kirsty; Finch, Meghan; Wiggers, John; Wyse, Rebecca; Jones, Jannah; Gillham, Karen; Yoong, Sze Lin

    2016-01-01

    Introduction Interventions to improve child diet are recommended as dietary patterns developed in childhood track into adulthood and influence the risk of chronic disease. For child health, childcare services are required to provide foods to children consistent with nutrition guidelines. Research suggests that foods and beverages provided by services to children are often inconsistent with nutrition guidelines. The primary aim of this study is to assess, relative to a usual care control group, the effectiveness of a multistrategy childcare-based intervention in improving compliance with nutrition guidelines in long day care services. Methods and analysis The study will employ a parallel group randomised controlled trial design. A sample of 58 long day care services that provide all meals (typically includes 1 main and 2 mid-meals) to children while they are in care, in the Hunter New England region of New South Wales, Australia, will be randomly allocated to a 6-month intervention to support implementation of nutrition guidelines or a usual care control group in a 1:1 ratio. The intervention was designed to overcome barriers to the implementation of nutrition guidelines assessed using the theoretical domains framework. Intervention strategies will include the provision of staff training and resources, audit and feedback, ongoing support and securing executive support. The primary outcome of the trial will be the change in the proportion of long day care services that have a 2-week menu compliant with childcare nutrition guidelines, measured by comprehensive menu assessments. As a secondary outcome, child dietary intake while in care will also be assessed. To assess the effectiveness of the intervention, the measures will be undertaken at baseline and ∼6 months postbaseline. Ethics and dissemination The study was approved by the Hunter New England Human Research Ethics Committee. Study findings will be disseminated widely through peer-reviewed publications. PMID

  15. PSYCHOSOMATIC "ARC" IN THE PSYCHOTHERAPEUTIC PRACTICE

    Directory of Open Access Journals (Sweden)

    Ivanka Boncheva

    2012-11-01

    Full Text Available The psychoneuroimmunology, the new brain science and the endocrinology today show a lot of results, with which symptoms are better to understand. The psychotherapeutic practice shows the ways to influence them by encoding the levels of bounding between the physical symptom and the psychological condition. The aim of the study was to show the encoding of the psychosomatic arc within a real psychotherapeutic contact. 59 psychotherapeutic cases are followed. 33 of them were with somatoform disorders and 26 with chronic psychosomatic diseases. Every patient has minimum 12 psychotherapeutic sessions. The treatment is provided on the base of the 5 levels model of the positive psychotherapy.We ascertain the following:1. The most significant moment in the arise of such symptomatic is the gained past experience - "vital concepts"; "coping strategies";2. Unlocking moment for the arise of the affection is the fixed emotion - fear, aggression or depression, specific for the particular morbid pictures;3. Showing the connection between symptom and fixed emotion by the technique "positive interpretation", which unlocks the process of changingThis shows that the psychotherapeutic help is possible only if the patient rethink the psychosomatic arc. Showing the connections between the content of the unconscious, the fixed emotion in behavioral models and the symptom gives the impetus to change.

  16. Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING]: study protocol of a non-inferiority randomized trial.

    Science.gov (United States)

    Massoudi, Btissame; Blanker, Marco H; van Valen, Evelien; Wouters, Hans; Bockting, Claudi L H; Burger, Huibert

    2017-06-13

    The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to deliver psychological treatment is blended care, i.e. guided online treatment. However, the cost-effectiveness of blended care formatted as an online psychological treatment supported by the patients' own GP or general practice mental health worker (MHW) in routine primary care is unknown. We aim to demonstrate non-inferiority of blended care compared with usual care in patients with depressive symptoms or a depressive disorder in general practice. Additionally, we will explore the real-time course over the day of emotions and affect, and events within individuals during treatment. This is a pragmatic non-inferiority trial including 300 patients with depressive symptoms, recruited by collaborating GPs and MHWs. After inclusion, participants are randomized to either blended care or usual care in routine general practice. Blended care consists of the 'Act and Feel' treatment: an eight-week web-based program based on behavioral activation with integrated monitoring of depressive symptomatology and automatized feedback. GPs or their MHWs coach the participants through regular face-to-face or telephonic consultations with at least three sessions. Depressive symptomatology, health status, functional impairment, treatment satisfaction, daily activities and resource use are assessed during a follow-up period of 12 months. During treatment, real-time fluctuations in emotions and affect, and daily events will be rated using ecological momentary assessment. The primary outcome is the reduction of depressive symptoms from baseline to three months follow-up. We will conduct intention-to-treat analyses and supplementary per-protocol analyses. This trial will show whether blended care might be an

  17. Mechanisms underlying mindfulness-based addiction treatment versus cognitive behavioral therapy and usual care for smoking cessation.

    Science.gov (United States)

    Spears, Claire Adams; Hedeker, Donald; Li, Liang; Wu, Cai; Anderson, Natalie K; Houchins, Sean C; Vinci, Christine; Hoover, Diana Stewart; Vidrine, Jennifer Irvin; Cinciripini, Paul M; Waters, Andrew J; Wetter, David W

    2017-11-01

    To examine cognitive and affective mechanisms underlying mindfulness-based addiction treatment (MBAT) versus cognitive-behavioral therapy (CBT) and usual care (UC) for smoking cessation. Participants in the parent study from which data were drawn (N = 412; 54.9% female; 48.2% African American, 41.5% non-Latino White, 5.4% Latino, 4.9% other; 57.6% annual income <$30,000) were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103). From quit date through 26 weeks postquit, participants completed measures of emotions, craving, dependence, withdrawal, self-efficacy, and attentional bias. Biochemically confirmed 7-day smoking abstinence was assessed at 4 and 26 weeks postquit. Although the parent study did not find a significant treatment effect on abstinence, mixed-effects regression models were conducted to examine treatment effects on hypothesized mechanisms, and indirect effects of treatments on abstinence were tested. Participants receiving MBAT perceived greater volitional control over smoking and evidenced lower volatility of anger than participants in both other treatments. However, there were no other significant differences between MBAT and CBT. Compared with those receiving UC, MBAT participants reported lower anxiety, concentration difficulties, craving, and dependence, as well as higher self-efficacy for managing negative affect without smoking. Indirect effects of MBAT versus UC on abstinence occurred through each of these mechanisms. Whereas several differences emerged between MBAT and UC, MBAT and CBT had similar effects on several of the psychosocial mechanisms implicated in tobacco dependence. Results help to shed light on similarities and differences between mindfulness-based and other active smoking cessation treatments. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  18. Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

    Science.gov (United States)

    Stam, Hanneke; Harting, Thomas; van der Sluijs, Marjolijn; van Marum, Rob; van der Horst, Henriëtte; van der Wouden, Johannes C.; Maarsingh, Otto R.

    2016-01-01

    Objective For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting Forty-six Dutch general practices. Patients The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key PointsIt is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.This study revealed a wide variety in management strategies for dizziness in older patients.There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment

  19. Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients.

    Science.gov (United States)

    Rahe-Meyer, Niels; Fennema, Hein; Schulman, Sam; Klimscha, Walter; Przemeck, Michael; Blobner, Manfred; Wulf, Hinnerk; Speek, Marcel; McCrary Sisk, Christine; Williams-Herman, Debora; Woo, Tiffany; Szegedi, Armin

    2014-11-01

    Previous studies show a prolongation of activated partial thromboplastin time and prothrombin time in healthy volunteers after treatment with sugammadex. The authors investigated the effect of sugammadex on postsurgical bleeding and coagulation variables. This randomized, double-blind trial enrolled patients receiving thromboprophylaxis and undergoing hip or knee joint replacement or hip fracture surgery. Patients received sugammadex 4 mg/kg or usual care (neostigmine or spontaneous recovery) for reversal of rocuronium- or vecuronium-induced neuromuscular blockade. The Cochran-Mantel-Haenszel method, stratified by thromboprophylaxis and renal status, was used to estimate relative risk and 95% confidence interval (CI) of bleeding events with sugammadex versus usual care. Safety was further evaluated by prespecified endpoints and adverse event reporting. Of 1,198 patients randomized, 1,184 were treated (sugammadex n = 596, usual care n = 588). Bleeding events within 24 h (classified by an independent, blinded Adjudication Committee) were reported in 17 (2.9%) sugammadex and 24 (4.1%) usual care patients (relative risk [95% CI], 0.70 [0.38 to 1.29]). Compared with usual care, increases of 5.5% in activated partial thromboplastin time (P sugammadex occurred 10 min after administration and resolved within 60 min. There were no significant differences between sugammadex and usual care for other blood loss measures (transfusion, 24-h drain volume, drop in hemoglobin, and anemia), or risk of venous thromboembolism, and no cases of anaphylaxis. Sugammadex produced limited, transient (<1 h) increases in activated partial thromboplastin time and prothrombin time but was not associated with increased risk of bleeding versus usual care.

  20. Ballistic strength training compared with usual care for improving mobility following traumatic brain injury: protocol for a randomised, controlled trial.

    Science.gov (United States)

    Williams, Gavin; Ada, Louise; Hassett, Leanne; Morris, Meg E; Clark, Ross; Bryant, Adam L; Olver, John

    2016-07-01

    Traumatic brain injury is the leading cause of disability in young adults aged 15 to 45 years. Mobility limitations are prevalent, and range in severity from interfering with basic day-to-day tasks to restricting participation in higher level social, leisure, employment and sporting activities. Despite the prevalence and severity of physical impairments, such as poor balance and spasticity, the main contributor to mobility limitations following traumatic brain injury is low muscle power generation. Strengthening exercises that are performed quickly are termed 'ballistic' as they are aimed at improving the rate of force production and, hence, muscle power. This is compared with conventional strength training, which is performed slowly and aims to improve maximum force production, yet has limited impact on mobility. In people recovering from traumatic brain injury: (1) is a 12-week ballistic strength-training program targeting the three muscle groups critical for walking more effective than usual care at improving mobility, strength and balance; and (2) does improved mobility translate to better health-related quality of life? A prospective, multi-centre, randomised, single-blind trial with concealed allocation will be conducted. Participants will be patients with a neurologically based movement disorder affecting mobility as a result of traumatic brain injury. Patients will be recruited during the acute phase of rehabilitation (n=166), from brain injury units in large metropolitan hospitals in Melbourne and Sydney, Australia. For 12 weeks, participants in the experimental group will have three 60-minute sessions of usual physiotherapy intervention replaced by three 60-minute sessions of strength training (ballistic strength, gait). The three key muscle groups responsible for forward propulsion will be targeted: ankle plantarflexors, hip flexors and the hip extensors. Initial loads will be low, to facilitate high contraction velocities. Progression to higher loads

  1. Psychotherapeutic Function of the Kazakh Traditional Music

    Science.gov (United States)

    Shakerimova, Zere S.; Nussupova, Aizada S.; Burambaeva, Maryam N.; Yermanov, Zhanat R.; Emreyeva, Akmaral E.; Janseitova, Sveta S.

    2016-01-01

    This article considers the psychotherapeutic parameters of traditional Kazakh music, best practices that were achieved in practical psychology. From the one hand, it allows us to see the music features in a new light, and from the other hand--to identify the ethnic psychology of the Kazakh nation. An important step in the study of the…

  2. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3: a randomised trial to determine the efficacy of adding a complex intervention for major depressive disorder (Depression Care for People with Lung Cancer to usual care, compared to usual care alone in patients with lung cancer

    Directory of Open Access Journals (Sweden)

    Sharpe Michael

    2009-09-01

    Full Text Available Abstract Background Depression Care for People with Lung Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3 Trial will test its efficacy when compared to usual care alone. Design A two arm parallel group multi-centre randomised controlled trial. 200 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of lung cancer; an estimated life expectancy of three months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Lung Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is average depression severity. This will be assessed using scores on the 20-item Symptom Hopkins Checklist (SCL-20D, collected every four weeks over 32 weeks. Secondary outcomes include severity of anxiety, pain and fatigue; self-rated improvement of depression; quality of life and satisfaction with depression care. Trial Registration Current controlled trials ISRCTN75905964

  3. A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes.

    Science.gov (United States)

    Blanc-Bisson, C; Dechamps, A; Gouspillou, G; Dehail, P; Bourdel-Marchasson, I

    2008-01-01

    To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy (ADL). Prospective randomized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual care. acute care geriatric medicine ward. A total of 76 acutely ill patients, acutely bedridden or with reduced mobility but who were autonomous for mobility within the previous 3 months. Patients in palliative care or with limiting mobility pathology were excluded. Mean age was 85.4 (SD 6.6) years. At admission, at clinical stability and one month later: anthropometry, energy and protein intakes, hand grip strength, ADL scores, and baseline inflammatory parameters. An exploratory principal axis analysis was performed on the baseline characteristics and general linear models were used to explore the course of ADL and nutritional variables. A 4-factor solution was found explaining 71.7% of variance with a factor "nutrition", a factor "function" (18.8% of variance) for ADL, handgrip strength, bedridden state, energy and protein intakes, serum albumin and C-reactive protein concentrations; a factor "strength" and a fourth factor . During follow-up, dietary intakes, handgrip strength, and ADL scores improved but no changes occurred for anthropometric variables. Intervention was associated only with an increase in protein intake. Better improvement in ADL was found in intervention group when model was adjusted on "function" factor items. Physical intervention programs should be proposed according to nutritional intakes with the aim of preventing illness induced disability.

  4. Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients With Chronic Heart Failure: The CASA Randomized Clinical Trial.

    Science.gov (United States)

    Bekelman, David B; Allen, Larry A; McBryde, Connor F; Hattler, Brack; Fairclough, Diane L; Havranek, Edward P; Turvey, Carolyn; Meek, Paula M

    2018-04-01

    Many patients with chronic heart failure experience reduced health status despite receiving conventional therapy. To determine whether a symptom and psychosocial collaborative care intervention improves heart failure-specific health status, depression, and symptom burden in patients with heart failure. A single-blind, 2-arm, multisite randomized clinical trial was conducted at Veterans Affairs, academic, and safety-net health systems in Colorado among outpatients with symptomatic heart failure and reduced health status recruited between August 2012 and April 2015. Data from all participants were included regardless of level of participation, using an intent-to-treat approach. Patients were randomized 1:1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention or usual care. The CASA intervention included collaborative symptom care provided by a nurse and psychosocial care provided by a social worker, both of whom worked with the patients' primary care clinicians and were supervised by a study primary care clinician, cardiologist, and palliative care physician. The primary outcome was patient-reported heart failure-specific health status, measured by difference in change scores on the Kansas City Cardiomyopathy Questionnaire (range, 0-100) at 6 months. Secondary outcomes included depression (measured by the 9-item Patient Health Questionnaire), anxiety (measured by the 7-item Generalized Anxiety Disorder Questionnaire), overall symptom distress (measured by the General Symptom Distress Scale), specific symptoms (pain, fatigue, and shortness of breath), number of hospitalizations, and mortality. Of 314 patients randomized (157 to intervention arm and 157 to control arm), there were 67 women and 247 men, mean (SD) age was 65.5 (11.4) years, and 178 (56.7%) had reduced ejection fraction. At 6 months, the mean Kansas City Cardiomyopathy Questionnaire score improved 5.5 points in the intervention arm and 2.9 points in the control

  5. Early rehabilitation after total knee replacement surgery: a multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care.

    Science.gov (United States)

    Han, Annie S Y; Nairn, Lillias; Harmer, Alison R; Crosbie, Jack; March, Lyn; Parker, David; Crawford, Ross; Fransen, Marlene

    2015-02-01

    To determine, at 6 weeks postsurgery, if a monitored home exercise program (HEP) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement (TKR) surgery for osteoarthritis. We conducted a multicenter, randomized clinical trial. Patients ages 45-75 years were allocated at the time of hospital discharge to usual care rehabilitation (n = 196) or the HEP (n = 194). Outcomes assessed 6 weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales, knee range of motion, and the 50-foot walk time. The upper bound of the 95% confidence interval (95% CI) mean difference favoring usual care was used to determine noninferiority. At 6 weeks after surgery there were no significant differences between usual care and HEP, respectively, for pain (7.4 and 7.2; 95% CI mean difference [MD] -0.7, 0.9), physical function (22.5 and 22.4; 95% CI MD -2.5, 2.6), knee flexion (96° and 97°; 95% CI MD -4°, 2°), knee extension (-7° and -6°; 95% CI MD -2°, 1°), or the 50-foot walk time (12.9 and 12.9 seconds; 95% CI MD -0.8, 0.7 seconds). At 6 weeks, 18 patients (9%) allocated to usual care and 11 (6%) to the HEP did not achieve 80° knee flexion. There was no difference between the treatment allocations in the number of hospital readmissions. The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR. Copyright © 2015 by the American College of Rheumatology.

  6. How the psychosocial context of clinical trials differs from usual care: A qualitative study of acupuncture patients

    Directory of Open Access Journals (Sweden)

    White Peter

    2011-05-01

    Full Text Available Abstract Background Qualitative studies of participants' experiences in randomised clinical trials (RCTs suggest that the psychosocial context of treatment in RCTs may be quite different to the psychosocial context of treatment in usual practice. This is important, as the psychosocial context of treatment is known to influence patient outcomes in chronic illness. Few studies have directly compared the psychosocial context of treatment across RCTs and usual practice. In this study, we explored differences in psychosocial context between RCT and usual practice settings, using acupuncture as our model. Methods We undertook a secondary analysis of existing qualitative interviews with 54 patients. 27 were drawn from a study of western and traditional acupuncture in usual practice (for a range of painful conditions. 27 were drawn from a qualitative study nested in an RCT of western acupuncture for osteoarthritis of the hip or knee. We used qualitative analysis software to facilitate an inductive thematic analysis in which we identified three main themes. Results In usual practice, starting acupuncture was more likely to be embedded in an active and ongoing search for pain relief, whereas in the RCT starting acupuncture was opportunistic. Usual practice patients reported few uncertainties and these had minimal consequences for them. In the RCT, patients experienced considerable uncertainties about their treatment and its effectiveness, and were particularly concerned about whether they were receiving real (or fake acupuncture. Patients stopped acupuncture only at the end of the fixed course of treatment in the RCT, which was similar to those receiving acupuncture in the public sector National Health Service (NHS. In comparison, private sector patients re-evaluated and re-negotiated treatments particularly when starting to use acupuncture. Conclusions Differences in psychosocial context between RCTs and usual practice could reduce the impact of

  7. Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Favela J

    2013-01-01

    Full Text Available Jesús Favela,1 Luis A Castro,2 Francisco Franco-Marina,3 Sergio Sánchez-García,4 Teresa Juárez-Cedillo,4 Claudia Espinel Bermudez,4 Julia Mora-Altamirano,4 Marcela D Rodriguez,5 Carmen García-Peña41Center for Scientific Research and Higher Education of Ensenada, Ensenada, Baja California, Mexico; 2Sonora Institute of Technology, Ciudad Obregon, Mexico; 3National Institute of Respiratory Diseases, Mexican Ministry of Health, Mexico City, Mexico; 4Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico; 5School of Engineering, MyDCI, Autonomous University of Baja California, Mexicali, MexicoObjective: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB is effective in reducing frailty compared to nurse home visits alone (NV-only and usual care (control group for older adults.Design: Unblinded, randomized, controlled trial.Setting: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.Participants: Patients were aged over 60 years with a frailty index score higher than 0.14.Intervention: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.Measurements: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.Results: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients, they had died (107, they were ill (50, or they were not currently living in the city (28. A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete

  8. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care.

    Science.gov (United States)

    Chiarelli, Anna M; Muradali, Derek; Blackmore, Kristina M; Smith, Courtney R; Mirea, Lucia; Majpruz, Vicky; O'Malley, Frances P; Quan, May Lynn; Holloway, Claire Mb

    2017-05-09

    Timely coordinated diagnostic assessment following an abnormal screening mammogram reduces patient anxiety and may optimise breast cancer prognosis. Since 1998, the Ontario Breast Screening Program (OBSP) has offered organised assessment through Breast Assessment Centres (BACs). For OBSP women seen at a BAC, an abnormal mammogram is followed by coordinated referrals through the use of navigators for further imaging, biopsy, and surgical consultation as indicated. For OBSP women seen through usual care (UC), further diagnostic imaging is arranged directly from the screening centre and/or through their physician; results must be communicated to the physician who is then responsible for arranging any necessary biopsy and/or surgical consultation. This study aims to evaluate factors associated with diagnostic wait times for women undergoing assessment through BAC and UC. Of the 2 147 257 women aged 50-69 years screened in the OBSP between 1 January 2002 and 31 December 2009, 155 866 (7.3%) had an abnormal mammogram. A retrospective design identified two concurrent cohorts of women diagnosed with screen-detected breast cancer at a BAC (n=4217; 47%) and UC (n=4827; 53%). Multivariable logistic regression analyses examined associations between wait times and assessment and prognostic characteristics by pathway. A two-sided 5% significance level was used. Screened women with breast cancer were two times more likely to be diagnosed within 7 weeks when assessed through a BAC vs UC (OR=1.91, 95% CI=1.73-2.10). In addition, compared with UC, women assessed through a BAC were significantly more likely to have their first assessment procedure within 3 weeks of their abnormal mammogram (OR=1.25, 95% CI=1.12-1.39), ⩽3 assessment procedures (OR=1.54, 95% CI=1.41-1.69), ⩽2 assessment visits (OR=1.86, 95% CI=1.70-2.05), and ⩾2 procedures per visit (OR=1.41, 95% CI=1.28-1.55). Women diagnosed through a BAC were also more likely than those in UC to have imaging (OR=1.99, 95

  9. Comparison of group-based outpatient physiotherapy with usual care after total knee replacement: a feasibility study for a randomized controlled trial.

    Science.gov (United States)

    Artz, Neil; Dixon, Samantha; Wylde, Vikki; Marques, Elsa; Beswick, Andrew D; Lenguerrand, Erik; Blom, Ashley W; Gooberman-Hill, Rachael

    2017-04-01

    To evaluate the feasibility of conducting a randomized controlled trial comparing group-based outpatient physiotherapy with usual care in patients following total knee replacement. A feasibility study for a randomized controlled trial. One secondary-care hospital orthopaedic centre, Bristol, UK. A total of 46 participants undergoing primary total knee replacement. The intervention group were offered six group-based exercise sessions after surgery. The usual care group received standard postoperative care. Participants were not blinded to group allocation. Feasibility was assessed by recruitment, reasons for non-participation, attendance, and completion rates of study questionnaires that included the Lower Extremity Functional Scale and Knee Injury and Osteoarthritis Outcome Score. Recruitment rate was 37%. Five patients withdrew or were no longer eligible to participate. Intervention attendance was high (73%) and 84% of group participants reported they were 'very satisfied' with the exercises. Return of study questionnaires at six months was lower in the usual care (75%) than in the intervention group (100%). Mean (standard deviation) Lower Extremity Functional Scale scores at six months were 45.0 (20.8) in the usual care and 57.8 (15.2) in the intervention groups. Recruitment and retention of participants in this feasibility study was good. Group-based physiotherapy was acceptable to participants. Questionnaire return rates were lower in the usual care group, but might be enhanced by telephone follow-up. The Lower Extremity Functional Scale had high responsiveness and completion rates. Using this outcome measure, 256 participants would be required in a full-scale randomized controlled trial.

  10. Effect of lifestyle coaching versus care coordination versus treatment as usual in people with severe mental illness and overweight

    DEFF Research Database (Denmark)

    Jakobsen, Ane Storch; Speyer, Helene; Nørgaard, Hans Christian Brix

    2017-01-01

    as usual group (P = 0.24). Also, there were no intervention effects for any secondary or exploratory outcomes, including cardiorespiratory fitness, weight, physical activity, diet and smoking. No reported adverse events could be ascribed to the intervention. We conclude that there was neither any direct...

  11. Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study.

    Science.gov (United States)

    Chan, Juliana C; So, Wing-Yee; Yeung, Chun-Yip; Ko, Gary T; Lau, Ip-Tim; Tsang, Man-Wo; Lau, Kam-Piu; Siu, Sing-Chung; Li, June K; Yeung, Vincent T; Leung, Wilson Y; Tong, Peter C

    2009-06-01

    Multifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes. A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150-350 micromol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure triglyceride 500 micromol/l or dialysis). Of these 205 patients (mean +/- SD age 65 +/- 7.2 years; disease duration 14 +/- 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 +/- 12 vs. 71 +/- 12 mmHg, respectively, P = 0.02; A1C 7.3 +/- 1.3 vs. 8.0 +/- 1.6%, P structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained >or=3 treatment goals (61%, n = 63, vs. 28%, n = 28; P or=3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21-0.86] compared with that of those who attained

  12. The 'carry-over' effects of patient self-testing: positive effects on usual care management by an anticoagulation management service.

    LENUS (Irish Health Repository)

    Ryan, Fiona

    2010-11-01

    Patient self-testing (PST) of the international normalised ratio (INR) has a positive effect on anticoagulation control. This study investigated whether the benefits of PST (other than increased frequency of testing, e.g. patient education, empowerment, compliance etc.) could be \\'carried-over\\' into usual care management after a period of home-testing has ceased.

  13. Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial

    NARCIS (Netherlands)

    Schellekens, M.P.J.; Hurk, D.G.M. van den; Prins, J.B.; Donders, A.R.T.; Molema, J.; Dekhuijzen, R.; Drift, M.A. van der; Speckens, A.E.M.

    2017-01-01

    OBJECTIVE: Lung cancer patients report among the highest distress rates of all cancer patients. Partners report similar distress rates. The present study examined the effectiveness of additional mindfulness-based stress reduction (care as usual [CAU] + MBSR) versus solely CAU to reduce psychological

  14. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: A pilot randomized controlled trial

    NARCIS (Netherlands)

    Oosting, E.; Jans, M.P.; Dronkers, J.J.; Naber, R.H.; Dronkers-Landman, C.M.; Appelman-De Vries, S.M.; Meeteren, N.L. van

    2012-01-01

    Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise

  15. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial.

    NARCIS (Netherlands)

    Meij, E.; Huirne, J.A.F.; Bouwsma, E.V.A.; van Dongen, J.M.; Terwee, Caroline B; van de Ven, P.M.; Bakker, C.M.; van der Meij, S.; van Baal, W.M.; Leclercq, W.K.G.; Geomini, P.M.; Consten, E.C.; Schraffordt Koops, S.E.; van Kesteren, P.J.; Stockmann, H.B.; Ten Cate, A.D.; Davids, P.H.P.; Scholten, P.C.; van den Heuvel, B.; Schaafsma, Frederieke G.; Meijerink, W.J.; Bonjer, H.J.; Anema, J.R.

    2016-01-01

    BACKGROUND: Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence,

  16. Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

    Science.gov (United States)

    Weisz, John R.; Southam-Gerow, Michael A.; Gordis, Elana B.; Connor-Smith, Jennifer K.; Chu, Brian C.; Langer, David A.; McLeod, Bryce D.; Jensen-Doss, Amanda; Updegraff, Alanna; Weiss, Bahr

    2009-01-01

    Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families…

  17. Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomised trial

    NARCIS (Netherlands)

    Pisters, M.F.; Veenhof, C.; de Bakker, D.H.; Schellevis, F.G.; Dekker, J.

    2010-01-01

    Question: Does behavioural graded activity result in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee? Design: Analysis of secondary outcomes of a cluster-randomised trial with concealed allocation, assessor blinding, and

  18. The effects of immunotherapy with intravenous immunoglobulins versus no intervention, placebo, or usual care in patients with recurrent miscarriages

    DEFF Research Database (Denmark)

    Egerup, Pia; Lindschou, Jane; Gluud, Christian

    2014-01-01

    , and publication status investigating infusions with immunoglobulins in relation to pregnancy compared to placebo, no intervention, or treatment as usual for assessments of benefits and harms. The relevant published literature will be searched using the following databases: Cochrane Central Register of Controlled...... Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, and Ovid Medline In-Process and Other Non-Indexed Citations databases. Two review authors will independently extract data and assess risk of bias. We will undertake meta-analyses according to the recommendations stated...

  19. Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care

    Directory of Open Access Journals (Sweden)

    Sabes-Figuera Ramon

    2012-08-01

    Full Text Available Abstract Background Fatigue is common and has been shown to result in high economic costs to society. The aim of this study is to compare the cost-effectiveness of two active therapies, graded-exercise (GET and counselling (COUN with usual care plus a self-help booklet (BUC for people presenting with chronic fatigue. Methods A randomised controlled trial was conducted with participants consulting for fatigue of over three months’ duration recruited from 31 general practices in South East England and allocated to one of three arms. Outcomes and use of services were assessed at 6-month follow-up. The main outcome measure used in the economic evaluation was clinically significant improvements in fatigue, measured using the Chalder fatigue scale. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves. Results Full economic and outcome data at six months were available for 163 participants; GET = 51, COUN = 58 and BUC = 54. Those receiving the active therapies (GET and COUN had more contacts with care professionals and therefore higher costs, these differences being statistically significant. COUN was more expensive and less effective than the other two therapies. The incremental cost-effectiveness ratio of GET compared to BUC was equal to £987 per unit of clinically significant improvement. However, there was much uncertainty around this result. Conclusion This study does not provide a clear recommendation about which therapeutic option to adopt, based on efficiency, for patients with chronic fatigue. It suggests that COUN is not cost-effective, but it is unclear whether GET represents value for money compared to BUC. Clinical Trial Registration number at ISRCTN register: 72136156

  20. Randomized clinical trial of an intravenous hydromorphone titration protocol versus usual care for management of acute pain in older emergency department patients.

    Science.gov (United States)

    Chang, Andrew K; Bijur, Polly E; Davitt, Michelle; Gallagher, E John

    2013-09-01

    Opioid titration is an effective strategy for treating pain; however, titration is generally impractical in the busy emergency department (ED) setting. Our objective was to test a rapid, two-step, hydromorphone titration protocol against usual care in older patients presenting to the ED with acute severe pain. This was a prospective, randomized clinical trial of patients 65 years of age and older presenting to an adult, urban, academic ED with acute severe pain. The study was registered at http://www.clinicaltrials.gov (NCT01429285). Patients randomized to the hydromorphone titration protocol initially received 0.5 mg intravenous hydromorphone. Patients randomized to usual care received any dose of any intravenous opioid. At 15 min, patients in both groups were asked, 'Do you want more pain medication?' Patients in the hydromorphone titration group who answered 'yes' received a second dose of 0.5 mg intravenous hydromorphone. Patients in the usual care group who answered 'yes' had their ED attending physician notified, who then could administer any (or no) additional medication. The primary efficacy outcome was satisfactory analgesia defined a priori as the patient declining additional analgesia at least once when asked at 15 or 60 min after administration of the initial opioid. Dose was calculated in morphine equivalent units (MEU: 1 mg hydromorphone = 7 mg morphine). The need for naloxone to reverse adverse opioid effects was the primary safety outcome. 83.0 % of 153 patients in the hydromorphone titration group achieved satisfactory analgesia compared with 82.5 % of 166 patients in the usual care group (p = 0.91). Patients in the hydromorphone titration group received lower mean initial doses of opioids at baseline than patients in the usual care group (3.5 MEU vs. 4.7 MEU, respectively; p ≤ 0.001) and lower total opioids through 60 min (5.3 MEU vs. 6.0 MEU; p = 0.03). No patient needed naloxone. Low-dose titration of intravenous hydromorphone in increments of

  1. Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey.

    Science.gov (United States)

    An, Ah Reum; Kim, Kyoungwoo; Lee, Jae-Ho; Sung, Nak-Jin; Lee, Sang-Il; Hyun, Min Kyung

    2016-11-29

    Usual source of care (USC) is one of the hallmarks of primary care. We aimed to examine the status of having a USC and its patient-related sociodemographic factors among Korean adults. Data were obtained from the 2012 Korea Health Panel survey. Panel participants were selected for the study who were aged 18 years or older and who replied to questionnaire items on having a USC (n = 11,935). Of the participants, 21.5% had a usual place and 13.9% had a usual physician. Reasons for not having a USC were seldom being ill (66.1%), the preference to visit multiple medical institutions (27.9%), and others. The private community clinic was the most common type of usual place (57.0%). In patient-reported attributes of care provided by a usual physician, the percentages of positive responses for comprehensiveness and coordination were 67.2% and 34.5%, respectively. By institution type, primary care clinics showed the lowest percentage (32.8%) of positive responses for coordination. Adjusted odds ratios of having a usual physician were 3.77 (95% confidence interval, CI: 3.75-3.79) for those aged 65 years or older (vs. aged 18-34 years), 1.31 (CI: 1.30-1.31) for females (vs. males), 0.72 (CI: 0.72-0.73) for unmarried people (vs. married), 1.16 (CI: 1.16-1.16) for college graduates or higher (vs. elementary school graduate or less), 0.64 for the fifth quintile (vs. the first quintile) by household income, 1.53 (CI: 1.52-1.54) for Medical Aid (vs. employee health insurance) for type of health insurance, and 4.09 (CI: 4.08-4.10) for presence (vs. absence) of a chronic diseases. The proportion of Korean adults who have a USC is extremely low, the most influential factor of having a USC is having a chronic disease or not, and Korean patients experience much poorer health care coordination than do patients in other industrialized countries. The findings of this study will give insight to researchers and policy makers regarding the potential facilitators of and barriers to

  2. Comparison of Simulated Treatment and Cost-effectiveness of a Stepped Care Case-Finding Intervention vs Usual Care for Posttraumatic Stress Disorder After a Natural Disaster.

    Science.gov (United States)

    Cohen, Gregory H; Tamrakar, Shailesh; Lowe, Sarah; Sampson, Laura; Ettman, Catherine; Linas, Ben; Ruggiero, Kenneth; Galea, Sandro

    2017-12-01

    Psychiatric interventions offered after natural disasters commonly address subsyndromal symptom presentations, but often remain insufficient to reduce the burden of chronic posttraumatic stress disorder (PTSD). To simulate a comparison of a stepped care case-finding intervention (stepped care [SC]) vs a moderate-strength single-level intervention (usual care [UC]) on treatment effectiveness and incremental cost-effectiveness in the 2 years after a natural disaster. This study, which simulated treatment scenarios that start 4 weeks after landfall of Hurricane Sandy on October 29, 2012, and ending 2 years later, created a model of 2 642 713 simulated agents living in the areas of New York City affected by Hurricane Sandy. Under SC, cases were referred to cognitive behavioral therapy, an evidence-based therapy that aims to improve symptoms through problem solving and by changing thoughts and behaviors; noncases were referred to Skills for Psychological Recovery, an evidence-informed therapy that aims to reduce distress and improve coping and functioning. Under UC, all patients were referred only to Skills for Psychological Recovery. The reach of SC compared with UC for 2 years, the 2-year reduction in prevalence of PTSD among the full population, the 2-year reduction in the proportion of PTSD cases among initial cases, and 10-year incremental cost-effectiveness. This population of 2 642 713 simulated agents was initialized with a PTSD prevalence of 4.38% (115 751 cases) and distributions of sex (52.6% female and 47.4% male) and age (33.9% aged 18-34 years, 49.0% aged 35-64 years, and 17.1% aged ≥65 years) that were comparable with population estimates in the areas of New York City affected by Hurricane Sandy. Stepped care was associated with greater reach and was superior to UC in reducing the prevalence of PTSD in the full population: absolute benefit was clear at 6 months (risk difference [RD], -0.004; 95% CI, -0.004 to -0.004), improving through 1

  3. Not the usual suspect: a case of erythema induration of Bazin in an urban primary care clinic

    Directory of Open Access Journals (Sweden)

    Ling Xu

    2015-12-01

    Full Text Available Frontline clinicians in the United States, especially those working in safety net hospitals or with immigrant populations, will likely see cutaneous tuberculosis given the tremendous burden of tuberculosis infection worldwide. The tuberculid is a subtype of cutaneous tuberculosis that poses a diagnostic challenge because organisms are not found in smears or cultures taken from the lesions. Tuberculid lesions can mimic erythema nodosum, thrombophlebitis, and cellulitis. We describe the case of a 57-year-old woman immigrant from China who presented with tender, subcutaneous nodules on her ankle and thigh in the setting of prior exposure to tuberculosis. We describe the clinical, pathophysiologic, and histopathologic features of tuberculids in order to raise awareness among primary care clinicians about this difficult to diagnose but readily treatable manifestation of tuberculosis.

  4. Variability in usual care mechanical ventilation for pediatric acute lung injury: the potential benefit of a lung protective computer protocol.

    Science.gov (United States)

    Khemani, Robinder G; Sward, Katherine; Morris, Alan; Dean, J Michael; Newth, Christopher J L

    2011-11-01

    Although pediatric intensivists claim to embrace lung protective ventilation for acute lung injury (ALI), ventilator management is variable. We describe ventilator changes clinicians made for children with hypoxemic respiratory failure, and evaluate the potential acceptability of a pediatric ventilation protocol. This was a retrospective cohort study performed in a tertiary care pediatric intensive care unit (PICU). The study period was from January 2000 to July 2007. We included mechanically ventilated children with PaO(2)/FiO(2) (P/F) ratio less than 300. We assessed variability in ventilator management by evaluating actual changes to ventilator settings after an arterial blood gas (ABG). We evaluated the potential acceptability of a pediatric mechanical ventilation protocol we adapted from National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) Acute Respiratory Distress Syndrome (ARDS) Network protocols by comparing actual practice changes in ventilator settings to changes that would have been recommended by the protocol. A total of 2,719 ABGs from 402 patients were associated with 6,017 ventilator settings. Clinicians infrequently decreased FiO(2), even when the PaO(2) was high (>68 mmHg). The protocol would have recommended more positive end expiratory pressure (PEEP) than was used in actual practice 42% of the time in the mid PaO(2) range (55-68 mmHg) and 67% of the time in the low PaO(2) range (ventilator rate (VR) when the protocol would have recommended a change, even when the pH was greater than 7.45 with PIP at least 35 cmH(2)O. There may be lost opportunities to minimize potentially injurious ventilator settings for children with ALI. A reproducible pediatric mechanical ventilation protocol could prompt clinicians to make ventilator changes that are consistent with lung protective ventilation.

  5. Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial

    Directory of Open Access Journals (Sweden)

    Duffy Sonia A

    2012-08-01

    Full Text Available Abstract Background The objectives of this smoking cessation study among hospitalized smokers are to: 1 determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys; 2 compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus usual care across hospitals, units, and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months (primary outcome post-recruitment; and 3 determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention relative to usual care including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. Methods/Design This effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care. In both the intervention and usual care sites, research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment. The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site. The Master Trainers, in turn, will teach the intervention to all staff nurses. Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination. Descriptive statistics will be used to summarize the results of surveys administered to nurses, nurses’ participation rates, smokers’ receipt of specific cessation services, and satisfaction with services. General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with

  6. [Negative symptoms in schizophrenia: psychotherapeutic approaches].

    Science.gov (United States)

    Azorin, J-M; Adida, M; Belzeaux, R; Pringuey, D; Micoulaud Franchi, J-A; Simon, N; Cermolacce, M; Kaladjian, A; Fakra, E

    2015-12-01

    Although negative symptoms are recognized as a central feature of schizophrenia, their definition as well as phenomenology have long been a vexing issue. During these last years, a major progress has been made with the delineation of two underlying subdomains of negative symptoms: diminished expression and anhedonia-avolition-apathy. As current guidelines are not always in accord on the efficacy of treatments on negative symptoms, it may be tempting to re-interpret the findings of clinical trials by looking at the effects of treatments on these two subdomains. This could concern both psychotropic treatments and psychotherapeutic interventions. Furthermore, neuroimaging as well as emotional response studies have permitted to better understand the mechanism which could be at the root of diminished expression and anhedonia in schizophrenia. On this basis, new psychotherapeutic methods have been devised which, by specifically targeting these two subdomains, are likely to be more efficient on negative symptoms. Further research is warranted to test their efficacy in randomized controlled trials. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. 2. Gestaltdrama as an Integrative Psychotherapeutic Approach

    Directory of Open Access Journals (Sweden)

    Polínek Martin Dominik

    2016-03-01

    Full Text Available The following text is an overview study which defines the basic phenomena and effective factors of Gestalt drama and outlines some of the researches carried out in this area by the author during recent years. Gestalt drama is the name of a specific psychotherapeutic approach applied by the author in his practice, which combines Gestalt therapy with expressive approaches (especially with dramatherapy, theatrotherapy and fairytale-therapy. Linking Gestalt therapy and expressive techniques results in a specific psychotherapeutic approach whose versatility and holistic conception makes it suitable not only for psychotherapy but also for self-development of people with special needs, as it has the potential to meet the higher psychological needs even when the lower needs are not sufficiently saturated. The article further presents the interpretation of the partial results of research focusing on the analysis of integration performance where gestaltdrama techniques have been applied. These performances resulted from one-day dramatherapy workshops with clients suffering from mental retardation and with clients with behavioural disorders. This includes the analysis of differences between dramatical expression within the above target groups.

  8. [Psychotherapeutic treatment of traumatized refugees in Germany].

    Science.gov (United States)

    Böttche, M; Stammel, N; Knaevelsrud, C

    2016-11-01

    Traumatic experiences resulting from war and violence can lead to a broad spectrum of psychological and somatic stress responses. The psychological strain of traumatized refugees is frequently aggravated by specific post-migration stressors. The current healthcare provision in Germany is characterized by many restrictions. The different residence permits are associated with a limited access to medical and psychotherapeutic services. In addition, there are several barriers limiting access of this group of patients to the healthcare system (e. g. low level of training of mental healthcare staff, language barriers and lack of financing for interpreters). Empirical studies have shown that traumatized refugees profit from existing trauma-focused and evidence-based interventions. Treatment is associated with particular challenges and issues (e. g. use of interpreters, migration and culture-specific as well as legal aspects). Specialized treatment centers for traumatized refugees use a multidisciplinary treatment approach, which includes psychotherapeutic, medical and social work interventions as well as assistance with the residential status and integration programs.

  9. Searching for Elements of Evidence-based Practices in Children’s Usual Care and Examining their Impact

    Science.gov (United States)

    Garland, Ann F.; Accurso, Erin C.; Haine-Schlagel, Rachel; Brookman-Frazee, Lauren; Roesch, Scott; Zhang, Jin Jin

    2014-01-01

    Objective Most of the knowledge generated to bridge the research - practice gap has been derived from experimental studies implementing specific treatment models. Alternatively, this study uses observational methods to generate knowledge about community-based treatment processes and outcomes. Aims are to (1) describe outcome trajectories for children with disruptive behavior problems (DBPs), and (2) test how observed delivery of a benchmark set of practice elements common in evidence-based (EB) treatments may be associated with outcome change, while accounting for potential confounding variables. Method Participants included 190 children ages 4–13 with DBPs and their caregivers, plus 85 psychotherapists, recruited from six clinics. All treatment sessions were video-taped and a random sample of four sessions in the first four months of treatment was reliably coded for intensity on 27 practice elements (benchmark set and others). Three outcomes (child symptom severity, parent discipline, and family functioning) were assessed by parent report at intake, four, and eight months. Data were collected on several potential covariates including child, parent, therapist, and service use characteristics. Multi-level modeling was used to assess relationships between observed practice and outcome slopes, while accounting for covariates. Results Children and families demonstrated improvements in all three outcomes, but few significant associations between treatment processes and outcome change were identified. Families receiving greater intensity on the benchmark practice elements did demonstrate greater improvement in the parental discipline outcome. Conclusion Observed changes in outcomes for families in community care were generally not strongly associated with the type or amount of treatment received. PMID:24555882

  10. Variability in Usual Care Mechanical Ventilation for Pediatric Acute Respiratory Distress Syndrome: Time for a Decision Support Protocol?

    Science.gov (United States)

    Newth, Christopher J L; Sward, Katherine A; Khemani, Robinder G; Page, Kent; Meert, Kathleen L; Carcillo, Joseph A; Shanley, Thomas P; Moler, Frank W; Pollack, Murray M; Dalton, Heidi J; Wessel, David L; Berger, John T; Berg, Robert A; Harrison, Rick E; Holubkov, Richard; Doctor, Allan; Dean, J Michael; Jenkins, Tammara L; Nicholson, Carol E

    2017-11-01

    Although pediatric intensivists philosophically embrace lung protective ventilation for acute lung injury and acute respiratory distress syndrome, we hypothesized that ventilator management varies. We assessed ventilator management by evaluating changes to ventilator settings in response to blood gases, pulse oximetry, or end-tidal CO2. We also assessed the potential impact that a pediatric mechanical ventilation protocol adapted from National Heart Lung and Blood Institute acute respiratory distress syndrome network protocols could have on reducing variability by comparing actual changes in ventilator settings to those recommended by the protocol. Prospective observational study. Eight tertiary care U.S. PICUs, October 2011 to April 2012. One hundred twenty patients (age range 17 d to 18 yr) with acute lung injury/acute respiratory distress syndrome. Two thousand hundred arterial and capillary blood gases, 3,964 oxygen saturation by pulse oximetry, and 2,757 end-tidal CO2 values were associated with 3,983 ventilator settings. Ventilation mode at study onset was pressure control 60%, volume control 19%, pressure-regulated volume control 18%, and high-frequency oscillatory ventilation 3%. Clinicians changed FIO2 by ±5 or ±10% increments every 8 hours. Positive end-expiratory pressure was limited at ~10 cm H2O as oxygenation worsened, lower than would have been recommended by the protocol. In the first 72 hours of mechanical ventilation, maximum tidal volume/kg using predicted versus actual body weight was 10.3 (8.5-12.9) (median [interquartile range]) versus 9.2 mL/kg (7.6-12.0) (p Ventilator management varies substantially in children with acute respiratory distress syndrome. Opportunities exist to minimize variability and potentially injurious ventilator settings by using a pediatric mechanical ventilation protocol offering adequately explicit instructions for given clinical situations. An accepted protocol could also reduce confounding by mechanical

  11. A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes.

    NARCIS (Netherlands)

    Blanc-Bisson, C.; Dechamps, A.A.; Gouspillou, G.; Dehail, P.; Bourdel-Marchasson, I.

    2008-01-01

    OBJECTIVE: To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy (ADL). DESIGN: Prospective randomized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual

  12. Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.

    Directory of Open Access Journals (Sweden)

    Annie LeBlanc

    Full Text Available Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown.Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01, improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively, had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001. Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer. There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07; medication adherence at 6 months was no different across arms.Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.clinical trials.gov NCT00949611.

  13. Effect of nurse home visits vs. usual care on reducing intimate partner violence in young high-risk pregnant women: a randomized controlled trial.

    Science.gov (United States)

    Mejdoubi, Jamila; van den Heijkant, Silvia C C M; van Leerdam, Frank J M; Heymans, Martijn W; Hirasing, Remy A; Crijnen, Alfons A M

    2013-01-01

    Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV). The nurse-family partnership (NFP) is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect of nurse home visiting on IPV is inconsistent. This study aims to study the effect of VoorZorg, the Dutch NFP, on IPV. A random sample of 460 eligible disadvantaged women births, was randomized. Women in the control group (C; n=223) received usual care; women in the intervention group (I; n=237) received usual care plus nurse home visits periodically during pregnancy and until the child's second birthday. At 32 weeks of pregnancy, women in the intervention group self-reported significantly less IPV victimization than women in the control group in: level 2 psychological aggression (C: 56% vs. I: 39%), physical assault level 1 (C: 58% vs. I: 40%) and level 2 (C: 31% vs. I: 20%), and level 1 sexual coercion (C: 16% vs. I: 8%). Furthermore, women in the intervention group reported significantly less IPV perpetration in: level 2 psychological aggression (C: 60% vs. I: 46%), level 1 physical assault (C: 65% vs. I: 52%), and level 1 injury (C: 27% vs. I: 17%). At 24 months after birth, IPV victimization was significantly lower in the intervention group for level 1 physical assault (C: 44% vs. I: 26%), and IPV perpetration was significantly lower for level 1 sexual assault (C: 18% vs. I: 3%). Multilevel analyses showed a significant improvement in IPV victimization and perpetration among women in the intervention group at 24 months after birth. VoorZorg, compared with the usual care, is effective in reducing IPV during pregnancy and in the two years after birth among young high-risk women. Dutch Trial Register NTR854 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=854.

  14. Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.

    Science.gov (United States)

    Closa, Conxita; Mas, Miquel À; Santaeugènia, Sebastià J; Inzitari, Marco; Ribera, Aida; Gallofré, Miquel

    2017-09-01

    To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Quasi-experimental longitudinal study. An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  15. Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Bove, Dorthe Gaby; Overgaard, Dorthe; Lomborg, Kirsten

    2015-01-01

    investigates the efficacy of a minimal home-based psychoeducative intervention versus usual care for patients with severe chronic obstructive pulmonary disease. METHODS AND ANALYSIS: The trial is a randomised controlled trial with a 4-week and 3-month follow-up. 66 patients with severe chronic obstructive...... pulmonary disease and associated anxiety will be randomised 1:1 to either an intervention or control group. The intervention consists of a single psychoeducative session in the patient's home in combination with a telephone booster session. The intervention is based on a manual, with a theoretical...

  16. [Psychiatric co-morbidity, body image problems and psychotherapeutic interventions for burn survivors: a review].

    Science.gov (United States)

    Jasper, Stefanie; Rennekampff, Hans-Oliver; de Zwaan, Martina

    2013-11-01

    Due to progress in burn treatment, more patients even with severe burn injuries survive. Despite this positive development, however, there are still negative somatic and mental consequences. These include the life-long care of scars and pain. In addition, posttraumatic-stress disorder and depression are common consequences. Also distress due to disfigurement and body image problems have to be considered, since this is likely to result in social withdrawal, low self-esteem, and reduction of quality of life. Overall, the impact of mental strain on burn victims is quite high. Therefore, psychotherapeutic treatment approaches should be integrated into the care of patients with burns. This might be helpful for both coping and compliance with long-term treatment. This paper provides a review of the mental co-morbidity of burn victims and of psychotherapeutic treatment approaches focusing on changes in body image and the respective social consequences. © Georg Thieme Verlag KG Stuttgart · New York.

  17. ATTACHMENT, RELATIONAL-NEEDS, AND PSYCHOTHERAPEUTIC PRESENCE

    Directory of Open Access Journals (Sweden)

    Richard G. Erskine

    2012-09-01

    Full Text Available Humans require the contactful presence of another person who is attuned and responsive to relational-needs. Insecure attachment patterns are the result of repeated disruptions in significant relationships. This article describes eight relational-needs that, when repeatedly unsatisfied, lead to insecure attachment patterns based on the fears of loss of relationship, vulnerability, violation, and invasion.The healing of insecure attachment patterns occurs through a contactful psychotherapeutic presence that occurs when the attitude, behavior and communication of the psychotherapist consistently respects and enhances the client's integrity while responding to relational-needs. The article is the Keynote Address given at the 5th International Integrative Psychotherapy Association Conference in Vichy, France, April 21, 2011.

  18. [Effectiveness of integrative psychotherapeutic counseling for students].

    Science.gov (United States)

    Sperth, Michael; Hofmann, Frank-Hagen; Holm-Hadulla, Rainer Mathias

    2014-06-01

    In this first effectiveness study of psychotherapeutic counseling for students in German-speaking countries, the effectiveness of an integrative model of counseling was evaluated based on a sample of 151 clients. Effectiveness of integrative counseling according to the ABCDE-model was found to be high in comparison to other international studies in this area. Pre-post differences on measures of mental distress and satisfaction were significant and effect sizes were mostly moderate to high. A high percentage of clients improved statistically and clinically significant. Counselors' expert rating and diagnostics according to ICD-10 that have been included in contrast to previous effectiveness studies showed that clients suitable for the counseling setting get treated in the counseling center while more severely disturbed clients in terms of psychopathology or diagnosis get referred to outpatient treatment, drop out or object to provide post-data. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks.

    Science.gov (United States)

    Hubschmid, M; Aybek, S; Maccaferri, G E; Chocron, O; Gholamrezaee, M M; Rossetti, A O; Vingerhoets, F; Berney, A

    2015-01-01

    The objective was to compare a brief interdisciplinary psychotherapeutic intervention to standard care as treatments for patients recently diagnosed with severe motor conversion disorder or nonepileptic attacks. This randomized controlled trial of 23 consecutive patients compared (a) an interdisciplinary psychotherapeutic intervention group receiving four to six sessions by a consultation liaison psychiatrist, the first and last sessions adding a neurological consultation and a joint psychiatric and neurological consultation, and (b) a standard care group. After intervention, patients were assessed at 2, 6 and 12 months with the Somatoform Dissociation Questionnaire (SDQ-20), Clinical Global Impression scale, Rankin scale, use of medical care, global mental health [Montgomery and Asberg Depression Rating Scale, Beck Depression Inventory, mental health component of Short Form (SF)-36] and quality of life (SF-36). We calculated linear mixed models. Our intervention brought a statistically significant improvement of physical symptoms [as measured by the SDQ-20 (P<.02) and the Clinical Global Impression scale (P=.02)] and psychological symptoms [better scores on the mental health component of the SF-36 (P<.05) and on the Beck Depression Inventory (P<.05)] and a reduction in new hospital stays after intervention (P<.05). A brief psychotherapeutic intervention taking advantage of a close collaboration with neurology consultants in the setting of consultation liaison psychiatry appears effective. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Mud-Bath Therapy in Addition to Usual Care in Bilateral Knee Osteoarthritis: An Economic Evaluation Alongside a Randomized Controlled Trial.

    Science.gov (United States)

    Ciani, Oriana; Pascarelli, Nicola Antonio; Giannitti, Chiara; Galeazzi, Mauro; Meregaglia, Michela; Fattore, Giovanni; Fioravanti, Antonella

    2017-07-01

    To perform a cost-effectiveness analysis of mud-bath therapy (MBT) in addition to usual treatment compared to usual treatment alone in patients with bilateral knee osteoarthritis (OA). An economic evaluation alongside a randomized controlled trial was conducted. Patients were randomly assigned to receive either a 2-week cycle of MBT in addition to their usual treatment or to continue routine care alone. The EuroQol 5-domain questionnaire was administered at baseline, 2 weeks, and at 3, 6, 9, and 12 months. Direct health care resource consumption data up until 12 months were derived from a daily diary given to patients and returned at prescheduled followup visits. A total of 103 patients were included (n = 53 for MBT patients; n = 50 for controls). Overall, patients in the MBT group accrued mean ± SD 0.835 ± 0.10 quality-adjusted life years (QALYs) compared to 0.753 ± 0.11 in the control group (P < 0.001). Average direct costs per patient (€303 versus €975; P < 0.001) were higher in the control group, primarily because of hospitalization for total knee replacement and use of intraarticular hyaluronic acid. Bootstrapping replications of costs and QALY sample distributions consistently indicated that the MBT therapy combined with standard therapy represents a dominant strategy as compared with standard therapy alone. The probability of MBT being cost-effective at standard cost-effectiveness thresholds (e.g., €20,000/QALY) is 100%. The results of this cost-effectiveness analysis support the use of MBT as midterm complementary therapy in the management of knee OA. © 2016, American College of Rheumatology.

  1. Early motion and directed exercise (EMADE) versus usual care post ankle fracture fixation: study protocol for a pragmatic randomised controlled trial.

    Science.gov (United States)

    Matthews, Paul A; Scammell, Brigitte E; Ali, Arfan; Coughlin, Timothy; Nightingale, Jessica; Khan, Tanvir; Ollivere, Ben J

    2018-05-31

    Following surgical fixation of ankle fractures, the traditional management has included immobilisation for 6 weeks in a below-knee cast. However, this can lead to disuse atrophy of the affected leg and joint stiffness. While early rehabilitation from 2 weeks post surgery is viewed as safe, controversy remains regarding its benefits. We will compare the effectiveness of early motion and directed exercise (EMADE) ankle rehabilitation, against usual care, i.e. 6 weeks' immobilisation in a below-knee cast. We have designed a pragmatic randomised controlled trial (p-RCT) to compare the EMADE intervention against usual care. We will recruit 144 independently living adult participants, absent of tissue-healing comorbidities, who have undergone surgical stabilisation of isolated Weber B ankle fractures. The EMADE intervention consists of a non-weight-bearing progressive home exercise programme, complemented with manual therapy and education. Usual care consists of immobilisation in a non-weight-bearing below-knee cast. The intervention period is between week 2 and week 6 post surgery. The primary outcome is the Olerud and Molander Ankle Score (OMAS) patient-reported outcome measure (PROM) at 12 weeks post surgery. Secondary PROMs include the EQ-5D-5 L questionnaire, return to work and return to driving, with objective outcomes including ankle range of motion. Analysis will be on an intention-to-treat basis. An economic evaluation will be included. The EMADE intervention is a package of care designed to address the detrimental effects of disuse atrophy and joint stiffness. An advantage of the OMAS is the potential of meta-analysis with other designs. Within the economic evaluation, the cost-utility analysis, may be used by commissioners, while the use of patient-relevant outcomes, such as return to work and driving, will ensure that the study remains pertinent to patients and their families. As it is being conducted in the clinical environment, this p-RCT has high external

  2. Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Jafar, Tazeen H; Jehan, Imtiaz; de Silva, H Asita; Naheed, Aliya; Gandhi, Mihir; Assam, Pryseley; Finkelstein, Eric A; Quigley, Helena Legido; Bilger, Marcel; Khan, Aamir Hameed; Clemens, John David; Ebrahim, Shah; Turner, Elizabeth L; Kasturiratne, Anuradhani

    2017-06-12

    High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka. This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training. The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed. Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will

  3. Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial.

    Science.gov (United States)

    Schellekens, M P J; van den Hurk, D G M; Prins, J B; Donders, A R T; Molema, J; Dekhuijzen, R; van der Drift, M A; Speckens, A E M

    2017-12-01

    Lung cancer patients report among the highest distress rates of all cancer patients. Partners report similar distress rates. The present study examined the effectiveness of additional mindfulness-based stress reduction (care as usual [CAU] + MBSR) versus solely CAU to reduce psychological distress in lung cancer patients and/or their partners. We performed a multicentre, parallel-group, randomized controlled trial. Mindfulness-based stress reduction is an 8-week group-based intervention, including mindfulness practice and teachings on stress. Care as usual included anticancer treatment, medical consultations, and supportive care. The primary outcome was psychological distress. Secondary outcomes included quality of life, caregiver burden, relationship satisfaction, mindfulness skills, self-compassion, rumination, and posttraumatic stress symptoms. Outcomes were assessed at baseline, post-intervention, and 3-month follow-up. Linear mixed modeling was conducted on an intention-to-treat sample. Moderation (gender, disease stage, baseline distress, participation with/without partner) and mediation analyses were performed. A total of 31 patients and 21 partners were randomized to CAU + MBSR and 32 patients and 23 partners to CAU. After CAU + MBSR patients reported significantly less psychological distress (p = .008, d = .69) than after CAU. Baseline distress moderated outcome: those with more distress benefitted most from MBSR. Additionally, after CAU + MBSR patients showed more improvements in quality of life, mindfulness skills, self-compassion, and rumination than after CAU. In partners, no differences were found between groups. Our findings suggest that psychological distress in lung cancer patients can be effectively treated with MBSR. No effect was found in partners, possibly because they were more focused on patients' well-being rather than their own. Copyright © 2017 John Wiley & Sons, Ltd.

  4. [Psychotherapeutic Interventions in Acute and Maintenance Treatment of Adult Patients Diagnosed With Schizophrenia].

    Science.gov (United States)

    García Valencia, Jenny; Ahunca Velásquez, Luisa Fernanda; Bohórquez Peñaranda, Adriana; Gómez Restrepo, Carlos; Jaramillo González, Luis Eduardo; Palacio Acosta, Carlos

    2014-01-01

    To determine the effectiveness of the psychotherapeutic strategies designed to improve the outcomes in adults with schizophrenia in both, acute and stable phase of disease. This evidence is used to propose recommendation in the guidelines of integral attention for the diagnosis, treatment and psychosocial rehabilitation of adults with schizophrenia. A guideline for clinical practice was developed using the methodological framework of the Ministerio de la Protección Social to collect evidence and grading recommendations. A search, evaluation and synthesis of evidence were carried out. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. The cognitive behavioral therapy showed higher efficacy, compared with the usual treatment, to reduce positive symptoms, prevent relapses and hospital readmissions and to improve the occupational stats. However, the quality of evidence was low. There was not enough evidence about the efficacy of adherence, psychodynamic and support therapy. Psychotherapeutic management must be offered to the patients with schizophrenia according to their needs and clinical characteristics. Among the different psychotherapeutic modalities, cognitive behavioral therapy is recommended. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  5. Effect of nurse home visits vs. usual care on reducing intimate partner violence in young high-risk pregnant women: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Jamila Mejdoubi

    Full Text Available BACKGROUND: Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV. The nurse-family partnership (NFP is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect of nurse home visiting on IPV is inconsistent. This study aims to study the effect of VoorZorg, the Dutch NFP, on IPV. METHODS: A random sample of 460 eligible disadvantaged women <26 years, with no previous live births, was randomized. Women in the control group (C; n=223 received usual care; women in the intervention group (I; n=237 received usual care plus nurse home visits periodically during pregnancy and until the child's second birthday. RESULTS: At 32 weeks of pregnancy, women in the intervention group self-reported significantly less IPV victimization than women in the control group in: level 2 psychological aggression (C: 56% vs. I: 39%, physical assault level 1 (C: 58% vs. I: 40% and level 2 (C: 31% vs. I: 20%, and level 1 sexual coercion (C: 16% vs. I: 8%. Furthermore, women in the intervention group reported significantly less IPV perpetration in: level 2 psychological aggression (C: 60% vs. I: 46%, level 1 physical assault (C: 65% vs. I: 52%, and level 1 injury (C: 27% vs. I: 17%. At 24 months after birth, IPV victimization was significantly lower in the intervention group for level 1 physical assault (C: 44% vs. I: 26%, and IPV perpetration was significantly lower for level 1 sexual assault (C: 18% vs. I: 3%. Multilevel analyses showed a significant improvement in IPV victimization and perpetration among women in the intervention group at 24 months after birth. CONCLUSION: VoorZorg, compared with the usual care, is effective in reducing IPV during pregnancy and in the two years after birth among young high-risk women. TRIAL REGISTRATION: Dutch Trial Register NTR854 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=854.

  6. Geriatric Logotherapy: Exploring the Psychotherapeutics of Memory in Treating the Elderly

    Directory of Open Access Journals (Sweden)

    John H. Morgan

    2012-10-01

    Full Text Available Geriatric Logotherapy is an analytical approach designed to address issues uniquely confronted in the counseling encounter with the elderly and is an adaptation of the psychotherapeutic school of thought known as Logotherapy. Logotherapy is a type of psychotherapeutic analysis and treatment which focuses on a will to meaning, founded upon the belief that striving to find meaning in one's life is the primary, most powerful motivating and driving force within the human experience. Sometimes called existential analysis, logotherapy grew out of the psychiatric research and personal experience of Viktor Frankl, M.D., based on his internment experience in Germany. Known as the Third Viennese School of Psychotherapy (Freud and Adler being the founders of the First and Second Schools, logotherapy as a school of thought emphasizes existential reflection rather than psychoanalytic repression, focusing upon the concept and centrality of “meaning” in one’s life rather than Freud’s “pleasure principle” and Adler’s “will to power.” This article explores, then, the application of this school of psychotherapeutic theory and practice to the psychological care and treatment of the elderly, emphasizing the “existential efficacy of the good memory” as an analytical tool for emotional nurture with emphasis upon “immediacy” rather than “longevity” of care and treatment.

  7. Economic evaluation of stepped-care versus usual care for depression and anxiety in older adults with vision impairment : randomized controlled trial

    NARCIS (Netherlands)

    van der Aa, Hilde P A; van Rens, Ger H M B; Bosmans, Judith E; Comijs, Hannie C; van Nispen, Ruth M A

    2017-01-01

    BACKGROUND: A stepped-care program was found effective in preventing depressive and anxiety disorders in older adults with vision impairment. However, before a decision can be made about implementation, the cost-effectiveness of this program should be investigated. Therefore, we aimed to compare the

  8. The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial

    NARCIS (Netherlands)

    Finnema, E.J.; Dr�es, R.M.; Ettema, T.P.; Ooms, M.E.; Adèr, H.J.; Ribbe, M.W.; van Tilburg, W.

    2005-01-01

    Objectives: To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants. Design: A multi-site randomized clinical trial with matched groups, and measurements at baseline and after seven months. Setting: Sixteen psychogeriatric wards in

  9. The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial

    NARCIS (Netherlands)

    Finnema, E.J.; Dr�es, R.M.; Ettema, T.P.; Ooms, M.E.; Adèr, H.J.; Ribbe, M.W.; Tilburg, van W.

    2005-01-01

    OBJECTIVES: To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants. DESIGN: A multi-site randomized clinical trial with matched groups, and measurements at baseline and after seven months. SETTING: Sixteen psychogeriatric wards in

  10. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2): a randomised trial to determine the effectiveness and cost-effectiveness of adding a complex intervention for major depressive disorder to usual care for cancer patients.

    Science.gov (United States)

    Walker, Jane; Cassidy, Jim; Sharpe, Michael

    2009-03-30

    Depression Care for People with Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. In a 'proof of concept' trial (Symptom Management Research Trials in Oncology-1) Depression Care for People with Cancer improved depression more than usual care alone. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2 Trial) will test its effectiveness and cost-effectiveness in a 'real world' setting. A two arm parallel group multi-centre randomised controlled trial. TRIAL PROCEDURES: 500 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of cancer (of various types); an estimated life expectancy of twelve months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is 'treatment response' measured at 24 week outcome data collection. 'Treatment response' will be defined as a reduction of 50% or more in the patient's baseline depression score, measured using the 20-item Symptom Checklist (SCL-20D). Secondary outcomes include remission of major depressive disorder, depression severity and patients' self-rated improvement of depression. Current controlled trials ISRCTN40568538 TRIAL HYPOTHESES: (1) Depression Care for People with Cancer as a supplement to usual care will be more effective than usual care alone in achieving a 50% reduction in baseline SCL-20D score at 24 weeks. (2) Depression Care for People with Cancer as a supplement to usual care will cost more than usual care alone but will be

  11. Effectiveness of app-based self-acupressure for women with menstrual pain compared to usual care: a randomized pragmatic trial.

    Science.gov (United States)

    Blödt, Susanne; Pach, Daniel; Eisenhart-Rothe, Sanna von; Lotz, Fabian; Roll, Stephanie; Icke, Katja; Witt, Claudia M

    2018-02-01

    Primary dysmenorrhea is common among women of reproductive age. Nonsteroidal anti-inflammatory drugs and oral contraceptives are effective treatments, although the failure rate is around 20% to 25%. Therefore additional evidence-based treatments are needed. In recent years, the use of smartphone applications (apps) has increased rapidly and may support individuals in self-management strategies. We aimed to investigate the effectiveness of app-based self-acupressure in women with menstrual pain. A 2-armed, randomized, pragmatic trial was conducted from December 2012 to April 2015 with recruitment until August 2014 in Berlin, Germany, among women aged 18 to 34 years with self-reported cramping pain of 6 or more on a numeric rating scale (NRS) for the worst pain intensity during the previous menstruation. After randomization, women performed either app-based self-acupressure (n = 111) or followed usual care only (n = 110) for 6 consecutive menstruation cycles. The primary outcome was the mean pain intensity (NRS 0-10) on the days with pain during the third menstruation. Secondary outcomes included worst pain intensity during menstruation, duration of pain, 50% responder rates (reduction of mean pain by at least 50%), medication intake, sick leave days, and body efficacy expectation assessed at the first, second, third, and sixth menstruation cycles. We included 221 women (mean age, 24.0 years; standard deviation [SD], 3.6 years). The mean pain intensity difference during the third menstruation was statistically significant in favor of acupressure (acupressure: 4.4; 95% confidence interval [CI], 4.0-4.7; usual care 5.0; 95% CI, 4.6-5.3; mean difference -0.6; 95% CI, - 1.2 to -0.1; P = .026). At the sixth cycle, the mean difference between the groups (-1.4; 95% CI, -2.0 to -0.8; P 0.5; 95% CI, 0.3-0.9] and 0.3 (95% CI, 0.2-0.5) were lower in the acupressure group. At the third cycle, hormonal contraceptive use was more common in the usual care group than in

  12. Comparative effectiveness of vildagliptin in combination with other oral anti-diabetes agents in usual-care conditions: the EDGE-Latin America study.

    Science.gov (United States)

    Mendivil, Carlos O; Márquez-Rodríguez, Eduardo; Angel, Iván D; Paz, Gustavo; Rodríguez, Cruz; Almada, Jorge; Szyskowsky, Ofelia

    2014-09-01

    To assess the proportion of patients on vildagliptin add-on dual therapy who respond to treatment over a 12 month follow-up, relative to comparator oral anti-diabetes dual therapy, in a usual care setting. Participants were patients with type 2 diabetes (T2DM) aged 18 years and older from 311 centers in Argentina, Colombia, Ecuador, Mexico and Venezuela. Patients were taking monotherapy with an oral anti-diabetes drug (OAD), and were prescribed a new add-on OAD based on the judgment of their personal physician. According to this choice, patients were assigned to one of the two cohorts: vildagliptin or comparator OADs. The primary endpoint was the proportion of patients achieving an A1c drop >0.3% without edema, hypoglycemia, weight gain or discontinuation due to gastrointestinal (GI) events. The secondary endpoint was the proportion of patients with baseline A1c ≥7% who reached the goal of an A1c vildagliptin cohort and 771 in the comparator cohort. The proportion of patients reaching the primary endpoint was higher in the vildagliptin cohort (60.3%) than the comparator cohort (50.7%), OR 1.48 (95% CI: 1.25-1.73). The same was observed for the secondary endpoint (44.8 versus 33.1%) OR 1.64 (95% CI: 1.37-1.98). The incidence of adverse events was low and similar between treatment cohorts. In a usual care setting, patients treated with a vildagliptin combination succeeded in lowering A1c to <7%, without weight gain, hypoglycemia or peripheral edema more often than patients treated with comparator combinations, without increased risk of adverse events. Key limitations are the observational nature of the study and its relatively limited 12 month timeframe.

  13. Effectiveness of manual therapy compared to usual care by the general practitioner for chronic tension-type headache: design of a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Dekker Joost

    2009-02-01

    Full Text Available Abstract Background Patients with Chronic Tension Type Headache (CTTH report functional and emotional impairments (loss of workdays, sleep disturbances, emotional well-being and are at risk for overuse of medication. Manual therapy may improve symptoms through mobilisation of the spine, correction of posture, and training of cervical muscles. We present the design of a randomised clinical trial (RCT evaluating the effectiveness of manual therapy (MT compared to usual care by the general practitioner (GP in patients with CTTH. Methods and design Patients are eligible for participation if they present in general practice with CTTH according to the classification of the International Headache Society (IHS. Participants are randomised to either usual GP care according to the national Dutch general practice guidelines for headache, or manual therapy, consisting of mobilisations (high- and low velocity techniques, exercise therapy for the cervical and thoracic spine and postural correction. The primary outcome measures are the number of headache days and use of medication. Secondary outcome measures are severity of headache, functional status, sickness absence, use of other healthcare resources, active cervical range of motion, algometry, endurance of the neckflexor muscles and head posture. Follow-up assessments are conducted after 8 and 26 weeks. Discussion This is a pragmatic trial in which interventions are offered as they are carried out in everyday practice. This increases generalisability of results, but blinding of patients, GPs and therapists is not possible. The results of this trial will contribute to clinical decision making of the GP regarding referral to manual therapy in patients with chronic tension headache.

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

    Science.gov (United States)

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

    2017-08-11

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

  15. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.

    Science.gov (United States)

    Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

    2016-10-07

    To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). 36 primary care general practices in North West England. 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision

  16. Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss.

    Science.gov (United States)

    de Buck, Petronella D M; le Cessie, Saskia; van den Hout, Wilbert B; Peeters, Andreas J; Ronday, Herman K; Westedt, Marie-Louise; Breedveld, Ferdinand C; Vliet Vlieland, Theodora P M

    2005-10-15

    Work disability is a major consequence of inflammatory rheumatic conditions. Evidence regarding the effectiveness of interventions aimed at the prevention or reduction of work disability in rheumatic diseases is limited. We conducted a randomized controlled trial to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation (VR) program in patients with a rheumatic condition who were at risk for job loss. A total of 140 patients with a chronic rheumatic condition were randomly assigned to either a multidisciplinary job-retention VR program (n = 74) or usual outpatient care (UC) (n = 66). Patients in the VR group were assessed and guided by a multidisciplinary team, whereas patients in the UC group received care as initiated by their rheumatologist, supplemented with written information. The main outcome measure was the occurrence of job loss (complete work disability or unemployment); additional outcome measures included job satisfaction, pain, functional status, emotional status, and quality of life. There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point, with 24% and 23% of the patients in the VR and UC groups, respectively, having lost their job after 24 months. Over the total period of 24 months, patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status (all P values job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss.

  17. Effectiveness of a transdiagnostic internet-based protocol for the treatment of emotional disorders versus treatment as usual in specialized care: study protocol for a randomized controlled trial.

    Science.gov (United States)

    González-Robles, Alberto; García-Palacios, Azucena; Baños, Rosa; Riera, Antonio; Llorca, Ginés; Traver, Francisco; Haro, Gonzalo; Palop, Vicente; Lera, Guillem; Romeu, José Enrique; Botella, Cristina

    2015-10-31

    Emotional disorders (depression and anxiety disorders) are highly prevalent mental health problems. Although evidence showing the effectiveness of disorder-specific treatments exists, high comorbidity rates among emotional disorders limit the utility of these protocols. This has led some researchers to focus their interest on transdiagnostic interventions, a treatment perspective that might be more widely effective across these disorders. Also, the current way of delivering treatments makes it difficult provide assistance to all of the population in need. The use of the Internet in the delivery of evidence-based treatments may help to disseminate treatments among the population. In this study, we aim to test the effectiveness of EmotionRegulation, a new transdiagnostic Internet-based protocol for unipolar mood disorders, five anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder and anxiety disorder not otherwise specified), and obsessive-compulsive disorder in comparison to treatment as usual as provided in Spanish public specialized mental health care. We will also study its potential impact on basic temperament dimensions (neuroticism/behavioral inhibition and extraversion/behavioral activation). Expectations and opinions of patients about this protocol will also be studied. The study is a randomized controlled trial. 200 participants recruited in specialized care will be allocated to one of two treatment conditions: a) EmotionRegulation or b) treatment as usual. Primary outcome measures will be the BAI and the BDI-II. Secondary outcomes will include a specific measure of the principal disorder, and measures of neuroticism/behavioral inhibition and extraversion/behavioral activation. Patients will be assessed at baseline, post-treatment, and 3- and 12-month follow-ups. Intention to treat and per protocol analyses will be performed. Although the effectiveness of face-to-face transdiagnostic protocols has been

  18. Immediate interruption of sedation compared with usual sedation care in critically ill postoperative patients (SOS-Ventilation): a randomised, parallel-group clinical trial.

    Science.gov (United States)

    Chanques, Gerald; Conseil, Matthieu; Roger, Claire; Constantin, Jean-Michel; Prades, Albert; Carr, Julie; Muller, Laurent; Jung, Boris; Belafia, Fouad; Cissé, Moussa; Delay, Jean-Marc; de Jong, Audrey; Lefrant, Jean-Yves; Futier, Emmanuel; Mercier, Grégoire; Molinari, Nicolas; Jaber, Samir

    2017-10-01

    Avoidance of excessive sedation and subsequent prolonged mechanical ventilation in intensive care units (ICUs) is recommended, but no data are available for critically ill postoperative patients. We hypothesised that in such patients stopping sedation immediately after admission to the ICU could reduce unnecessary sedation and improve patient outcomes. We did a randomised, parallel-group, clinical trial at three ICUs in France. Stratified randomisation with minimisation (1:1 via a restricted web platform) was used to assign eligible patients (aged ≥18 years, admitted to an ICU after abdominal surgery, and expected to require at least 12 h of mechanical ventilation because of a critical illness defined by a Sequential Organ Failure Assessment score >1 for any organ, but without severe acute respiratory distress syndrome or brain injury) to usual sedation care provided according to recommended practices (control group) or to immediate interruption of sedation (intervention group). The primary outcome was the time to successful extubation (defined as the time from randomisation to the time of extubation [or tracheotomy mask] for at least 48 h). All patients who underwent randomisation (except for those who were excluded after randomisation) were included in the intention-to-treat analysis. This study is registered with ClinicalTrials.gov, number NCT01486121. Between Dec 2, 2011, and Feb 27, 2014, 137 patients were randomly assigned to the control (n=68) or intervention groups (n=69). In the intention-to-treat analysis, time to successful extubation was significantly lower in the intervention group than in the control group (median 8 h [IQR 4-36] vs 50 h [29-93], group difference -33·6 h [95% CI -44·9 to -22·4]; p<0·0001). The adjusted hazard ratio was 5·2 (95% CI 3·1-8·8, p<0·0001). Immediate interruption of sedation in critically ill postoperative patients with organ dysfunction who were admitted to the ICU after abdominal surgery improved outcomes compared

  19. Living well after breast cancer randomized controlled trial protocol: evaluating a telephone-delivered weight loss intervention versus usual care in women following treatment for breast cancer.

    Science.gov (United States)

    Reeves, Marina M; Terranova, Caroline O; Erickson, Jane M; Job, Jennifer R; Brookes, Denise S K; McCarthy, Nicole; Hickman, Ingrid J; Lawler, Sheleigh P; Fjeldsoe, Brianna S; Healy, Genevieve N; Winkler, Elisabeth A H; Janda, Monika; Veerman, J Lennert; Ware, Robert S; Prins, Johannes B; Vos, Theo; Demark-Wahnefried, Wendy; Eakin, Elizabeth G

    2016-10-28

    Obesity, physical inactivity and poor diet quality have been associated with increased risk of breast cancer-specific and all-cause mortality as well as treatment-related side-effects in breast cancer survivors. Weight loss intervention trials in breast cancer survivors have shown that weight loss is safe and achievable; however, few studies have examined the benefits of such interventions on a broad range of outcomes and few have examined factors important to translation (e.g. feasible delivery method for scaling up, assessment of sustained changes, cost-effectiveness). The Living Well after Breast Cancer randomized controlled trial aims to evaluate a 12-month telephone-delivered weight loss intervention (versus usual care) on weight change and a range of secondary outcomes including cost-effectiveness. Women (18-75 years; body mass index 25-45 kg/m 2 ) diagnosed with stage I-III breast cancer in the previous 2 years are recruited from public and private hospitals and through the state-based cancer registry (target n = 156). Following baseline assessment, participants are randomized 1:1 to either a 12-month telephone-delivered weight loss intervention (targeting diet and physical activity) or usual care. Data are collected at baseline, 6-months (mid-intervention), 12-months (end-of-intervention) and 18-months (maintenance). The primary outcome is change in weight at 12-months. Secondary outcomes are changes in body composition, bone mineral density, cardio-metabolic and cancer-related biomarkers, metabolic health and chronic disease risk, physical function, patient-reported outcomes (quality of life, fatigue, menopausal symptoms, body image, fear of cancer recurrence) and behaviors (dietary intake, physical activity, sitting time). Data collected at 18-months will be used to assess whether outcomes achieved at end-of-intervention are sustained six months after intervention completion. Cost-effectiveness will be assessed, as will mediators and moderators of

  20. Psychotherapeutic counseling and pregnancy rates in in vitro fertilization.

    Science.gov (United States)

    Poehl, M; Bichler, K; Wicke, V; Dörner, V; Feichtinger, W

    1999-07-01

    Since the Austrian propagation bill of July 1, 1992, was passed into law, Austrian physicians are committed to offer psychological counseling to women before performing assisted reproductive techniques, unless refused by the patient. The acceptance of psychotherapeutic counseling (PSITCO) and its influence on pregnancy rate were carefully reviewed. The study comprised 1156 consecutive patients (mean age, 33.3 years) and 1736 in vitro fertilization (IVF) cycles. In a consent form for follicle puncture, the patients were interviewed about PSITCO as follows. Several methods of psychological support during IVF-embryo transfer treatment were offered to patients especially psychotherapy, hypnotherapy, and relaxation and physical perception exercises. Forty-two and three-tenths percent of patients rejected PSITCO, 17.8% had already received PSITCO, and 10.4% were willing to undergo PSITCO. The acceptance of PSITCO had no relevance on pregnancy rate. The cumulative calculation of pregnancy rates showed that up to 56.4% of women who had undergone PSITCO conceived. In patients who were planning to undergo PSITCO, the pregnancy rate was 41.9%. Concerning the cumulative pregnancy rate, this study showed that patients who accepted or underwent PSITCO had a higher pregnancy rate than those who did not avail themselves of this possibility. These results should encourage sterility specialists to consider psychological therapy as an essential aspect of IVF. Solely a written declaration of the patient stating his/her awareness of the possibility to undergo PSITCO is, in our opinion, insufficient.

  1. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial

    Directory of Open Access Journals (Sweden)

    Bergman Gert JD

    2010-09-01

    Full Text Available Abstract Background Shoulder complaints are common in primary care and have unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC by the general practitioner in the treatment of shoulder complaints. Methods This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy and were allocated at random (yes/no to manipulative therapy (manipulation and mobilization. Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Results Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%, but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (€1167 vs. €555. This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at €2876. Conclusion Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. International Standard

  2. 'Pragmatic randomized controlled trial of individually prescribed exercise versus usual care in a heterogeneous cancer survivor population': a feasibility study PEACH trial: prescribed exercise after chemotherapy.

    LENUS (Irish Health Repository)

    Walsh, Julie M

    2010-01-01

    BACKGROUND: Many cancer survivors suffer a range of physical and psychological symptoms which may persist for months or years after cessation of treatment. Despite the known benefits of exercise and its potential to address many of the adverse effects of treatment, the role of exercise as well as optimum duration, frequency, and intensity in this population has yet to be fully elucidated. Many cancer rehabilitation programmes presented in the literature are very long and have tight eligibility criteria which make them non-applicable to the majority of cancer survivors. This paper presents the protocol of a novel 8-week intervention which aims to increase fitness, and address other physical symptoms in a heterogeneous cancer survivor population. METHODS\\/DESIGN: The aim is to recruit 64 cancer survivors 2-6 months after completion of chemotherapy, usually adjuvant, with curative intent. Subjects will be recruited through oncology clinics in a single institution and randomised to usual care or an exercise intervention. The exercise intervention consists of two specifically tailored supervised moderate intensity aerobic exercise sessions weekly over 8-weeks. All participants will be assessed at baseline (0 weeks), at the end of the intervention (8 weeks), and at 3-month follow-up. The primary outcome measure is fitness, and secondary patient-related outcome measures include fatigue, quality of life, and morphological outcomes. A further secondary outcome is process evaluation including adherence to and compliance with the exercise program. DISCUSSION: This study will provide valuable information about the physical outcomes of this 8-week supervised aerobic programme. Additionally, process information and economic evaluation will inform the feasibility of implementing this program in a heterogeneous population post cessation of chemotherapy.

  3. Revascularization and cardioprotective drug treatment in myocardial infarction patients: how do they impact on patients' survival when delivered as usual care

    Directory of Open Access Journals (Sweden)

    Courteau Josiane

    2006-05-01

    Full Text Available Abstract Background Randomized clinical trials showed the benefit of pharmacological and revascularization treatments in secondary prevention of myocardial infarction (MI, in selected population with highly controlled interventions. The objective of this study is to measure these treatments' impact on the cardiovascular (CV mortality rate among patients receiving usual care in the province of Quebec. Methods The study population consisted of a "naturalistic" cohort of all patients ≥ 65 years old living in the Quebec province, who survived a MI (ICD-9: 410 in 1998. The studied dependant variable was time to death from a CV disease. Independent variables were revascularization procedure and cardioprotective drugs. Death from a non CV disease was also studied for comparison. Revascularization procedure was defined as percutaneous transluminal coronary angioplasty (PTCA or coronary artery bypass graft (CABG. The exposure to cardioprotective drugs was defined as the number of cardioprotective drug classes (Acetylsalicylic Acid (ASA, Beta-Blockers, Angiotensin-Converting Enzyme (ACE Inhibitors, Statins claimed within the index period (first 30 days after the index hospitalization. Age, gender and a comorbidity index were used as covariates. Kaplan-Meier survival curves, Cox proportional hazard models, logistic regressions and regression trees were used. Results The study population totaled 5596 patients (3206 men; 2390 women. We observed 1128 deaths (20% within two years following index hospitalization, of them 603 from CV disease. The CV survival rate at two years is much greater for patients with revascularization, regardless of pharmacological treatments. For patients without revascularization, the CV survival rate increases with the number of cardioprotective drug classes claimed. Finally, Cox proportional hazard models, regression tree and logistic regression analyses all revealed that the absence of revascularization and, to a lower extent

  4. Efficacy and cost-effectiveness of a specialist depression service versus usual specialist mental health care to manage persistent depression: a randomised controlled trial.

    Science.gov (United States)

    Morriss, Richard; Garland, Anne; Nixon, Neil; Guo, Boliang; James, Marilyn; Kaylor-Hughes, Catherine; Moore, Richard; Ramana, Rajini; Sampson, Christopher; Sweeney, Timothy; Dalgleish, Tim

    2016-09-01

    Persistent moderate or severe unipolar depression is common and expensive to treat. Clinical guidelines recommend combined pharmacotherapy and psychotherapy. Such treatments can take up to 1 year to show an effect, but no trials of suitable duration have been done. We investigated the efficacy and cost-effectiveness of outpatient-based, specialist depression services (SDS) versus treatment as usual (TAU) on depression symptoms and function. We did a multicentre, single-blind, patient-level, parallel, randomised controlled trial (RCT), as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) study, in three mental health outpatient settings in England. Eligible participants were in secondary care, were older than 18 years, had unipolar depression (with a current major depressive episode, a 17-item Hamilton Depression Rating Scale [HDRS17] score of ≥16, and a Global Assessment of Function [GAF] score of ≤60), and had not responded to 6 months or more of treatment for depression. Randomisation was stratified by site with allocation conveyed to a trial administrator, with research assessors masked to outcome. Patients were randomised (1:1) using a computer-generated pseudo-random code with random permuted blocks of varying sizes of two, four, or six to either SDS (collaborative care approach between psychiatrists and cognitive behavioural therapists for 12 months, followed by graduated transfer of care up to 15 months) or to the TAU group. Intention-to-treat primary outcome measures were changes in HDRS17 and GAF scores between baseline and 6, 12, and 18 months' follow-up. We will separately publish follow-up outcomes for months 24 and 36. Clinical efficacy and cost-effectiveness were examined from health and social care persp ectives at 18 months, as recommended by the National Institute for Health and Care Excellence. This trial is registered at ClinicalTrials.gov (NCT01047124) and the

  5. A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management.

    Science.gov (United States)

    Thomas, Mary Laudon; Elliott, Janette E; Rao, Stephen M; Fahey, Kathleen F; Paul, Steven M; Miaskowski, Christine

    2012-01-01

    To test the effectiveness of two interventions compared to usual care in decreasing attitudinal barriers to cancer pain management, decreasing pain intensity, and improving functional status and quality of life (QOL). Randomized clinical trial. Six outpatient oncology clinics (three Veterans Affairs [VA] facilities, one county hospital, and one community-based practice in California, and one VA clinic in New Jersey)Sample: 318 adults with various types of cancer-related pain. Patients were randomly assigned to one of three groups: control, standardized education, or coaching. Patients in the education and coaching groups viewed a video and received a pamphlet on managing cancer pain. In addition, patients in the coaching group participated in four telephone sessions with an advanced practice nurse interventionist using motivational interviewing techniques to decrease attitudinal barriers to cancer pain management. Questionnaires were completed at baseline and six weeks after the final telephone calls. Analysis of covariance was used to evaluate for differences in study outcomes among the three groups. Pain intensity, pain relief, pain interference, attitudinal barriers, functional status, and QOL. Attitudinal barrier scores did not change over time among groups. Patients randomized to the coaching group reported significant improvement in their ratings of pain-related interference with function, as well as general health, vitality, and mental health. Although additional evaluation is needed, coaching may be a useful strategy to help patients decrease attitudinal barriers toward cancer pain management and to better manage their cancer pain. By using motivational interviewing techniques, advanced practice oncology nurses can help patients develop an appropriate plan of care to decrease pain and other symptoms.

  6. Treatment of chronically depressed patients: A multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP for chronic depressions versus usual secondary care

    Directory of Open Access Journals (Sweden)

    Penninx Brenda WJH

    2008-03-01

    Full Text Available Abstract Background 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP is a form of psychotherapy specifically developed for patients with chronic depression. In a study in the U.S., remarkable favorable effects of CBASP have been demonstrated. However, no other studies have as yet replicated these findings and CBASP has not been tested outside the United States. This protocol describes a randomized controlled trial on the effectiveness of CBASP in the Netherlands. Methods/Design The purpose of the present paper is to report the study protocol of a multisite randomized controlled trial testing the effectiveness of 'Cognitive Behavioral Analysis System of Psychotherapy' (CBASP for chronic depression in the Netherlands. In this study, CBASP in combination with medication, will be tested versus usual secondary care in combination with medication. The aim is to recruit 160 patients from three mental health care organizations. Depressive symptoms will be assessed at baseline, after 8 weeks, 16 weeks, 32 weeks and 52 weeks, using the 28-item Inventory for Depressive Symptomatology (IDS. Effect modification by co morbid anxiety, alcohol consumption, general and social functioning and working alliance will be tested. GEE analyses of covariance, controlling for baseline value and center will be used to estimate the overall treatment effectiveness (difference in IDS score at post-treatment and follow up. The primary analysis will be by 'intention to treat' using double sided tests. An economic analysis will compare the two groups in terms of mean costs and cost-effectiveness from a societal perspective. Discussion The study will provide an answer to the question whether the favorable effects of CBASP can be replicated outside the US. Trial Registration The Dutch Cochrane Center, NTR1090.

  7. An economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy: An interim analysis.

    Science.gov (United States)

    de Kinderen, Reina J A; Lambrechts, Danielle A J E; Wijnen, Ben F M; Postulart, Debby; Aldenkamp, Albert P; Majoie, Marian H J M; Evers, Silvia M A A

    2016-01-01

    To gain insight into the cost-effectiveness of the ketogenic (KD) diet compared with care as usual (CAU) in children and adolescents with intractable epilepsy, we conducted an economic evaluation from a societal perspective, alongside a randomized controlled trial. Participants from a tertiary epilepsy center were randomized into KD (intervention) group or CAU (control) group. Seizure frequency, quality adjusted life years (QALYs), health care costs, production losses of parents and patient, and family costs were assessed at baseline and during a 4-month study period and compared between the intervention and control groups. The incremental cost-effectiveness ratios (ICERs) (i.e., cost per QALY and cost per responder), and cost-effectiveness acceptability curves (CEACs) were calculated and presented. In total, 48 children were included in the analyses of this study (26 KD group). At 4 months, 50% of the participants in the KD group had a seizure reduction ≥50% from baseline, compared with 18.2 of the participants in the CAU group. The mean costs per patient in the CAU group were €15,245 compared to €20,986 per patient in the KD group, resulting in an ICER of €18,044 per responder. We failed, however, to measure any benefits in terms of QALYs and therefore, the cost per QALY rise high above any acceptable ceiling ratio. It might be that the quality of life instruments used in this study were not sufficiently sensitive to detect changes, or it might be that being a clinical responder is not sufficient to improve a patient's quality of life. Univariate and multivariate sensitivity analyses and nonparametric bootstrapping were performed and demonstrated the robustness of our results. The results show that the KD reduces seizure frequency. The study did not find any improvements in quality of life and, therefore, unfavorable cost per QALY ratio's resulted. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  8. Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up.

    Science.gov (United States)

    Mehlum, Lars; Ramberg, Maria; Tørmoen, Anita J; Haga, Egil; Diep, Lien M; Stanley, Barbara H; Miller, Alec L; Sund, Anne M; Grøholt, Berit

    2016-04-01

    We conducted a 1-year prospective follow-up study of posttreatment clinical outcomes in adolescents with recent and repetitive self-harm who had been randomly allocated to receive 19 weeks of either dialectical behavior therapy adapted for adolescents (DBT-A) or enhanced usual care (EUC) at community child and adolescent psychiatric outpatient clinics. Assessments of self-harm, suicidal ideation, depression, hopelessness, borderline symptoms, and global level of functioning were made at the end of the 19-week treatment period and at follow-up 1 year later. Altogether 75 of the 77 (97%) adolescents participated at both time points. Frequencies of hospitalizations, emergency department visits and other use of mental health care during the 1-year follow-up period were recorded. Change analyses were performed using mixed effects linear spline regression and mixed effect Poisson regression with robust variance. Over the 52-week follow-up period, DBT-A remained superior to EUC in reducing the frequency of self-harm. For other outcomes such as suicidal ideation, hopelessness, and depressive or borderline symptoms and for the global level of functioning, inter-group differences apparent at the 19-week assessment were no longer observed, mainly due to participants in the EUC group having significantly improved on these dimensions over the follow-up year, whereas DBT-A participants remained unchanged. A stronger long-term reduction in self-harm and a more rapid recovery in suicidal ideation, depression, and borderline symptoms suggest that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior. Treatment for Adolescents With Deliberate Self Harm; http://clinicaltrials.gov/; NCT00675129. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  9. Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial.

    Science.gov (United States)

    Nadeau, Stephen E; Wu, Samuel S; Dobkin, Bruce H; Azen, Stanley P; Rose, Dorian K; Tilson, Julie K; Cen, Steven Y; Duncan, Pamela W

    2013-05-01

    After inpatient stroke rehabilitation, many people still cannot participate in community activities because of limited walking ability. To compare the effectiveness of 2 conceptually different, early physical therapy (PT) interventions to usual care (UC) in improving walking 6 months after stroke. The locomotor experience applied post-stroke (LEAPS) study was a single-blind, randomized controlled trial conducted in 408 adults with disabling hemiparetic stroke. Participants were stratified at baseline (2 months) by impairment in walking speed: severe (exercise at home (home exercise program [HEP], n = 126). LTP participants were 18% more likely to transition to a higher functional walking level: severe to >0.4 m/s and moderate to >0.8 m/s than UC participants (95% confidence interval [CI] = 7%-29%), and HEP participants were 17% more likely to transition (95% CI = 5%-29%). Mean gain in walking speed in LTP participants was 0.13 m/s greater (95% CI = 0.09-0.18) and in HEP participants, 0.10 m/s greater (95% CI = 0.05-0.14) than in UC participants. Progressive PT, using either walking training on a treadmill and overground, conducted in a clinic, or strength and balance exercises conducted at home, was superior to UC in improving walking, regardless of severity of initial impairment.

  10. The HAQ compared with the MDHAQ: "keep it simple, stupid" (KISS), with feasibility and clinical value as primary criteria for patient questionnaires in usual clinical care.

    Science.gov (United States)

    Pincus, Theodore; Swearingen, Christopher J

    2009-11-01

    The health assessment questionnaire (HAQ) is the questionnaire most widely used to assess and monitor patients with rheumatic diseases. The HAQ includes 20 activities grouped into 8 categories of 2 or 3 (and queries the use of "aids and devices" and "help from another person" to perform these activities), and visual analog scales (VAS) for pain and patient global estimate of status. Use of the HAQ in usual care over the years has led to several modifications to develop a multidimensional HAQ (MDHAQ). The MDHAQ includes 10 activities, one from each category of the HAQ plus 2 complex activities-walk 2 miles or 3 km-all on one side of a page for easy "eyeball" review by a clinician; pain, global and fatigue VAS with 21 circles rather than 10-cm lines for ease of scoring; recent medical history; review of systems; a query about exercise; and scoring templates for the 3 rheumatoid arthritis (RA) Core Data Set patient-reported measures-physical function, pain, and global estimate-for a routine assessment of patient index data (RAPID3) composite score. Both the HAQ and MDHAQ involve 2 sides of one sheet of paper, and are completed by patients in 5 to 10 minutes. The HAQ requires 42 seconds to score, compared with 5 to 10 seconds for RAPID3 on the MDHAQ.

  11. Preliminary examination of metabolic syndrome response to motivational interviewing for weight loss as compared to an attentional control and usual care in primary care for individuals with and without binge-eating disorder.

    Science.gov (United States)

    Barnes, Rachel D; Barber, Jessica A

    2017-08-01

    Motivational interviewing (MI) treatment for weight loss is being studied in primary care. The effect of such interventions on metabolic syndrome or binge eating disorder (BED), both highly related to excess weight, has not been examined in primary care. This study conducted secondary analyses from a randomized controlled trial to test the impact of MI for weight loss in primary care on metabolic syndrome. 74 adult participants with overweight/obesity recruited through primary care were randomized to 12weeks of either MI, an attentional control, or usual care. Participants completed measurements for metabolic syndrome at pre- and post-treatment. There were no statistically significant differences in metabolic syndrome rates at pre-, X 2 (2)=0.16, p=0.921, or post-, X 2 (2)=0.852, p=0.653 treatment. The rates in metabolic syndrome, however, decreased for MI (10.2%) and attentional control (13.8%) participants, but not for usual care. At baseline, metabolic syndrome rates did not differ significantly between participants with BED or without BED across treatments. At post-treatment, participants with BED were significantly more likely to meet criteria for metabolic syndrome than participants without BED, X 2 (1)=5.145, p=0.023, phi=0.273. Across treatments, metabolic syndrome remitted for almost a quarter of participants without BED (23.1%) but for 0% of those with BED. These preliminary results are based on a small sample and should be interpreted with caution, but they are the first to suggest that relatively low intensity MI weight loss interventions in primary care may decrease metabolic syndrome rates but not for individuals with BED. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Effectiveness of psychotherapeutic consultation in the workplace: a controlled observational trial.

    Science.gov (United States)

    Rothermund, Eva; Gündel, Harald; Rottler, Edit; Hölzer, Michael; Mayer, Dorothea; Rieger, Monika; Kilian, Reinhold

    2016-08-26

    This study compares the effectiveness of psychotherapeutic consultation in the workplace (PSIW) with psychotherapeutic outpatient care (PSOC) in Germany. Work ability (WAI), quality of life (SF-12), clinical symptoms (PHQ) and work-related stress (MBI, IS) were assessed in 367 patients seeking mental health care via two routes (PSIW n = 174; PSOC n = 193) before consultation and 12 weeks later. Changes in outcome variables were assessed using covariance analysis with repeated measures (ANCOVA) with sociodemographic variables (propensity score method), therapy dose, setting and symptom severity as covariates. The PSIW and PSOC groups included 122 and 66 men respectively. There were 102 first-time users of mental healthcare in the PSIW group and 83 in the PSOC group. There were group differences in outcome variables at baseline (p effect of group on outcome variables and no group*time interaction. Work-related stress indicators did not change during the intervention, but work ability improved in both groups (F = 10.149, p = 0.002; baseline M = 27.2, SD = 8.85); follow-up M = 28.6, SD = 9.02), as did perceived mental health (SF-12 MCS), depression (PHQ-9) and anxiety (PHQ-7). Effect sizes were between η(2) = 0.028 and η(2) = 0.040. Psychotherapeutic consultation is similarly effective in improving patients' functional and clinical status whether delivered in the workplace or in an outpatient clinic. Offering mental health services in the workplace makes it easier to reach patients at an earlier stage in their illness and thus enables provision of early and effective mental health care. DRKS00003184 , retrospectively registered 13 January 2012.

  13. Two-Year Stability and Change in Access to and Reasons for Lacking a Usual Source of Care Among Working-Age US Adults.

    Science.gov (United States)

    Stransky, Michelle L

    The objective of this study was to investigate usual source of care (USC) over time. A nationally representative sample of working-age adults in the Medical Expenditure Panel Survey (Panels 16 [2011-2012] and 17 [2012-2013]) was divided into 3 groups based on USC questions asked during 2 waves: (1) those having a USC during both waves (always USC), (2) those not having a USC during either wave (never USC), and (3) those who gained or lost a USC between the 2 waves (changed USC). The study examined the sociodemographic and health characteristics associated with these groups and the main reasons for not having a USC among those who never had a USC and those who changed their USC. Of the 10 792 adults in the analysis, a longitudinally weighted 18.8% reported that their USC changed during the period. Among adults in the changed USC group, those with private (odds ratio [OR] = 2.0, P = .001) or public (OR = 2.2, P = .001) health insurance and 1 (OR = 1.7, P = .04) or ≥2 (OR = 3.1, P = .02) chronic health conditions were more likely to transition to having a USC from not having a USC, compared with those who had no insurance and no chronic conditions. Compared with those in the changed USC group, those in the never USC group were more likely to report preferring not to have a USC (57.9% vs 80.1%, P USC and increase the number of adults with ongoing, consistent USC.

  14. Reports of "satisfactory relief" by IBS patients receiving usual medical care are confounded by baseline symptom severity and do not accurately reflect symptom improvement.

    Science.gov (United States)

    Whitehead, William E; Palsson, Olafur S; Levy, Rona L; Feld, Andrew D; VonKorff, Michael; Turner, Marsha

    2006-05-01

    Treatment trials for irritable bowel syndrome (IBS) usually define a responder as a patient who reports satisfactory relief or adequate relief of symptoms at the end of the trial. However, these measures have not been adequately validated. (1) Compare a binary satisfactory relief measure to alternative ways of defining a treatment responder. (2) Determine whether baseline IBS symptom severity or psychological distress influence the sensitivity of these outcome measures. A total of 350 patients (81% females, average age 50 yr) who had a medical diagnosis of IBS and satisfied Rome II criteria, were recruited from Group Health Cooperative of Puget Sound. At baseline the Irritable Bowel Severity Scale (IBSS) was used to assess symptom severity and to classify patients as mild, moderate, or severe. Psychological distress and IBS-specific quality of life (IBS-QOL) were also assessed. After 6 months treatment with standard medical care, IBSS and IBS-QOL were reassessed, and patients were asked whether they had experienced satisfactory relief and whether they were somewhat or markedly better. Initial severity of IBS significantly affected the proportion who reported satisfactory relief (mild, 72%; moderate, 53%; severe, 44%) and the proportion who were somewhat or markedly better (mild, 62%; moderate, 44%; severe, 38%), but did not affect the proportion with a 50% reduction in symptoms (mild, 26%; moderate, 25%; severe, 23%). Although mild patients were the most likely to report satisfactory relief, they showed no average decrease in symptom severity or improvement in IBS-QOL. Conversely, severe patients, who were the least likely to report satisfactory relief, had the largest reductions in IBS symptom severity and the largest improvements in IBS-QOL. Psychological distress had no significant effect on the responder rate after adjusting for IBS symptom severity. These data from a descriptive study suggest that satisfactory relief is confounded with initial IBS symptom

  15. Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil).

    Science.gov (United States)

    de Negreiros Cabral, Kelem; Perracini, Monica Rodrigues; Soares, Aline Thomaz; de Cristo Stein, Francine; Sera, Celisa Tiemi Nakagawa; Tiedemann, Anne; Sherrington, Cathie; Filho, Wilson Jacob; Paschoal, Sérgio Márcio Pacheco

    2013-03-15

    Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. This study is the

  16. Return-to-work intervention versus usual care for sick-listed employees: health-economic investment appraisal alongside a cluster randomised trial

    Science.gov (United States)

    Lokman, Suzanne; Volker, Danielle; Zijlstra-Vlasveld, Moniek C; Brouwers, Evelien PM; Boon, Brigitte; Beekman, Aartjan TF; Smit, Filip; Van der Feltz-Cornelis, Christina M

    2017-01-01

    Objective To evaluate the health-economic costs and benefits of a guided eHealth intervention (E-health module embedded in Collaborative Occupational healthcare (ECO)) encouraging sick-listed employees to a faster return to work. Design A two-armed cluster randomised trial with occupational physicians (OPs) (n=62), clustered and randomised by region into an experimental and a control group, to conduct a health-economic investment appraisal. Online self-reported data were collected from employees at baseline, after 3, 6, 9 and 12 months. Setting Occupational health care in the Netherlands. Participants Employees from small-sized and medium-sized companies (≥18 years), sick-listed between 4 and 26 weeks with (symptoms of) common mental disorders visiting their OP. Interventions In the intervention group, employees (N=131) received an eHealth module aimed at changing cognitions regarding return to work, while OPs were supported by a decision aid for treatment and referral options. Employees in the control condition (N=89) received usual sickness guidance. Outcomes Measures Net benefits and return on investment based on absenteeism, presenteeism, health care use and quality-adjusted life years (QALYs) gained. Results From the employer’s perspective, the incremental net benefits were €3187 per employee over a single year, representing a return of investment of €11 per invested Euro, with a break-even point at 6 months. The economic case was also favourable from the employee’s perspective, partly because of QALY health gains. The intervention was costing €234 per employee from a health service financier’s perspective. The incremental net benefits from a social perspective were €4210. This amount dropped to €3559 in the sensitivity analysis trimming the 5% highest costs. Conclusions The data suggest that the ECO intervention offers good value for money for virtually all stakeholders involved, because initial investments were more than recouped within a

  17. Comparative Effectiveness of Homoeopathic vs. Conventional Therapy in Usual Care of Atopic Eczema in Children: Long-Term Medical and Economic Outcomes

    Science.gov (United States)

    Roll, Stephanie; Reinhold, Thomas; Pach, Daniel; Brinkhaus, Benno; Icke, Katja; Staab, Doris; Jäckel, Tanja; Wegscheider, Karl; Willich, Stefan N.; Witt, Claudia M.

    2013-01-01

    Background One in five children visiting a homeopathic physician suffers from atopic eczema. Objectives We aimed to examine the long-term effectiveness, safety and costs of homoeopathic vs. conventional treatment in usual medical care of children with atopic eczema. Methods In this prospective multi-centre comparative observational non-randomized rater-blinded study, 135 children (48 homoeopathy, 87 conventional) with mild to moderate atopic eczema were included by their respective physicians. Depending on the specialisation of the physician, the primary treatment was either standard conventional treatment or individualized homeopathy as delivered in routine medical care. The main outcome was the SCORAD (SCORing Atopic Dermatitis) at 36 months by a blinded rater. Further outcomes included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months after baseline. A multilevel ANCOVA was used, with physician as random effect and the following fixed effects: age, gender, baseline value, severity score, social class and parents’ expectation. Results The adjusted mean SCORAD showed no significant differences between the groups at 36 months (13.7 95% CI [7.9–19.5] vs. 14.9 [10.4–19.4], p = 0.741). The SCORAD response rates at 36 months were similar in both groups (33% response: homoeopathic 63.9% vs. conventional 64.5%, p = 0.94; 50% response: 52.0% vs. 52.3%, p = 0.974). Total costs were higher in the homoeopathic versus the conventional group (months 31–36 200.54 Euro [132.33–268.76] vs. 68.86 Euro [9.13–128.58], p = 0.005). Conclusions Taking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs. PMID:23383019

  18. Screening for distress, the 6th vital sign: common problems in cancer outpatients over one year in usual care: associations with marital status, sex, and age

    Directory of Open Access Journals (Sweden)

    Giese-Davis Janine

    2012-10-01

    Full Text Available Abstract Background Very few studies examine the longitudinal prevalence of problems and the awareness or use of clinical programs by patients who report these problems. Of the studies that examine age, gender and marital status as predictors of a range of patient outcomes, none examines the interactions between these demographic variables. This study examined the typical trajectory of common practical and psychosocial problems endorsed over 12 months in a usual-care sample of cancer outpatients. Specifically, we examined whether marital status, sex, age, and their interactions predicted these trajectories. We did not actively triage or refer patients in this study in order to examine the natural course of problem reports. Methods Patients completed baseline screening (N = 1196 of 1707 approached and the sample included more men (N = 696 than women (N = 498, average age 61.1 years. The most common diagnoses were gastrointestinal (27.1%, prostate (19.2%, skin (11.1% and gynecological (9.2%. Among other measures, patients completed a Common Problem Checklist and Psychosocial Resources Use questions at baseline, 3, 6, and 12 months using paper and pencil surveys. Results Results indicated that patients reported psychosocial problems more often than practical and both decreased significantly over time. Younger single patients reported more practical problems than those in committed relationships. Younger patients and women of all ages reported more psychosocial problems. Among a number of interesting interactions, for practical problems, single older patients improved more; whereas among married people, younger patients improved more. For psychosocial problems we found that older female patients improved more than younger females, but among males, it was younger patients who improved more. Young single men and women reported the most past-and future-use of services. Conclusions Younger women are particularly vulnerable to experiencing

  19. The effect of African breath psychotherapeutic workshops on ...

    African Journals Online (AJOL)

    The aim of this research was to investigate the effect of an African breath psychotherapeutic workshop called Shiso on spirituality perceptions and experiences. In view of previous pilot study findings, it was hypothesized that further Shiso workshops with enlarged samples would improve participants' spirituality in ...

  20. Psychotherapeutic treatment levels of personality disorders in older adults

    NARCIS (Netherlands)

    Videler, Arjan; Cornelis, Christina; Rossi, G.; van Royen, R.J.J.; Rosowsky, E.; van Alphen, S.P.J.

    2015-01-01

    Treatment of personality disorders (PDs) in older adults is a highly underexplored topic. In this article clinical applicability of the findings from a recent Delphi study regarding treatment aspects of PDs in older adults is explored. This concerns the relevance of three psychotherapeutic treatment

  1. Barriers and facilitators for the implementation of an online clinical health community in addition to usual fertility care: a cross-sectional study.

    Science.gov (United States)

    Aarts, Johanna W M; Faber, Marjan J; den Boogert, Anne G; Cohlen, Ben J; van der Linden, Paul J Q; Kremer, Jan A M; Nelen, Willianne L D M

    2013-08-30

    not feeling the need for such an online health community. After subscription, determinants for participation consisted of aspects related to participant's age (OR 0.86, 95% CI 0.76-0.97), length of infertility (OR 1.48, 05% CI 1.09-2.02), and to intervention-related facilitators (OR 5.79, 95% CI 2.40-13.98), such as its reliable character and possibility to interact with the medical team and peers. Implementing an online health community in addition to usual fertility care should be performed stepwise. At least 2 strategies are needed to increase the proportion of patient subscribers and consequently make them active participants. First, the marketing strategy should contain information tailored to different subgroups of the patient population. Second, for a living online health community, incorporation of interactive elements, as well as frequent news and updates are needed. These results imply that involving patients and their needs into the promotion strategy, community's design, and implementation are crucial.

  2. Clinical- and cost-effectiveness of the STAR care pathway compared to usual care for patients with chronic pain after total knee replacement: study protocol for a UK randomised controlled trial.

    Science.gov (United States)

    Wylde, Vikki; Bertram, Wendy; Beswick, Andrew D; Blom, Ashley W; Bruce, Julie; Burston, Amanda; Dennis, Jane; Garfield, Kirsty; Howells, Nicholas; Lane, Athene; McCabe, Candy; Moore, Andrew J; Noble, Sian; Peters, Tim J; Price, Andrew; Sanderson, Emily; Toms, Andrew D; Walsh, David A; White, Simon; Gooberman-Hill, Rachael

    2018-02-21

    Approximately 20% of patients experience chronic pain after total knee replacement. There is little evidence for effective interventions for the management of this pain, and current healthcare provision is patchy and inconsistent. Given the complexity of this condition, multimodal and individualised interventions matched to pain characteristics are needed. We have undertaken a comprehensive programme of work to develop a care pathway for patients with chronic pain after total knee replacement. This protocol describes the design of a randomised controlled trial to evaluate the clinical- and cost-effectiveness of a complex intervention care pathway compared with usual care. This is a pragmatic two-armed, open, multi-centred randomised controlled trial conducted within secondary care in the UK. Patients will be screened at 2 months after total knee replacement and 381 patients with chronic pain at 3 months postoperatively will be recruited. Recruitment processes will be optimised through qualitative research during a 6-month internal pilot phase. Patients are randomised using a 2:1 intervention:control allocation ratio. All participants receive usual care as provided by their hospital. The intervention comprises an assessment clinic appointment at 3 months postoperatively with an Extended Scope Practitioner and up to six telephone follow-up calls over 12 months. In the assessment clinic, a standardised protocol is followed to identify potential underlying causes for the chronic pain and enable appropriate onward referrals to existing services for targeted and individualised treatment. Outcomes are assessed by questionnaires at 6 and 12 months after randomisation. The co-primary outcomes are pain severity and pain interference assessed using the Brief Pain Inventory at 12 months after randomisation. Secondary outcomes relate to resource use, function, neuropathic pain, mental well-being, use of pain medications, satisfaction with pain relief, pain frequency, capability

  3. Modelling the cost-effectiveness of pregabalin versus usual care in daily practice in the treatment of refractory generalised anxiety disorder in Spain.

    Science.gov (United States)

    De Salas-Cansado, Marina; Álvarez, Enrique; Olivares, José M; Carrasco, Jose L; Ferro, M Belén; Rejas, Javier

    2013-06-01

    To model the cost-effectiveness (CEA) of the use of pregabalin versus usual care (UC) in outpatients with refractory generalised anxiety disorder (GAD) treated in daily practice in mental health settings in Spain. This CEA model used data extracted from a 6-month prospective non-interventional trial: the Amplification of Definition of ANxiety (ADAN) study, which was conducted to determine the cost-of-illness in GAD subjects. Refractory subjects were those who reported persistent symptoms of anxiety and showed suboptimal response in the Hamilton-anxiety scale (HAM-A ≥ 16) after a standard dose regimen of anxiolytics other than pregabalin, alone or in combination, over 6 months. The pregabalin arm was documented with data extracted from patients who received pregabalin in the study for the first time, added or replacing the existing therapy. In the UC arm, treatment might include one or more of the following: a serotonin selective reuptake inhibitor, a serotonin-norepinephrine reuptake inhibitor, other anti-depressants, a benzodiazepine or an anti-epileptic drug other than pregabalin. The time horizon of the modelling was 6 months in the base-case scenario, and the National Health System perspective was chosen to calculate costs. Effectiveness was expressed as quality-adjusted life years (QALYs) gained, which were derived using the EQ-5D questionnaire, at baseline and end-of-trial visits. Results of the CEA model was expressed as an incremental cost-effectiveness ratio (ICER) per QALY gained. Probabilistic sensitivity analysis using bootstrapping techniques was also carried out to obtain the cost-effectiveness plane and the corresponding acceptability curve. Data from a total of 429 subjects per arm (mean HAM-A score 25.7) meeting eligible criteria for inclusion in CEA modelling were extracted from the original trial. Compared with UC, pregabalin (average dose 218 mg/day) was associated with significantly higher QALY gain; 0.1209 ± 0.1030 versus 0.0994

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

    NARCIS (Netherlands)

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

    Introduction Osteoarthritis is the most common joint disorder worldwide. Total hip arthroplasty (THA) is considered one of the most effective treatments for end-stage hip osteoarthritis. The number of THAs is expected to increase dramatically in the coming decades. Usual postoperative rehabilitation

  5. The feasibility of a randomised controlled trial to compare the cost-effectiveness of palliative cardiology or usual care in people with advanced heart failure: Two exploratory prospective cohorts.

    Science.gov (United States)

    Johnson, Miriam J; McSkimming, Paula; McConnachie, Alex; Geue, Claudia; Millerick, Yvonne; Briggs, Andrew; Hogg, Karen

    2018-06-01

    The effectiveness of cardiology-led palliative care is unknown; we have insufficient information to conduct a full trial. To assess the feasibility (recruitment/retention, data quality, variability/sample size estimation, safety) of a clinical trial of palliative cardiology effectiveness. Non-randomised feasibility. Unmatched symptomatic heart failure patients on optimal cardiac treatment from (1) cardiology-led palliative service (caring together group) and (2) heart failure liaison service (usual care group). Outcomes/safety: Symptoms (Edmonton Symptom Assessment Scale), Kansas City Cardiomyopathy Questionnaire, performance, understanding of disease, anticipatory care planning, cost-effectiveness, survival and carer burden. A total of 77 participants (caring together group = 43; usual care group = 34) were enrolled (53% men; mean age 77 years (33-100)). The caring together group scored worse in Edmonton Symptom Assessment Scale (43.5 vs 35.2) and Kansas City Cardiomyopathy Questionnaire (35.4 vs 39.9). The caring together group had a lower consent/screen ratio (1:1.7 vs 1: 2.8) and few died before approach (0.08% vs 16%) or declined invitation (17% vs 37%). Data quality: At 4 months, 74% in the caring together group and 71% in the usual care group provided data. Most attrition was due to death or deterioration. Data quality in self-report measures was otherwise good. There was no difference in survival. Symptoms and quality of life improved in both groups. A future trial requires 141 (202 allowing 30% attrition) to detect a minimal clinical difference (1 point) in Edmonton Symptom Assessment Scale score for breathlessness (80% power). More participants (176; 252 allowing 30% attrition) are needed to detect a 10.5 change in Kansas City Cardiomyopathy Questionnaire score (80% power; minimum clinical difference = 5). A trial to test the clinical effectiveness (improvement in breathlessness) of cardiology-led palliative care is feasible.

  6. Effectiveness of additional self-care acupressure for women with menstrual pain compared to usual care alone: using stakeholder engagement to design a pragmatic randomized trial and study protocol.

    Science.gov (United States)

    Blödt, Susanne; Schützler, Lena; Huang, Wenjing; Pach, Daniel; Brinkhaus, Benno; Hummelsberger, Josef; Kirschbaum, Barbara; Kuhlmann, Kirsten; Lao, Lixing; Liang, Fanrong; Mietzner, Anna; Mittring, Nadine; Müller, Sabine; Paul, Anna; Pimpao-Niederle, Carolina; Roll, Stephanie; Wu, Huangan; Zhu, Jiang; Witt, Claudia M

    2013-04-11

    Self-care acupressure might be successful in treating menstrual pain, which is common among young women. There is a need for comparative effectiveness research with stakeholder engagement in all phases seeking to address the needs of decision-makers. Our aim was to design a study on the effectiveness of additional self-care acupressure for menstrual pain comparing usual care alone using different methods of stakeholder engagement. The study was designed using multiple mixed methods for stakeholder engagement. Based on the results of a survey and focus group discussion, a stakeholder advisory group developed the study design. Stakeholder engagement resulted in a two-arm pragmatic randomized trial. Two hundred and twenty women aged 18 to 25 years with menstrual pain will be included in the study. Outcome measurement will be done using electronic questionnaires provided by a study specific mobile application (App). Primary outcome will be the mean pain intensity at the days of pain during the third menstruation after therapy start. Stakeholder engagement helped to develop a study design that better serves the needs of decision makers, including an App as a modern tool for both intervention and data collection in a young target group. Clinicaltrials.gov identifier http://NCT01582724.

  7. Three-year follow-up of 3-year-old to 5-year-old children after participation in a multidisciplinary or a usual-care obesity treatment program

    NARCIS (Netherlands)

    Bocca, Gianni; Corpeleijn, Eva; van den Heuvel, Edwin R.; Stolk, Ronald P.; Sauer, Pieter J. J.

    2014-01-01

    Background & aims: Little is known on the long-term effects of obesity intervention programs in preschool-aged children. We compared the long-term effects of a multidisciplinary treatment program with a usual-care program in seventy-five 3- to 5-year-old overweight or obese children who had

  8. Economic evaluation of Internet-based problem-solving guided self-help treatment in comparison with enhanced usual care for depressed outpatients waiting for face-to-face treatment: A randomized controlled trial.

    Science.gov (United States)

    Kolovos, Spyros; Kenter, Robin M F; Bosmans, Judith E; Beekman, Aartjan T F; Cuijpers, Pim; Kok, Robin N; van Straten, Annemieke

    2016-08-01

    Previous studies have demonstrated the effectiveness of Internet-based interventions for depression in comparison with usual care. However, evidence on the cost-effectiveness of these interventions when delivered in outpatient clinics is lacking. The aim of this study was to estimate the cost-effectiveness of an Internet-based problem-solving guided self-help intervention in comparison with enhanced usual care for outpatients on a waiting list for face-to-face treatment for major depression. After the waiting list period, participants from both groups received the same treatment at outpatient clinics. An economic evaluation was performed alongside a randomized controlled trial with 12 months follow-up. Outcomes were improvement in depressive symptom severity (measured by CES-D), response to treatment and Quality-Adjusted Life-Years (QALYs). Statistical uncertainty around cost differences and incremental cost-effectiveness ratios were estimated using bootstrapping. Mean societal costs for the intervention group were €1579 higher than in usual care, but this was not statistically significant (95% CI - 1395 to 4382). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.57 at a ceiling ratio of €15,000/additional point of improvement in CES-D, and 0.25 and 0.30 for an additional response to treatment and an extra QALY respectively, at a ceiling ratio of €30,000. Sensitivity analysis showed that from a mental healthcare provider perspective the probability of the intervention being cost-effective was 0.68 for a ceiling ratio of 0 €/additional unit of effect for the CES-D score, response to treatment and QALYs. As the ceiling ratio increased this probability decreased, because the mean costs in the intervention group were lower than the mean costs in the usual care group. The patients in the intervention group showed low adherence to the Internet-based treatment

  9. Psychotherapeutic work with Families with Life-threatening Maternal Illness

    OpenAIRE

    Chinoy, Freni

    2016-01-01

    This exploratory research study describes a child and adolescent psychotherapeutic clinical service offered to children/adolescents and their families with mothers with a life-threatening illness. The clinical service itself was also exploratory in nature. The research objectives of the study were (i) to explore whether this form of clinical work could be beneficial for such families in relieving distress and supporting their development; (ii) to discover the factors at play within and betwee...

  10. Presence and Enactment as a Vehicle of Psychotherapeutic Change

    OpenAIRE

    Viederman, Milton

    1999-01-01

    This article addresses an aspect of psychoanalytic and psychotherapeutic process that leads to change. Focusing on an aspect of the patient-therapist interaction that the author calls “presence” of the therapist, it demonstrates how the experience of this may lead the patient to unconscious enactment of early wishful fantasies concerning the good parent. The gratification of these wishes implicit in the interaction influences the therapist-patient relationship and plays a significant role in ...

  11. Presence and enactment as a vehicle of psychotherapeutic change.

    Science.gov (United States)

    Viederman, M

    1999-01-01

    This article addresses an aspect of psychoanalytic and psychotherapeutic process that leads to change. Focusing on an aspect of the patient-therapist interaction that the author calls "presence" of the therapist, it demonstrates how the experience of this may lead the patient to unconscious enactment of early wishful fantasies concerning the good parent. The gratification of these wishes implicit in the interaction influences the therapist-patient relationship and plays a significant role in change.

  12. Psychotherapeutic treatment levels of personality disorders in older adults

    OpenAIRE

    Videler, Arjan; Cornelis, Christina; Rossi, G.; van Royen, R.J.J.; Rosowsky, E.; van Alphen, S.P.J.

    2015-01-01

    Treatment of personality disorders (PDs) in older adults is a highly underexplored topic. In this article clinical applicability of the findings from a recent Delphi study regarding treatment aspects of PDs in older adults is explored. This concerns the relevance of three psychotherapeutic treatment levels for PDs in later life: (a) personality-changing treatment, (b) adaptation-enhancing treatment, and (c) supportive-structuring treatment. By means of three cases concerning the three levels,...

  13. Not the usual sinusitis

    Science.gov (United States)

    Ammar, Hussam; Kott, Amy; Fouda, Ragai

    2012-01-01

    An encephalocele is a protrusion of the cranial contents beyond the normal confines of the skull. It is a rare cause of seizure in adults. A 38-year-old woman presented with a first-onset seizure. Brain CT was interpreted as right frontal sinus opacification suggestive of sinusitis. The patient was discharged home with an amoxicillin prescription. A few days later, she was re-admitted with another seizure. Careful evaluation of the brain CT and MRI revealed a right frontal sinus posterior wall defect and possible brain encephalocele. The patient had complained of chronic nasal discharge for years and had also noticed a watery discharge from her right nostril. We suspected cerebrospinal fluid rhinorrhea. A bifrontal craniotomy was performed, the encephalocele was resected and cranialisation of the frontal sinus was completed. The patient remained free of seizures at the last follow-up. PMID:23188840

  14. The use of a Cumulative Needs for Care Monitor for individual treatment v. care as usual for patients diagnosed with severe mental illness, a cost-effectiveness analysis from the health care perspective

    NARCIS (Netherlands)

    Drukker, M.; Joore, M.; van Os, J.; Sytema, S.; Driessen, G.; Bak, M.; Delespaul, Ph.

    2012-01-01

    Aims. To study the systematic assessment of need for care and clinical parameters for use in treatment plans in patients diagnosed with severe mental illness. Methods. The Cumulative Needs for Care Monitor (CNCM) includes various validated instruments, such as the Camberwell Assessment of Need. A

  15. Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho: The CASCADE Randomized Clinical Trial.

    Science.gov (United States)

    Labhardt, Niklaus D; Ringera, Isaac; Lejone, Thabo I; Klimkait, Thomas; Muhairwe, Josephine; Amstutz, Alain; Glass, Tracy R

    2018-03-20

    Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa. However, with referral to health facilities, less than half of those who test HIV positive link to care and initiate antiretroviral therapy (ART). To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural, high-prevalence setting in sub-Saharan Africa. Open-label, 2-group, randomized clinical trial (February 22, 2016-September 17, 2017), involving 6 health care facilities in northern Lesotho. During home-based HIV testing in 6655 households from 60 rural villages and 17 urban areas, 278 individuals aged 18 years or older who tested HIV positive and were ART naive from 268 households consented and enrolled. Individuals from the same household were randomized into the same group. Participants were randomly assigned to be offered same-day home-based ART initiation (n = 138) and subsequent follow-up intervals of 1.5, 3, 6, 9, and 12 months after treatment initiation at the health facility or to receive usual care (n = 140) with referral to the nearest health facility for preparatory counseling followed by ART initiation and monthly follow-up visits thereafter. Primary end points were rates of linkage to care within 3 months (presenting at the health facility within 90 days after the home visit) and viral suppression at 12 months, defined as a viral load of less than 100 copies/mL from 11 through 14 months after enrollment. Among 278 randomized individuals (median age, 39 years [interquartile range, 28.0-52.0]; 180 women [65.7%]), 274 (98.6%) were included in the analysis (137 in the same-day group and 137 in the usual care group). In the same-day group, 134 (97.8%) indicated readiness to start ART that day and 2 (1.5%) within the next few days and were given a 1-month supply of ART. At 3 months, 68.6% (94) in same-day group vs 43.1% (59) in usual care group had linked to care

  16. Effectiveness of psychotherapeutic consultation in the workplace: a controlled observational trial

    Directory of Open Access Journals (Sweden)

    Eva Rothermund

    2016-08-01

    Full Text Available Abstract Background This study compares the effectiveness of psychotherapeutic consultation in the workplace (PSIW with psychotherapeutic outpatient care (PSOC in Germany. Methods Work ability (WAI, quality of life (SF-12, clinical symptoms (PHQ and work-related stress (MBI, IS were assessed in 367 patients seeking mental health care via two routes (PSIW n = 174; PSOC n = 193 before consultation and 12 weeks later. Changes in outcome variables were assessed using covariance analysis with repeated measures (ANCOVA with sociodemographic variables (propensity score method, therapy dose, setting and symptom severity as covariates. Results The PSIW and PSOC groups included 122 and 66 men respectively. There were 102 first-time users of mental healthcare in the PSIW group and 83 in the PSOC group. There were group differences in outcome variables at baseline (p < 0.05; PSIW patients were less impaired overall. There were no group difference in sociodemographic variables, number of sessions within the offer or symptom severity. There was no main effect of group on outcome variables and no group*time interaction. Work-related stress indicators did not change during the intervention, but work ability improved in both groups (F = 10.149, p = 0.002; baseline M = 27.2, SD = 8.85; follow-up M = 28.6, SD = 9.02, as did perceived mental health (SF-12 MCS, depression (PHQ-9 and anxiety (PHQ-7. Effect sizes were between η2 = 0.028 and η2 = 0.040. Conclusions Psychotherapeutic consultation is similarly effective in improving patients’ functional and clinical status whether delivered in the workplace or in an outpatient clinic. Offering mental health services in the workplace makes it easier to reach patients at an earlier stage in their illness and thus enables provision of early and effective mental health care. Trial registration DRKS00003184 , retrospectively registered 13 January 2012.

  17. The 2BFit study: is an unsupervised proprioceptive balance board training programme, given in addition to usual care, effective in preventing ankle sprain recurrences? Design of a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    van Mechelen Willem

    2008-05-01

    Full Text Available Abstract Background There is strong evidence that athletes have a twofold risk for re-injury after a previous ankle sprain, especially during the first year post-injury. These ankle sprain recurrences could result in disability and lead to chronic pain or instability in 20 to 50% of these cases. When looking at the high rate of ankle sprain recurrences and the associated chronic results, ankle sprain recurrence prevention is important. Objective To evaluate the effect of a proprioceptive balance board training programme on ankle sprain recurrences, that was applied to individual athletes after rehabilitation and treatment by usual care. Methods/Design This study was designed as a randomized controlled trial with a follow-up of one year. Healthy individuals between 12 and 70 years of age, who were actively participating in sports and who had sustained a lateral ankle sprain up to two months prior to inclusion, were eligible for inclusion in the study. The intervention programme was compared to usual care. The intervention programme consisted of an eight-week proprioceptive training, which started after finishing usual care and from the moment that sports participation was again possible. Outcomes were assessed at baseline and every month for 12 months. The primary outcome of this study was the incidence of recurrent ankle injuries in both groups within one year after the initial sprain. Secondary outcomes were severity and etiology of re-injury and medical care. Cost-effectiveness was evaluated from a societal perspective. A process evaluation was conducted for the intervention programme. Discussion The 2BFit trial is the first randomized controlled trial to study the effect of a non-supervised home-based proprioceptive balance board training programme in addition to usual care, on the recurrence of ankle sprains in sports. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains. Results will

  18. The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study.

    Science.gov (United States)

    Valdivieso, Bernardo; García-Sempere, Anibal; Sanfélix-Gimeno, Gabriel; Faubel, Raquel; Librero, Julian; Soriano, Elisa; Peiró, Salvador

    2018-04-25

    To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562). Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  19. Barriers and Facilitators for the Implementation of an Online Clinical Health Community in Addition to Usual Fertility Care: A Cross-Sectional Study

    OpenAIRE

    Aarts, Johanna WM; Faber, Marjan J; den Boogert, Anne G; Cohlen, Ben J; van der Linden, Paul JQ; Kremer, Jan AM; Nelen, Willianne LDM

    2013-01-01

    BACKGROUND: Online health communities are becoming more popular in health care. Patients and professionals can communicate with one another online, patients can find peer support, and professionals can use it as an additional information channel to their patients. However, the implementation of online health communities into daily practice is challenging. These challenges relate to the fact that patients need to be activated to (1) become a member (ie, subscription) and (2) participate active...

  20. Economic evaluation of Internet-based problem-solving guided self-help treatment in comparison with enhanced usual care for depressed outpatients waiting for face-to-face treatment

    DEFF Research Database (Denmark)

    Kolovos, Spyros; Kenter, Robin M F; Bosmans, Judith E

    2016-01-01

    at outpatient clinics. METHODS: An economic evaluation was performed alongside a randomized controlled trial with 12 months follow-up. Outcomes were improvement in depressive symptom severity (measured by CES-D), response to treatment and Quality-Adjusted Life-Years (QALYs). Statistical uncertainty around cost......BACKGROUND: Previous studies have demonstrated the effectiveness of Internet-based interventions for depression in comparison with usual care. However, evidence on the cost-effectiveness of these interventions when delivered in outpatient clinics is lacking. The aim of this study was to estimate...... the cost-effectiveness of an Internet-based problem-solving guided self-help intervention in comparison with enhanced usual care for outpatients on a waiting list for face-to-face treatment for major depression. After the waiting list period, participants from both groups received the same treatment...

  1. Effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depression: a systematic review (METACHRON

    Directory of Open Access Journals (Sweden)

    von Wolff Alessa

    2010-11-01

    Full Text Available Abstract Background Chronic depressions represent a substantial part of depressive disorders and are associated with severe consequences. Several studies were performed addressing the effectiveness of psychotherapeutic, pharmacological, and combined treatments for chronic depressions. Yet, a systematic review comparing the effectiveness of multiple treatment options and considering all subtypes of chronic depressions is still missing. Methods/Design Aim of this project is to summarize empirical evidence on efficacy and effectiveness of treatments for chronic depression by means of a systematic review. The primary objectives of the study are to examine, which interventions are effective; to examine, if any differences in effectiveness between active treatment options exist; and to find possible treatment effect modifiers. Psychotherapeutic, pharmacological, and combined treatments will be considered as experimental interventions and no treatment, wait-list, psychological/pharmacological placebo, treatment as usual, and other active treatments will be seen as comparators. The population of patients will include adults with chronic major depression, dysthymia, double depression, or recurrent depression without complete remission between episodes. Outcomes of the analyses are depressive symptoms, associated consequences, adverse events, and study discontinuation. Only randomized controlled trials will be considered. Discussion Given the high prevalence and serious consequences of chronic depression and a considerable amount of existing primary studies addressing the effectiveness of different treatments the present systematic review may be of high relevance. Special attention will be given to the use of current methodological standards. Findings are likely to provide crucial information that may help clinicians to choose the appropriate treatment for chronically depressed patients.

  2. The Effect of Group Discussion-based Education on Self-management of Adults with Type 2 Diabetes Mellitus Compared with Usual Care: A Randomized Control Trial.

    Science.gov (United States)

    Habibzadeh, Hosein; Sofiani, Akbar; Alilu, Leyla; Gillespie, Mark

    2017-11-01

    We sought to determine the effect of group discussion-based education on the self-management capability of patients with type 2 diabetes in Iran. This randomized control trial was conducted on 90 patients with type 2 diabetes. Participants were allocated randomly into one of two groups; intervention and control. The intervention group received the group discussion-based education while the control group received routine care only. The Lin's self-management questionnaire was completed at baseline and three months post-intervention. Statistical analysis, including the use of independent t -test, identified that in comparison to the control group, significant increases were observed in the scores of self-organization ( t =11.24, p health experts ( t = 7.31, p diet ( t = 5.22, p diabetes.

  3. Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective 'mystery shopper' study in UK primary care.

    Science.gov (United States)

    Stevens, Sarah L; McManus, Richard J; Stevens, Richard John

    2018-04-12

    Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. (1) An online cross-sectional survey and (2) a prospective 'mystery shopper' study where patients agreed to report how BP was measured during their next appointment. Primary care. Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. Proportion of patients having BP measured according to guidelines. 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Pilot study of psychotherapeutic text messaging for depression.

    Science.gov (United States)

    Pfeiffer, Paul N; Henry, Jennifer; Ganoczy, Dara; Piette, John D

    2017-08-01

    Background Text messaging services could increase access to psychotherapeutic content for individuals with depression by avoiding barriers to in-person psychotherapy such as cost, transportation, and therapist availability. Determining whether text messages reflecting different psychotherapeutic techniques exhibit differences in acceptability or effectiveness may help guide service development. Objectives We aimed to determine: (1) the feasibility of delivering a psychotherapy-based text messaging service to people with depression identified via the internet, (2) whether there is variation in satisfaction with messages according to the type of psychotherapeutic technique they represent, and (3) whether symptoms of depression vary according to receipt of each message type and participants' satisfaction with the messages they received. Methods For this study 190 US adults who screened positive for a major depressive episode (Patient Health Questionnaire (PHQ-9) score ≥10) were recruited from online advertisements. Participants received a daily psychotherapy-based text message 6 days per week for 12 weeks. Text messages were developed by a team of psychiatrists, psychologists, and social workers to reflect three psychotherapeutic approaches: acceptance and commitment therapy (ACT), behavioural activation, and cognitive restructuring. Each week the message type for the week was randomly assigned from one of the three types, allowing for repeats. Participants were asked daily to rate each message. On the 7th day of each week, participants completed a two-item depression screener (PHQ-2). Web-based surveys at baseline, 6, and 12 weeks were used as the primary measure of depressive symptoms (PHQ-9). Results Of the 190 participants enrolled, 85 (45%) completed the 6-week web survey and 67 (35%) completed the 12-week survey. The mean baseline PHQ-9 score was 19.4 (SD 4.2) and there was a statistically significant mean improvement in PHQ-9 scores of -2.9 (SD 6.0; p

  5. How can psychiatrists offer psychotherapeutic leadership in the public sector?

    Science.gov (United States)

    Cammell, Paul; Amos, Jackie; Baigent, Michael

    2016-06-01

    This article reviews the forms that psychotherapeutic leadership can take for psychiatrists attempting to optimise outcomes for individuals receiving treatment in the public mental health sector. It explores a range of roles and functions that psychiatrists can take on as psychotherapy leaders, and how these can be applied in clinical, administrative and research contexts. Psychiatrists need to play an increasing role in clinical, administrative and academic settings to advance service provision, resource allocation, training and research directed at psychotherapies in the public health sector. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  6. Testing the effectiveness of a motivational interviewing-based brief intervention for substance use as an adjunct to usual care in community-based AIDS service organizations: study protocol for a multisite randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bryan R. Garner

    2017-11-01

    Full Text Available Abstract Background In 2010, the first comprehensive National HIV/AIDS Strategy for the United States was released and included three goals: (1 reducing the number of people who become infected with HIV, (2 increasing access to care and improving health outcomes for people living with HIV, and (3 reducing HIV-related health disparities and health inequities. In 2013, as part of its effort to help address the National HIV/AIDS Strategy, the National Institute on Drug Abuse (NIDA funded a type 2 effectiveness-implementation hybrid trial titled the Substance Abuse Treatment to HIV Care (SAT2HIV Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI for substance use as an adjunct to usual care within AIDS Service Organizations (ASOs as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF as an adjunct to the Addiction Technology Transfer Center (ATTC model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Methods As part of a multisite randomized controlled trial, individuals with comorbid HIV/AIDS and problematic substance use are randomized to receive either the ASOs’ usual care (control condition or usual care plus a MIBI for substance use (experimental condition delivered by trained ASO case-management staff. Primary outcome measures are reductions in days of primary substance use, number of substance-related problems, times engaging in risky behaviors, days of non-adherence to HIV medications, and increases in substance use treatment. As part of this paper, we describe the trial protocol in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines. Discussion If successfully able to implement MIBI as an effective adjunct to usual care, the current trial may

  7. An Economic Evaluation of TENS in Addition to Usual Primary Care Management for the Treatment of Tennis Elbow: Results from the TATE Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Martyn Lewis

    Full Text Available The TATE trial was a multicentre pragmatic randomized controlled trial of supplementing primary care management (PCM-consisting of a GP consultation followed by information and advice on exercises-with transcutaneous electrical nerve stimulation (TENS, to reduce pain intensity in patients with tennis elbow. This paper reports the health economic evaluation.Adults with new diagnosis of tennis elbow were recruited from 38 general practices in the UK, and randomly allocated to PCM (n = 120 or PCM plus TENS (n = 121. Outcomes included reduction in pain intensity and quality-adjusted-life-years (QALYs based on the EQ5D and SF6D. Two economic perspectives were evaluated: (i healthcare-inclusive of NHS and private health costs for the tennis elbow; (ii societal-healthcare costs plus productivity losses through work absenteeism. Mean outcome and cost differences between the groups were evaluated using a multiple imputed dataset as the base case evaluation, with uncertainty represented in cost-effectiveness planes and through probabilistic cost-effectiveness acceptability curves. Incremental healthcare cost was £33 (95%CI -40, 106 and societal cost £65 (95%CI -307, 176 for PCM plus TENS. Mean differences in outcome were: 0.11 (95%CI -0.13, 0.35 for change in pain (0-10 pain scale; -0.015 (95%CI -0.058, 0.029 for QALYEQ5D; 0.007 (95%CI -0.022, 0.035 for QALYSF6D (higher score differences denote greater benefit for PCM plus TENS. The ICER (incremental cost effectiveness ratio for the main evaluation of mean difference in societal cost (£ relative to mean difference in pain outcome was -582 (95%CI -8666, 8113. However, incremental ICERs show differences in cost-effectiveness of additional TENS, according to the outcome being evaluated.Our findings do not provide evidence for or against the cost-effectiveness of TENS as an adjunct to primary care management of tennis elbow.

  8. The Effect of Group Discussion-based Education on Self-management of Adults with Type 2 Diabetes Mellitus Compared with Usual Care: A Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Hosein Habibzadeh

    2017-11-01

    Full Text Available Objectives: We sought to determine the effect of group discussion-based education on the self-management capability of patients with type 2 diabetes in Iran. Methods: This randomized control trial was conducted on 90 patients with type 2 diabetes. Participants were allocated randomly into one of two groups; intervention and control. The intervention group received the group discussion-based education while the control group received routine care only. The Lin’s self-management questionnaire was completed at baseline and three months post-intervention. Results: Statistical analysis, including the use of independent t-test, identified that in comparison to the control group, significant increases were observed in the scores of self-organization (t =11.24, p < 0.001, self-adjustment (t = 7.53, p < 0.001, interaction with health experts (t = 7.31, p < 0.001, blood sugar self-monitoring (t = 6.42, p < 0.001, adherence to the proposed diet (t = 5.22, p < 0.001, and total self-management (t = 10.82, p < 0.001 in the intervention group. Conclusions: Sharing experiences through group discussions and receiving instructive feedback can improve the ability to self-manage diabetes.

  9. Just-in-time consent: The ethical case for an alternative to traditional informed consent in randomized trials comparing an experimental intervention with usual care.

    Science.gov (United States)

    Vickers, Andrew J; Young-Afat, Danny A; Ehdaie, Behfar; Kim, Scott Yh

    2018-02-01

    Informed consent for randomized trials often causes significant and persistent anxiety, distress and confusion to patients. Where an experimental treatment is compared to a standard care control, much of this burden is potentially avoidable in the control group. We propose a "just-in-time" consent in which consent discussions take place in two stages: an initial consent to research from all participants and a later specific consent to randomized treatment only from those assigned to the experimental intervention. All patients are first approached and informed about research procedures, such as questionnaires or tests. They are also informed that they might be randomly selected to receive an experimental treatment and that, if selected, they can learn more about the treatment and decide whether or not to accept it at that time. After randomization, control patients undergo standard clinical consent whereas patients randomized to the experimental procedure undergo a second consent discussion. Analysis would be by intent-to-treat, which protects the trial from selection bias, although not from poor acceptance of experimental treatment. The advantages of just-in-time consent stem from the fact that only patients randomized to the experimental treatment are subject to a discussion of that intervention. We hypothesize that this will reduce much of the patient's burden associated with the consent process, such as decisional anxiety, confusion and information overload. We recommend well-controlled studies to compare just-in-time and traditional consent, with endpoints to include characteristics of participants, distress and anxiety and participants' understanding of research procedures.

  10. Rates of detection of developmental problems at the 18-month well-baby visit by family physicians' using four evidence-based screening tools compared to usual care: a randomized controlled trial.

    Science.gov (United States)

    Thomas, R E; Spragins, W; Mazloum, G; Cronkhite, M; Maru, G

    2016-05-01

    Early and regular developmental screening can improve children's development through early intervention but is insufficiently used. Most developmental problems are readily evident at the 18-month well-baby visit. This trial's purpose is to: (1) compare identification rates of developmental problems by GPs/family physicians using four evidence-based tools with non-evidence based screening, and (2) ascertain whether the four tools can be completed in 10-min pre-visit on a computer. We compared two approaches to early identification via random assignment of 54 families to either: 'usual care' (informal judgment including ad-hoc milestones, n = 25); or (2) 'Evidence-based' care (use of four validated, accurate screening tools, n = 29), including: the Parents' Evaluation of Developmental Status (PEDS), the PEDS-Developmental Milestones (PEDS-DM), the Modified Checklist for Autism in Toddlers (M-CHAT) and PHQ9 (maternal depression). In the 'usual care' group four (16%) and in the evidence-based tools group 18 (62%) were identified as having a possible developmental problem. In the evidence-based tools group three infants were to be recalled at 24 months for language checks (no specialist referrals made). In the 'usual care' group four problems were identified: one child was referred for speech therapy, two to return to check language at 24 months and a mother to discuss depression. All forms were completed on-line within 10 min. Despite higher early detection rates in the evidence-based care group, there were no differences in referral rates between evidence-based and usual-care groups. This suggests that clinicians: (1) override evidence-based screening results with informal judgment; and/or (2) need assistance understanding test results and making referrals. Possible solutions are improve the quality of information obtained from the screening process, improved training of physicians, improved support for individual practices and acceptance by the regional

  11. A comparative consecutive case series of 20 children with a diagnosis of ADHD receiving homeopathic treatment, compared with 10 children receiving usual care.

    Science.gov (United States)

    Fibert, Philippa; Relton, Clare; Heirs, Morag; Bowden, Deborah

    2016-05-01

    methodically rigorous research is warranted. "We recommend that future research in this area uses comparative effectiveness randomised controlled trial designs. We also recommend that these trials measure outcomes of relevance to stakeholder needs - the people and services who care for those with ADHD - parents, teachers and social workers and the criminal justice system". Copyright © 2015 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  12. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial.

    Science.gov (United States)

    van Gaalen, Johanna L; Bakker, Moira J; van Bodegom-Vos, Leti; Snoeck-Stroband, Jiska B; Assendelft, Willem J J; Kaptein, Ad A; van der Meer, Victor; Taube, Christian; Thoonen, Bart P; Sont, Jacob K

    2012-11-21

    Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS): dissemination of the IBSM program; intermediate strategy (IS): MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals); and extended strategy (ES): IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions) are primarily targeted at general practices, randomisation will occur at practice level.In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations); self-management related outcomes (health education impact, medication adherence, and illness perceptions); and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption. Follow-up is six months per patient. This study

  13. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial

    Directory of Open Access Journals (Sweden)

    van Gaalen Johanna L

    2012-11-01

    Full Text Available Abstract Background Internet-based self-management (IBSM support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. Methods/design This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS: dissemination of the IBSM program; intermediate strategy (IS: MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals; and extended strategy (ES: IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions are primarily targeted at general practices, randomisation will occur at practice level. In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations; self-management related outcomes (health education impact, medication adherence, and illness perceptions; and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption

  14. Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial

    Science.gov (United States)

    2014-01-01

    Background Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at ‘training the brain’ is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up. The aim of this study is to assess the effectiveness of a modern neuroscience approach, compared to usual care evidence-based physiotherapy, for reducing pain and improving functioning in patients with CSP. A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP. Methods/Design The study is a multi-center, triple-blind, two-arm (1:1) randomized clinical trial with 1-year follow-up. 120 CSP patients will be randomly allocated to either the experimental (receiving pain neuroscience education followed by cognition-targeted motor control training) or the control group (receiving usual care physiotherapy), each comprising of 3 months treatment. The main outcome measures are pain (including symptoms and indices of central sensitization) and self-reported disability. Secondary outcome measures include brain gray matter structure, motor control, muscle properties, and psychosocial correlates. Clinical assessment and brain imaging will be performed at baseline, post-treatment and at 1-year follow-up. Web

  15. [Academic procrastination in clients of a psychotherapeutic student counselling center].

    Science.gov (United States)

    Jamrozinski, Katja; Kuda, Manfred; Mangholz, Astrid

    2009-01-01

    The start of university education is the beginning of a new phase of life for young adults, which requires significant psychosocial adjustments. Sociobiographical data, clinical symptoms, characteristics of education, work attitude, and career perspectives were gathered from 152 clients by a psychotherapeutic student counselling center to evaluate characteristics of students with and without academic procrastination. The procrastination group comprised heightened numbers of students who had changed universities, and people with suboptimal career prospects and career targets. These subjects were more often male and showed increased incidences of drug- and alcohol problems, as well as a lack of planning of the future. Furthermore, they had larger amounts of their study self-financed. On the basis of these results, concrete recommendations for preventive measures to improve on-time completion of study, and to prevent student drop-out are presented. Georg Thieme Verlag KG Stuttgart-New York.

  16. Psychotherapeutics and the problematic origins of clinical psychology in America.

    Science.gov (United States)

    Taylor, E

    2000-09-01

    The problematic place of psychotherapy within the larger history of scientific psychology is reviewed, especially in the absence of any definitive history of clinical psychology yet written. Although standard histories of psychology imply that psychotherapy was somehow derived from the tradition of German laboratory science, modern historiography reveals a dramatically different story. Personality, abnormal, social, and clinical psychology have their roots in an international psychotherapeutic alliance related more to French neurophysiology, and this alliance flourished for several decades before psychoanalysis. Reconstruction of the American contribution to this alliance, the so-called Boston school of abnormal psychology, suggests an era of medical psychology in advance of today. Note is also made of the possible misattribution of Lightner Witmer as the father of clinical psychology.

  17. A conceptual model of transference and its psychotherapeutic application.

    Science.gov (United States)

    Corradi, Richard B

    2006-01-01

    The tendency to repeat formative human relationships in later life, a universal developmental characteristic, is referred to as transference when it occurs in the doctor-patient relationship. Its systematic therapeutic application in psychiatry has historically been associated with classical psychoanalysis. As psychoanalysis has lost its cachet, and as drug treatment has replaced psychotherapy as psychiatry's major treatment modality, the therapeutic potential of transference risks being neglected. This is to the great detriment of psychiatric patients. Knowledge of the power of transference and expertise in its clinical use in psychotherapy should be the most powerful tool in the psychiatric therapeutic armamentarium. This article discusses a concept of transference that the author has found effective, both in clinical practice and in teaching about transference to psychiatric residents. The article delineates a psychology of transference, discusses its universal applicability to the whole of the psychotherapeutic process, and utilizes case material to illustrate principles of its application.

  18. Content Validity of a Psychotherapeutic Intervention Model in Nursing: A Modified e-Delphi Study.

    Science.gov (United States)

    Sampaio, Francisco Miguel Correia; Sequeira, Carlos; Lluch Canut, Teresa

    2017-04-01

    To estimate the content validity of a psychotherapeutic intervention model in nursing. Mental health nurses encounter great extrinsic difficulties when it comes to providing psychotherapeutic interventions due to the fact that they are not allowed to perform such practice in some countries. In this light, the pursuit of a psychotherapeutic intervention model in nursing seems germane to guide the professionals' psychotherapeutic practice, contributing hereof to increase mental health nurses' professional autonomy. Modified e-Delphi. Data were collected from October 2015 to January 2016 by means of three rounds of online questionnaires. The initial questionnaire was structured into five sections: general structure of the model, patients' exclusion criteria, assessment framework, nursing diagnoses, and nursing psychotherapeutic interventions. From the 42 experts invited, at least twenty (20) participated in each round. The experts achieved consensus with regard to the conclusion that nursing psychotherapeutic interventions should always seek to address a nursing diagnosis. These defined furthermore that a psychotherapeutic intervention model in nursing should be exercised by means of 3 to 12 sessions using Nursing Interventions Classification (NIC) as a resource. Finally, experts deemed that the model should follow the principles of integrative psychotherapy, so that techniques from different schools of psychotherapy could therefore be used in conjunction to promote the resolution of a nursing diagnosis. Achieving consensus about the structure of a psychotherapeutic intervention model in nursing is imperative to guide nurses in the provision of nursing psychotherapeutic interventions and to enable an effective evaluation of the health gains associated with its implementation. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The effectiveness of Stepping stones Triple P: the design of a randomised controlled trial on a parenting programme regarding children with mild intellectual disability and psychosocial problems versus care as usual

    Science.gov (United States)

    2011-01-01

    Background Children with an intellectual disability are at increased risk of psychosocial problems. This leads to serious restrictions in the daily functioning of the children and to parental stress. Stepping Stones Triple P aims to prevent severe behavioural, emotional and developmental problems in children with a (intellectual) disability by enhancing parenting knowledge and skills, and the self-confidence of parents. This paper aims to describe the design of a study of the effectiveness of parenting counselling using Stepping Stones Triple P compared to Care as Usual. Methods/Design The effects of Stepping Stones Triple P will be studied in a Randomised Controlled Trial. Parents of children aged 5-12 years with an IQ of 50-85 will be recruited from schools. Prior to randomisation, parents complete a screening questionnaire about their child's psychosocial problems and their parenting skills. Subsequently, parents of children with increased levels of psychosocial problems (score on Strengths and Difficulties Questionnaire ≥ 14) will be invited to participate in the intervention study. After obtaining consent, parents will be randomised either to the experimental group (Stepping Stones Triple P) or to Care as Usual. The primary outcome is a change in the child's psychosocial problems according to parents and teachers. The secondary outcome is a change in parenting skills. Data will be collected before the start of the intervention, immediately after the intervention, and six months after. Discussion This paper presents an outline of the background and design of a randomised controlled trial to investigate the effectiveness of Stepping Stones Triple P, which aims to decrease psychosocial problems in children with a mild intellectual disability. Stepping Stones Triple P seems promising, but evidence on its effectiveness for this population is still lacking. This study provides evidence about the effects of this intervention in a community-based population of

  20. The effectiveness of Stepping Stones Triple P: the design of a randomised controlled trial on a parenting programme regarding children with mild intellectual disability and psychosocial problems versus care as usual.

    Science.gov (United States)

    Kleefman, Marijke; Jansen, Daniëlle E M C; Reijneveld, Sijmen A

    2011-08-30

    Children with an intellectual disability are at increased risk of psychosocial problems. This leads to serious restrictions in the daily functioning of the children and to parental stress. Stepping Stones Triple P aims to prevent severe behavioural, emotional and developmental problems in children with a (intellectual) disability by enhancing parenting knowledge and skills, and the self-confidence of parents. This paper aims to describe the design of a study of the effectiveness of parenting counselling using Stepping Stones Triple P compared to Care as Usual. The effects of Stepping Stones Triple P will be studied in a Randomised Controlled Trial. Parents of children aged 5-12 years with an IQ of 50-85 will be recruited from schools. Prior to randomisation, parents complete a screening questionnaire about their child's psychosocial problems and their parenting skills. Subsequently, parents of children with increased levels of psychosocial problems (score on Strengths and Difficulties Questionnaire ≥ 14) will be invited to participate in the intervention study. After obtaining consent, parents will be randomised either to the experimental group (Stepping Stones Triple P) or to Care as Usual. The primary outcome is a change in the child's psychosocial problems according to parents and teachers. The secondary outcome is a change in parenting skills. Data will be collected before the start of the intervention, immediately after the intervention, and six months after. This paper presents an outline of the background and design of a randomised controlled trial to investigate the effectiveness of Stepping Stones Triple P, which aims to decrease psychosocial problems in children with a mild intellectual disability. Stepping Stones Triple P seems promising, but evidence on its effectiveness for this population is still lacking. This study provides evidence about the effects of this intervention in a community-based population of children with a mild intellectual

  1. The effectiveness of Stepping stones Triple P: the design of a randomised controlled trial on a parenting programme regarding children with mild intellectual disability and psychosocial problems versus care as usual

    Directory of Open Access Journals (Sweden)

    Jansen Daniëlle EMC

    2011-08-01

    Full Text Available Abstract Background Children with an intellectual disability are at increased risk of psychosocial problems. This leads to serious restrictions in the daily functioning of the children and to parental stress. Stepping Stones Triple P aims to prevent severe behavioural, emotional and developmental problems in children with a (intellectual disability by enhancing parenting knowledge and skills, and the self-confidence of parents. This paper aims to describe the design of a study of the effectiveness of parenting counselling using Stepping Stones Triple P compared to Care as Usual. Methods/Design The effects of Stepping Stones Triple P will be studied in a Randomised Controlled Trial. Parents of children aged 5-12 years with an IQ of 50-85 will be recruited from schools. Prior to randomisation, parents complete a screening questionnaire about their child's psychosocial problems and their parenting skills. Subsequently, parents of children with increased levels of psychosocial problems (score on Strengths and Difficulties Questionnaire ≥ 14 will be invited to participate in the intervention study. After obtaining consent, parents will be randomised either to the experimental group (Stepping Stones Triple P or to Care as Usual. The primary outcome is a change in the child's psychosocial problems according to parents and teachers. The secondary outcome is a change in parenting skills. Data will be collected before the start of the intervention, immediately after the intervention, and six months after. Discussion This paper presents an outline of the background and design of a randomised controlled trial to investigate the effectiveness of Stepping Stones Triple P, which aims to decrease psychosocial problems in children with a mild intellectual disability. Stepping Stones Triple P seems promising, but evidence on its effectiveness for this population is still lacking. This study provides evidence about the effects of this intervention in a community

  2. Psychotherapeutic Methods of Coping with Stress in Everyday Life

    Directory of Open Access Journals (Sweden)

    Senol TURAN

    2015-12-01

    Full Text Available Stress is an inevitable part of life. Knowing the ways of coping with stress are necessary to preserve our mental and physical health and to maintain good social and/or occupational functioning in daily life activities. Different ways of coping with stress have been developed throughout history. Various type of therapies offer quite effective remedies for coping with stress in everyday life. Among psychotherapeutic treatments cognitive behavioral therapy which involves teaching stressful individuals to develop coping strategies have yielded very promising results. It is helpful to determine first whether stress source can be changed, several therapeutic approaches may then be used. Lazarus and Folkman have identified two major approaches for coping with stress so-called "problem-focused" and "emotion-focused". In "problem-focused" approaches targets are acquiring time management, self-monitoring, problem-solving skills, while in "emotion-focused" approaches, through ways of accepting or rejecting of stress associated negative emotions, or reconciling with these emotions, the target is learning how to keep emotions under control. "Problem-focused" and "emotion-focused" approaches may independently be used effectively in appropriate cases, their simultaneous practice may increase chances of successful treatment. Apart from this methods, psychodynamic therapy may be indicated in some cases. [JCBPR 2015; 4(3.000: 133-140

  3. [The emphases and basic procedures of genetic counseling in psychotherapeutic model].

    Science.gov (United States)

    Zhang, Yuan-Zhi; Zhong, Nanbert

    2006-11-01

    The emphases and basic procedures of genetic counseling are all different with those in old models. In the psychotherapeutic model, genetic counseling will not only focus on counselees' genetic disorders and birth defects, but also their psychological problems. "Client-centered therapy" termed by Carl Rogers plays an important role in genetic counseling process. The basic procedures of psychotherapeutic model of genetic counseling include 7 steps: initial contact, introduction, agendas, inquiry of family history, presenting information, closing the session and follow-up.

  4. 'right@home': a randomised controlled trial of sustained nurse home visiting from pregnancy to child age 2 years, versus usual care, to improve parent care, parent responsivity and the home learning environment at 2 years.

    Science.gov (United States)

    Goldfeld, Sharon; Price, Anna; Bryson, Hannah; Bruce, Tracey; Mensah, Fiona; Orsini, Francesca; Gold, Lisa; Hiscock, Harriet; Smith, Charlene; Bishop, Lara; Jackson, Dianne; Kemp, Lynn

    2017-03-20

    By the time children start school, inequities in learning, development and health outcomes are already evident. Sustained nurse home visiting (SNHV) offers a potential platform for families experiencing adversity, who often have limited access to services. While SNHV programmes have been growing in popularity in Australia and internationally, it is not known whether they can improve children's learning and development when offered via the Australian service system. The right@home trial aims to investigate the effectiveness of an SNHV programme, offered to women from pregnancy to child age 2 years, in improving parent care of and responsivity to the child, and the home learning environment. Pregnant Australian women (n=722) are identified after completing a screening survey of 10 factors known to predict children's learning and development (eg, young pregnancy, poor mental or physical health, lack of support). Consenting women-surveyed while attending clinics at 10 hospitals in Victoria and Tasmania-are enrolled if they report having 2 or more risk factors. The intervention comprises 25 home visits from pregnancy to 2 years, focusing on parent care of the child, responsivity to the child and providing a good quality home learning environment. The standard, universal, Australian child and family health service provides the comparator (control). Primary outcome measures include a combination of parent-reported and objective assessments of children's sleep, safety, nutrition, parenting styles and the home learning environment, including the Home Observation of the Environment Inventory and items adapted from the Longitudinal Study of Australian Children. This study is approved by the Royal Children's Hospital Human Research Ethics Committees (HREC 32296) and site-specific HRECs. The investigators and sponsor will communicate the trial results to stakeholders, participants, healthcare professionals, the public and other relevant groups via presentations and

  5. Psychotherapeutical effects of stimulate positive connotation in the increase of forgiveness

    Directory of Open Access Journals (Sweden)

    Andrés Fernando López Pell

    2009-10-01

    Full Text Available This work presents different aspects that have been related to the aptitude to forgive, emphasizing its importance for the psychotherapeutic practice in order to promote an increase of such capacity. Existing empirical evidence tends to relate forgiveness to emotional, physical and psychological well-being of the persons, and shows that the way of providing sense to the experiences influences the process of forgiveness. An alternative to increase the aptitude to forgive is proposed and results of an experimental study with 60 patients demonstrate the psychotherapeutic effects of stimulating positive connotation in the increase of forgiveness. The independent variable was the type of psychotherapeutic approach applied and the dependant variables were measured with the Aptitude to Forgive Scale (CAPER that evaluates the general predisposition of a subject to forgive, across four independent constructs: a Self, b Others, c Situation, and d Beliefs.

  6. Cost-utility of cognitive behavioral therapy versus U.S. Food and Drug Administration recommended drugs and usual care in the treatment of patients with fibromyalgia: an economic evaluation alongside a 6-month randomized controlled trial.

    Science.gov (United States)

    Luciano, Juan V; D'Amico, Francesco; Cerdà-Lafont, Marta; Peñarrubia-María, María T; Knapp, Martin; Cuesta-Vargas, Antonio I; Serrano-Blanco, Antoni; García-Campayo, Javier

    2014-10-01

    Cognitive behavioral therapy (CBT) and U.S. Food and Drug Administration (FDA)-recommended pharmacologic treatments (RPTs; pregabalin, duloxetine, and milnacipran) are effective treatment options for fibromyalgia (FM) syndrome and are currently recommended by clinical guidelines. We compared the cost-utility from the healthcare and societal perspectives of CBT versus RPT (combination of pregabalin + duloxetine) and usual care (TAU) groups in the treatment of FM. The economic evaluation was conducted alongside a 6-month, multicenter, randomized, blinded, parallel group, controlled trial. In total, 168 FM patients from 41 general practices in Zaragoza (Spain) were randomized to CBT (n = 57), RPT (n = 56), or TAU (n = 55). The main outcome measures were Quality-Adjusted Life Years (QALYs, assessed by using the EuroQoL-5D questionnaire) and improvements in health-related quality of life (HRQoL, assessed by using EuroQoL-5D visual analogue scale, EQ-VAS). The costs of healthcare use were estimated from patient self-reports (Client Service Receipt Inventory). Cost-utility was assessed by using the net-benefit approach and cost-effectiveness acceptability curves (CEACs). On average, the total costs per patient in the CBT group (1,847 €) were significantly lower than those in patients receiving RPT (3,664 €) or TAU (3,124 €). Patients receiving CBT reported a higher quality of life (QALYs and EQ-VAS scores); the differences between groups were significant only for EQ-VAS. From a complete case-analysis approach (base case), the point estimates of the cost-effectiveness ratios resulted in dominance for the CBT group in all of the comparisons performed, by using both QALYs and EQ-VAS as outcomes. These findings were confirmed by bootstrap analyses, net-benefit curves, and CEACs. Two additional sensitivity analyses (intention-to-treat analysis and per-protocol analysis) indicated that the results were robust. The comparison of RPT with TAU yielded no clear preference for

  7. Copenhagen infant mental health project: study protocol for a randomized controlled trial comparing circle of security –parenting and care as usual as interventions targeting infant mental health risks

    Directory of Open Access Journals (Sweden)

    Mette Skovgaard Væver

    2016-11-01

    Full Text Available Abstract Background Infant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security–Parenting (COS-P, currently being conducted in Denmark. Methods/design In a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2–12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314, who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline and at follow-up when the child is 12–16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing

  8. Body dysmorphic concerns, social adaptation, and motivation for psychotherapeutic support in dermatological outpatients.

    Science.gov (United States)

    Ritter, Viktoria; Fluhr, Joachim W; Schliemann-Willers, Sibylle; Elsner, Peter; Strauß, Bernhard; Stangier, Ulrich

    2016-09-01

    Dermatologists are increasingly confronted with patients affected by body dysmorphic disorder (BDD). BDD is characterized by excessive preoccupation with one or more perceived defect(s) or flaw(s) in physical appearance which are not observable or appear slight to others. So far, there have been only few studies examining the prevalence of BDD in dermatological outpatients. In addition, the need for psychotherapeutic support in dermatological outpatients with body dysmorphic concerns has not yet been systematically examined. The objective of the present study was therefore to investigate the frequency of body dysmorphic concerns as well as social adaptation and the need for psychotherapeutic support in the aforementioned patient group. A total of 252 dermatological outpatients seen at a German university hospital were consecutively enrolled, and examined using the Dysmorphic Concerns Questionnaire, the Social Adaptation Self-Evaluation Scale, and the German version of the University of Rhode Island Change Assessment Scale. 7.9 % of all outpatients (unselected sample) showed positive test results, suggesting clinically relevant body dysmorphic concerns. Patients with clinically relevant body dysmorphic concerns exhibited poor social adaptation. Contrary to expectations, these patients revealed a high motivation for change, indicating the necessity for psychotherapeutic support. Our findings confirm previous prevalence rates of BDD in dermatological outpatients, and highlight the need for providing psychotherapeutic support to dermatological patients. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  9. Memory reconsolidation, repeating, and working through: Science and culture in psychotherapeutic research and practice.

    Science.gov (United States)

    Levin, Charles

    2015-01-01

    Hypothesizing that an effective common feature in divergent forms of psychotherapy is a process of memory reconsolidation integrating new emotional experiences, Lane et al. usefully shift the focus away from established and/or specialized techniques to deeper questions about the underlying principles of psychotherapeutic change. More research attention to cultural factors influencing the definition and treatment of psychopathology is also needed.

  10. Publication Bias in Meta-Analyses of the Efficacy of Psychotherapeutic Interventions for Depression

    Science.gov (United States)

    Niemeyer, Helen; Musch, Jochen; Pietrowsky, Reinhard

    2013-01-01

    Objective: The aim of this study was to assess whether systematic reviews investigating psychotherapeutic interventions for depression are affected by publication bias. Only homogeneous data sets were included, as heterogeneous data sets can distort statistical tests of publication bias. Method: We applied Begg and Mazumdar's adjusted rank…

  11. Dreaming the Research Process: A Psychotherapeutic Contribution to the Culture of Healthcare Research

    Science.gov (United States)

    Macaskie, Jane; Lees, John

    2011-01-01

    This paper challenges the neglect of psychotherapeutic methods in therapy research and discusses the use of methods arising directly from therapy practice to generate research data. Recent developments in therapy research culture are critiqued in order to contextualise the present contribution. The research design and methodology evolve from the…

  12. Evaluating the Efficacy of an Attachment-Informed Psychotherapeutic Program for Incarcerated Parents

    Science.gov (United States)

    Kamptner, N. Laura; Teyber, Faith H.; Rockwood, Nicholas J.; Drzewiecki, Dolly

    2017-01-01

    An attachment-based, psychotherapeutic parent education course was created for incarcerated mothers and fathers to help improve their ability to provide positive parenting and a more stable home environment for their children. The current study assessed the effects of this parenting curriculum on parents' reported tendencies to be abusive, their…

  13. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis.

    Directory of Open Access Journals (Sweden)

    Jürgen Barth

    Full Text Available BACKGROUND: Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression. METHODS AND FINDINGS: We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d = -0.62 to d = -0.92. Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d = 0.01 to d = -0.30. Interpersonal therapy was significantly more effective than supportive therapy (d = -0.30, 95% credibility interval [CrI] [-0.54 to -0.05]. Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δd = 0.29 [-0.01 to 0.58]; p = 0.063 and large size (Δd = 0.33 [0.08 to 0.61]; p = 0.012 and those that had adequate outcome assessment (Δd = 0.38 [-0.06 to 0.87]; p = 0.100. Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46 compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions. CONCLUSIONS: Overall our

  14. Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat‐related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage

    Science.gov (United States)

    Schaal, Susanne; Hecker, Tobias; Elbert, Thomas

    2015-01-01

    Background Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex‐combatants present with trauma‐related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma‐related suffering and the lowered threshold for aggressive behaviour. Objective Supporting the demobilization process of ex‐combatants in the eastern DR‐Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET). Method In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3‐week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment‐as‐usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success. Results Six months post‐intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months. Conclusions Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley

  15. Psychotherapeutic issues with "kinky" clients: clinical problems, yours and theirs.

    Science.gov (United States)

    Nichols, Margaret

    2006-01-01

    People whose sexual repertoire includes BDSM, fetish, or other "kinky" practices have become increasingly visible, on the Internet, in the real world, and in psychotherapists' offices. Unfortunately, the prevailing psychiatric view of BDSM remains a negative one: These sexual practices are usually considered paraphilias, i.e., de facto evidence of pathology. A different, affirming view of BDSM is taken in this paper. After defining BDSM and reviewing common misconceptions, a variety of issues the practitioner will face are described. These include problems of countertransference, of working with people with newly emerging sexual identities, working with spouses and partners, and discriminating between abuse and sexual "play."

  16. Anorexia nervosa and bulimia nervosa - a psychotherapeutic cognitive-constructivist approach.

    Science.gov (United States)

    Abreu, Cristiano Nabuco de; Cangelli Filho, Raphael

    2017-06-01

    Of the eating disorders, anorexia nervosa and bulimia nervosa are the ones that have made adolescent patients-often females and aged younger and younger-seek for help. This help is provided through a multidisciplinary treatment involving psychiatrists, psychologists and dietists. Psychotherapy has shown to be an efficient component for these patients' improvement. The present article aims at presenting a proposal of psychotherapeutic treatment based on a cognitive-constructivist approach.

  17. Adaptation of instruments developed to study the effectiveness of psychotherapeutic processes

    Directory of Open Access Journals (Sweden)

    Shushanikova, Anastasia A.

    2016-06-01

    Full Text Available The objective of the research was to adapt for use in Russian-language contexts a set of instruments that assess the effectiveness of psychotherapeutic practices. The instruments explore the effectiveness of different types of therapy, without evaluating the abstract, idealized characteristics or specifics of each approach, specialist, or therapeutic case. The adapted instruments are based on reflective data about the significance of therapeutic events, from the point of view of both the client and the therapist. We translated, edited, and adapted forms developed by John McLeod and Mick Cooper — a “Goals Form”, a “Goal Assessment Form”, a “Post-Session Form”, and a “Therapy Personalization Form”. The adaption was intended to cohere with the stylistic and cultural aspects of the Russian language. The research showed that the instruments and the methods have great potential for practical and theoretical application in qualitative studies to formulate hypotheses and to verify them in quantitative studies. The phenomenological analysis reveals the reliability, appropriateness, and validity of the adapted instruments for identifying specific meanings of the psychotherapeutic cases considered. The instruments can be used in studies exploring helpful aspects and effectiveness in different types of therapy (cognitive, existential, outdoor therapy, online counseling, etc. with different groups of clients. It is reasonable to continue the use of the Russian-language version of the instruments in further studies exploring the effectiveness of psychological practices. The adapted instruments facilitate comparison and cross-cultural studies, and formulation of meaningful hypotheses about the effectiveness and quality of the psychotherapeutic process.

  18. Prevention of anxiety and depression in the age group of 75 years and over: a randomised controlled trial testing the feasibility and effectiveness of a generic stepped care programme among elderly community residents at high risk of developing anxiety and depression versus usual care [ISRCTN26474556

    Directory of Open Access Journals (Sweden)

    van Oppen Patricia

    2006-07-01

    Full Text Available Abstract Background In frail elderly, the effects of depression and anxiety are deep encroaching. Indicated prevention studies, aimed at subjects with subthreshold disorder, have shown that well designed interventions are capable of reducing the incidence of depression and anxiety. In this randomised prevention trial for elderly, living in the community and suffering from subthreshold depression and anxiety, a stepped care programme was put together to be tested versus usual (GP care. Methods/design Design: randomised controlled trial. (See figure 1: organisation chart together with two other projects, this project is part of a national consortium that investigates the prevention of anxiety and depressive disorders in later life using a stepped care programme. The three projects have their own particular focus. This project is aimed at elderly living in the community. Inclusion: subjects with a high risk for depression and anxiety without clinical evidence of these syndromes. The participants are 75 years of age and over and have subthreshold symptoms of depression and or anxiety: they score above the cut-off point on the self-report Centre for Epidemiologic Studies Depression (CES-D scale, but the criteria for a major depressive disorder or anxiety disorder (panic disorder, agoraphobia, social phobia, generalized anxiety disorder according to a validated interview, the Mini International Neuropsychiatric Interview (MINI are not fulfilled. Outcomes: primary outcome: incidence of a depressive or anxiety disorder over a period of two years (MINI; secondary outcome: a positive influence of the intervention, a stepped care programme, on symptoms of depression and anxiety and on quality of life as assessed with the CES D, the HADS A and the SF36 respectively (i.e. stabilisation or improvement of symptoms [see table 1]. Measurements: Take place at baseline and at 3, 6, 9, 12, 18 and 24 months. Trained independent evaluators assess depression and

  19. Discourse-voice regulatory strategies in the psychotherapeutic interaction: a state-space dynamics analysis.

    Science.gov (United States)

    Tomicic, Alemka; Martínez, Claudio; Pérez, J Carola; Hollenstein, Tom; Angulo, Salvador; Gerstmann, Adam; Barroux, Isabelle; Krause, Mariane

    2015-01-01

    This study seeks to provide evidence of the dynamics associated with the configurations of discourse-voice regulatory strategies in patient-therapist interactions in relevant episodes within psychotherapeutic sessions. Its central assumption is that discourses manifest themselves differently in terms of their prosodic characteristics according to their regulatory functions in a system of interactions. The association between discourse and vocal quality in patients and therapists was analyzed in a sample of 153 relevant episodes taken from 164 sessions of five psychotherapies using the state space grid (SSG) method, a graphical tool based on the dynamic systems theory (DST). The results showed eight recurrent and stable discourse-voice regulatory strategies of the patients and three of the therapists. Also, four specific groups of these discourse-voice strategies were identified. The latter were interpreted as regulatory configurations, that is to say, as emergent self-organized groups of discourse-voice regulatory strategies constituting specific interactional systems. Both regulatory strategies and their configurations differed between two types of relevant episodes: Change Episodes and Rupture Episodes. As a whole, these results support the assumption that speaking and listening, as dimensions of the interaction that takes place during therapeutic conversation, occur at different levels. The study not only shows that these dimensions are dependent on each other, but also that they function as a complex and dynamic whole in therapeutic dialog, generating relational offers which allow the patient and the therapist to regulate each other and shape the psychotherapeutic process that characterizes each type of relevant episode.

  20. Psychotherapeutic and work-oriented interventions: employment outcomes among young adults with work disability due to a mental disorder.

    Science.gov (United States)

    Mattila-Holappa, Pauliina; Joensuu, Matti; Ahola, Kirsi; Koskinen, Aki; Tuisku, Katinka; Ervasti, Jenni; Virtanen, Marianna

    2016-01-01

    We examined the extent to which psychotherapeutic and work-oriented interventions were included in a medical treatment and rehabilitation plan and whether they predicted future employment among young adults with work disability due to a mental disorder. Data were obtained from the treatment and rehabilitation plans of 1163 young adults aged 18‒34 years, who in 2008 were granted fixed-term work disability compensation due to a mental disorder and were followed for 5 years. Forty-six percent had no proposal for psychotherapy or a work-oriented intervention in their treatment and rehabilitation plan, 22 % had a plan for only a psychotherapeutic intervention, 23 % had a plan for only a work-oriented intervention, and 10 % had both types of interventions planned. Having a planned psychotherapeutic intervention (HR = 1.35, 95 % CI 1.07-1.69) and of the work-oriented interventions, planned rehabilitative courses and training (HR = 1.34, 95 % CI 1.03-1.70) predicted quicker entry into competitive employment. Having a plan for both a psychotherapeutic and work-oriented intervention was associated with being employed at the end of the follow-up (OR = 1.77, 95 % CI 1.07-2.95). Young adults with a long-term psychiatric work disability episode rarely have a recorded plan for rehabilitation in their treatment and rehabilitation plan although psychotherapeutic interventions and a combination of a psychotherapeutic and work-oriented intervention might help them gain employment.

  1. PRECISE - pregabalin in addition to usual care: Statistical analysis plan

    NARCIS (Netherlands)

    S. Mathieson (Stephanie); L. Billot (Laurent); C. Maher (Chris); A.J. McLachlan (Andrew J.); J. Latimer (Jane); B.W. Koes (Bart); M.J. Hancock (Mark J.); I. Harris (Ian); R.O. Day (Richard O.); J. Pik (Justin); S. Jan (Stephen); C.-W.C. Lin (Chung-Wei Christine)

    2016-01-01

    textabstractBackground: Sciatica is a severe, disabling condition that lacks high quality evidence for effective treatment strategies. This a priori statistical analysis plan describes the methodology of analysis for the PRECISE study. Methods/design: PRECISE is a prospectively registered, double

  2. Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Cæcilie; Andersen, Ida; Mortensen, Erik Lykke

    2015-01-01

    INTRODUCTION: Cognitive behavioural therapy (CBT) with trauma focus is the most evidence supported psychotherapeutic treatment of PTSD, but few CBT treatments for traumatized refugees have been described in detail. PURPOSE: To describe and evaluate a manualized cognitive behavioral therapy...... for traumatized refugees incorporating exposure therapy, mindfulness and acceptance and commitment therapy. MATERIAL AND METHODS: 85 patients received six months' treatment at a Copenhagen Trauma Clinic for Refugees and completed self-ratings before and after treatment. The treatment administered to each patient...... and the observed change. CONCLUSION: The study suggests that CBT treatment incorporating mindfulness and acceptance and commitment therapy is promising for traumatized refugees and punctures the myth that this group of patients are unable to participate fully in structured CBT. However, treatment methods must...

  3. [Psychosocial Treatment of Addictive Disorders--An Overview of Psychotherapeutic Options and their Efficacy].

    Science.gov (United States)

    Walter, M; Dürsteler, K M; Petitjean, S A; Wiesbeck, G A; Euler, S; Sollberger, D; Lang, U E; Vogel, M

    2015-04-01

    Addictive disorders are chronic relapsing conditions marked by compulsive and often uncontrolled use of psychotropic substances or stimuli. In this review, we present and discuss the current specific psychosocial interventions for addictive disorders and their effectiveness. In particular cognitive behavioral therapy, motivational interviewing, relapse prevention, the community reinforcement approach, and contingency management were found to be effective. For these psychotherapeutic treatments, mostly moderate effect sizes have been found. Their effectiveness seems to be highest in cannabis dependence. Empirical evidence for dependence on "hard" drugs is largest for contingency management, while for alcohol dependence motivational interviewing and the community reinforcement approach show the largest effect sizes. Presumably, combinations of different approaches as well as online interventions will bring further progress in the psychosocial treatment of addictive disorders in the future. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Psychotherapeutic approaches to non-suicidal self-injury in adolescents

    Directory of Open Access Journals (Sweden)

    Washburn Jason J

    2012-03-01

    Full Text Available Abstract Non-suicidal self-injury (NSSI among adolescents is gaining increasing attention in both clinical and scientific arenas. The lifetime prevalence of NSSI is estimated to vary between 7.5% to 8% for preadolescents, increasing to between 12% and 23% for adolescents. Despite the prevalence and the increasing interest in NSSI, few psychotherapeutic treatments have been designed specifically for NSSI, and no treatments have been evaluated specifically for the treatment of NSSI among adolescents. Consequently, child and adolescent clinicians are left with little evidence-based guidance for treating this challenging population. To provide some guidance, evaluations of treatments for adults with NSSI and for adolescents with related conditions, such as deliberate self-harm and borderline personality disorder, are reviewed. Clinical guidelines and resources are also discussed to assist with the gaps in the knowledge base for treatment of NSSI among adolescents.

  5. Discourse-Voice Regulatory Strategies in the Psychotherapeutic Interaction: A State-Space Dynamics Analysis

    Directory of Open Access Journals (Sweden)

    Alemka eTomicic

    2015-04-01

    Full Text Available This study seeks to provide evidence of the dynamics associated with the configurations of discourse-voice regulatory strategies in patient-therapist interactions in relevant episodes within psychotherapeutic sessions. Its central assumption is that discourses manifest themselves differently in terms of their prosodic characteristics according to their regulatory functions in a system of interactions. The association between discourse and vocal quality in patients and therapists was analyzed in a sample of 153 relevant episodes taken from 164 sessions of five psychotherapies using the State Space Grid (SSG method, a graphical tool based on the Dynamic Systems Theory (DST. The results showed eight recurrent and stable discourse-voice regulatory strategies of the patients and three of the therapists. Also, four specific groups of these discourse-voice strategies were identified. The latter were interpreted as regulatory configurations, that is to say, as emergent self-organized groups of discourse-voice regulatory strategies constituting specific interactional systems. Both regulatory strategies and their configurations differed between two types of relevant episodes: Change Episodes and Rupture Episodes. As a whole, these results support the assumption that speaking and listening, as dimensions of the interaction that takes place during therapeutic conversation, occur at different levels. The study not only shows that these dimensions are dependent on each other, but also that they function as a complex and dynamic whole in therapeutic dialogue, generating relational offers which allow the patient and the therapist to regulate each other and shape the psychotherapeutic process that characterizes each type of relevant episode.

  6. Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Almut Zeeck

    2018-05-01

    Full Text Available Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare treatment effects according to service level (inpatient vs. outpatient and age group (adolescents vs. adults.Methods:The data bases PubMed, Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017. Search terms were adapted for data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a comparison of service levels and age groups, standard mean change (SMC statistics were used and naturalistic, non-randomized studies included.Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants were included in the network meta-analysis. SMC analyses were conducted with 38 studies (1,164 participants. While family-based approaches dominate interventions for adolescents, individual psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient treatment.Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response. Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment

  7. Neural Correlates of Psychotherapeutic Treatment of Post-traumatic Stress Disorder: A Systematic Literature Review.

    Science.gov (United States)

    Malejko, Kathrin; Abler, Birgit; Plener, Paul L; Straub, Joana

    2017-01-01

    Post-traumatic stress disorder (PTSD) is a common psychiatric disease with changes in neural circuitries. Neurobiological models conceptualize the symptoms of PTSD as correlates of a dysfunctional stress reaction to traumatic events. Functional imaging studies showed an increased amygdala and a decreased prefrontal cortex response in PTSD patients. As psychotherapeutic approaches represent the gold standard for PTSD treatment, it is important to examine its underlying neurobiological correlates. Studies published until August 2016 were selected through systematic literature research in the databases PubMed, PsychInfo, and Cochrane Library's Central Register of Controlled Trials or were identified manually by searching reference lists of selected articles. Search terms were "neural correlates" OR "fMRI" OR "SPECT," AND "therapy" AND "PTSD." A total of 19 articles were included in the present review whereof 15 studies compared pre-to-post-therapy signal changes, six studies related pre-treatment activity to pre-to-post-symptom improvement, and four studies compared neural correlates of responders versus non-responders. The disposed therapy forms were cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing, cognitive therapy, exposure therapy, mindfulness-based intervention, brief eclectic psychotherapy, and unspecified therapy. Successful psychotherapy of PTSD was repeatedly shown to be accompanied by decreased activity in the amygdala and the insula as well as increased activity in the dorsal anterior cingulate cortex (dACC) and hippocampus. Elevated dACC activity prior to treatment was related to subsequent treatment success and a positive predictor for treatment response. Elevated amygdala and insula pre-treatment activities were related to treatment failure. Decreased activity in limbic brain regions and increased activity in frontal brain areas in PTSD patients after successful psychotherapeutic treatment might reflect regained top

  8. Humanistic therapies versus treatment as usual for depression

    Science.gov (United States)

    Davies, Philippa; Hunot, Vivien; Moore, Theresa HM; Caldwell, Deborah; Jones, Hannah; Lewis, Glyn; Churchill, Rachel

    2014-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all humanistic therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different humanistic therapy models (person-centred, gestalt, process-experiential, transactional analysis, existential and non-directive therapies) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all humanistic therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression. PMID:25408624

  9. Smartphone-based psychotherapeutic micro-interventions to improve mood in a real-world setting

    Directory of Open Access Journals (Sweden)

    Gunther Meinlschmidt

    2016-07-01

    Full Text Available Background: Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes.Method: As part of a larger neurofeedback study, all subjects – after being randomly assigned to an experimental or control neurofeedback condition – underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good–bad, GB; awake–tired, AT; and calm–nervous, CN. Results: Twenty-seven men participated on at least eleven days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13% and contemplative repetition (68 sessions, 20.30% being the most frequently applied techniques. Mixed models indicated that subjects showed better mood (GB: b=0.464, 95%confidence interval (CI [0.068, 0.860], t(613.3=2.298, p=0.022 and became more awake (AT: b=0.514, 95%CI [0.103, 0.925], t(612.4=2.456, p=0.014 and calmer (CN: b=0.685, 95%CI [0.360, 1.010], t(612.3=4.137, p<0.001 from pre- to post-micro-intervention. These mood improvements from pre- to post-micro-intervention were associated with changes in mood from the first day until the last day with regard to GB mood (r=0.614, 95%CI [0.297, 0.809], p<0.001, but not AT mood (r=0.279, 95%CI [-0.122, 0.602], p=0.167 and CN mood (r=0.277, 95

  10. It's not business as usual anymore

    International Nuclear Information System (INIS)

    Brown, C.W. Jr.

    1992-01-01

    In 20 years, a complex body of environmental laws, regulations, and decisions has been established in the U.S. Basic knowledge of environmental laws, regulations, and management techniques is now necessary for design, construction, and operation of oil field facilities. Environmental permits are on the critical path and could significantly affect project viability or the cost of doing business. In California and many other states, resource development projects face complex and voluminous environmental regulations. Because of these permitting obstacles and the competition for the available permits, early environmental planning is necessary if a project is to be successful and if costs and future liabilities are to be minimized. This paper reviews eight federal environmental laws, significant events that affect our daily business, and the reasons why environmental management must be integrated in our business as usual work decisions to minimize future (hidden) liabilities

  11. It's not business as usual - anymore

    International Nuclear Information System (INIS)

    Brown, C.W.

    1991-01-01

    In a short period of 20 years, a complex body of environmental laws, regulations, and decisions has been established in the United States. Basic knowledge of environmental laws, regulations, and environmental management are now necessary for design, construction, and operation of our oil field facilities. environmental permits are on the critical path and could have the potential to significantly affect project viability or the cost of doing business. In California and many other States, resource development projects faced complex and voluminous environmental regulations. These permitting obstacles along with competition for the available permits require early project environmental planning if a project is to be successful and if costs and future liability are to be minimized. This paper will review eight Federal environmental laws, significant events that affect our daily business, and why environmental management must be integrated in our business as usual work decisions to minimize future (hidden) liabilities

  12. Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services

    Directory of Open Access Journals (Sweden)

    G. Bergström

    2017-05-01

    Full Text Available Abstract Background Common mental disorders (CMDs are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis. Methods The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention’s cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out. Discussion The study includes analyses of the effectiveness of the

  13. Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services.

    Science.gov (United States)

    Bergström, G; Lohela-Karlsson, M; Kwak, L; Bodin, L; Jensen, I; Torgén, M; Nybergh, L

    2017-05-12

    Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis. The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out. The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of

  14. Do Postoperative Psychotherapeutic Interventions and Support Groups Influence Weight Loss Following Bariatric Surgery? A Systematic Review and Meta-analysis of Randomized and Nonrandomized Trials

    DEFF Research Database (Denmark)

    Beck, Nina N.; Johannsen, Maja; Støvring, René K.

    2012-01-01

    Bariatric surgery is currently considered the most effective treatment of severe obesity, but considerable individual variations in weight loss results have been reported. We therefore conducted a systematic review and meta-analysis of studies investigating the effect of psychotherapeutic...

  15. Usual Vitamin Intakes by Mexican Populations.

    Science.gov (United States)

    Pedroza-Tobías, Andrea; Hernández-Barrera, Lucía; López-Olmedo, Nancy; García-Guerra, Armando; Rodríguez-Ramírez, Sonia; Ramírez-Silva, Ivonne; Villalpando, Salvador; Carriquiry, Alicia; Rivera, Juan A

    2016-09-01

    In the past several years, the consumption of high-energy, nutrient-poor foods has increased globally. Dietary intake data collected by the National Health and Nutrition Survey (ENSANUT) 2012 provide information to assess the quality of the Mexican diet and to guide food and nutrition policy. The aim was to describe the usual intake and the prevalence of inadequate intakes of vitamins for the overall Mexican population and by subgroups defined by sex, age, region, urban or rural areas, and socioeconomic status (SES). ENSANUT 2012 is a cross-sectional probabilistic survey representative of the Mexican population. Dietary information was collected by using the 24-h recall automated multiple-pass method (n = 10,096) with a repeated measurement on a subsample (n = 889) to permit adjustment for intraindividual variability with the use of the Iowa State University method. Mean usual intakes and the prevalence of inadequate intakes of thiamin, riboflavin, niacin, folate, and vitamins A, D, E, C, B-6, and B-12 were calculated for children aged 1-4 y (CH1-4y), children aged 5-11 y (CH5-11y), adolescents aged 12-19 y, and adults aged ≥20 y. In all of the age groups, prevalences of inadequate intakes of vitamins D and E were the highest (77-99% of adults and adolescents and 53-95% of CH5-11y and CH1-4y) and those of folate and vitamin A were intermediate (47-70% of adults and adolescents, 15-23% of CH5-11y and 8-13% of CH1-4y), whereas those of thiamin, riboflavin, niacin, and vitamins B-6, B-12, and C were the lowest (0-37% of adults, 1-27% of adolescents, and 0-2.4% of CH5-11y and CH1-4y). With few exceptions, the highest prevalences of inadequate intakes for vitamins were observed in the poorest populations (rural South region and the lowest tertile of SES). The intake of vitamins among Mexicans is inadequate overall. Information collected by ENSANUT can help target food assistance programs and develop strategies to prevent vitamin deficiencies. © 2016 American Society

  16. STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness

    Science.gov (United States)

    Best, Christoph; Tschan, Regine; Stieber, Nikola; Beutel, Manfred E.; Eckhardt-Henn, Annegret; Dieterich, Marianne

    2015-01-01

    Patients with somatoform vertigo and dizziness (SVD) disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI) using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (Q H/V), reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n = 28); baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ). Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: Q H/V = 0.31 versus controls: Q H/V = 0.38; p = 0.022). After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles. PMID:26843786

  17. The experience of mental health professionals using neuro emotional technique in psychotherapeutic practice

    Science.gov (United States)

    Marriage, Amanda Lynn

    This study reviewed how Neuro Emotional Technique (NET) is used in psychotherapeutic practice, and how it is understood and experienced by the practitioners who use it. Participants included 18 mental health professionals who have obtained the certification-level of training in NET and have incorporated NET into their professional practice. A qualitative method was used to explore NET providers' experiences through an online survey. Data from these surveys was analyzed using the constant comparative method. Six categories containing 18 themes emerged as a result of this analysis. These categories included: (1) practitioners currently employing NET; (2) technique utilization; (3) participant estimation of the efficacy of NET; (4) talking about NET; (5) clients most likely to benefit from NET; and (6) clients least likely to benefit from NET. The 18 themes that emerged within these categories represent important components of the integration of NET into psychological treatment. These themes were compared with existing literature to serve as valuable information for psychologists and other mental health professionals seeking to incorporate NET into their professional practices. This study helps to fill the current void in the area of research on NET as a psychological intervention, or more specifically, as a holistic mind-body approach to self-betterment and the amelioration of symptoms for humans who are healing from a broad spectrum of traumatic and stressful experiences.

  18. STEADFAST: Psychotherapeutic Intervention Improves Postural Strategy of Somatoform Vertigo and Dizziness

    Directory of Open Access Journals (Sweden)

    Christoph Best

    2015-01-01

    Full Text Available Patients with somatoform vertigo and dizziness (SVD disorders often report instability of stance or gait and fear of falling. Posturographic measurements indeed indicated a pathological postural strategy. Our goal was to evaluate the effectiveness of a psychotherapeutic and psychoeducational short-term intervention (PTI using static posturography and psychometric examination. Seventeen SVD patients took part in the study. The effects of PTI on SVD were evaluated with quantitative static posturography. As primary endpoint a quotient characterizing the relation between horizontal and vertical sway was calculated (QH/V, reflecting the individual postural strategy. Results of static posturography were compared to those of age- and gender-matched healthy volunteers (n=28; baseline measurements were compared to results after PTI. The secondary endpoint was the participation-limiting consequences of SVD as measured by the Vertigo Handicap Questionnaire (VHQ. Compared to the healthy volunteers, the patients with SVD showed a postural strategy characterized by stiffening-up that resulted in a significantly reduced body sway quotient before PTI (patients: QH/V=0.31 versus controls: QH/V=0.38; p=0.022. After PTI the postural behavior normalized, and psychological distress was reduced. PTI therefore appears to modify pathological balance behaviour. The postural strategy of patients with SVD possibly results from anxious anticipatory cocontraction of the antigravity muscles.

  19. General Overview of Psychotherapeutic Practice in Poland. Results from a Nationwide Survey.

    Science.gov (United States)

    Suszek, Hubert; Grzesiuk, Lidia; Styła, Rafał; Krawczyk, Krzysztof

    2017-09-01

    A total of 1196 persons conducting psychotherapy in Poland fully completed a nationwide online survey (or, alternatively, a paper and pencil enquiry) concerning their education, training, experience, and clinical work (professional environment, patients treated). The results are described in detail and compared with findings of similar studies from other countries. Among the primary findings were: (1) psychotherapy in Poland is conducted mostly by women (80 %); (2) almost all participants have an MA degree (91 %), including 75.2 % having graduated in psychology; (3) the therapists are well trained (mean number of training hours is above 942) and established (average experience is about 9.8 years), however, more than half of the therapists have no type of certificate; (4) 54 % of respondents identify with the integrative or eclectic orientation and, simultaneously, for 48.6 % of the therapists the most important approach is either psychodynamic or psychoanalytic; (5) the most common form of therapy is individual psychotherapy in private practice; (6) the majority of the therapists treat adult patients with anxiety or personality disorders. In sum, the results show that psychotherapeutic practice is well established in Poland and many indices are similar to those found in Western countries.

  20. Therapists' Metacognitive Monitoring of the Psychotherapeutic Process With Patients With Borderline Personality Disorder.

    Science.gov (United States)

    Bourke, Marianne E; Grenyer, Brin F S

    2017-07-01

    Therapy for borderline personality disorder (BPD) is challenging, in part, because of the impact of BPD on the therapeutic relationship. The therapist's metacognitive capacity within therapy may be perturbed due to the complexity of verbal and nonverbal affect and cognition in the therapeutic interchange; however, research on this issue is lacking. Therapists (N=20 clinical psychologists) were asked to discuss the treatment process when working with their patients with BPD (N=40) and their patients with major depressive disorder (N=40). Verbatim transcripts of the therapists' verbalizations were then scored using computerized linguistic content analysis. When discussing their patients with BPD, clinicians used significantly fewer words associated with cognitive processes (think, understand, realize) or words indicating causation (cause, because, effect), and more first-person singular pronouns, and adverbs. When describing their depressed patients, the therapists used more words associated with negative emotions, anxiety, anger, and sadness than positive words. The results did not seem to be influenced by the therapists' age, sex, or years of experience. Reflection on the psychotherapeutic process with patients with BPD induced in therapists a self-focused, emotionally intense linguistic style dominated by references to themselves and their experience of intense emotional states. These results suggest that, when describing their work with patients with BPD, therapists experience metacognitive challenges and mentalization processes that may parallel the challenges therapists face when thinking and working during the psychotherapy sessions themselves. The results underscore the important role of supervision in assisting therapists to organize their reflective processes when working with patients with BPD.

  1. Functional neuroimaging of psychotherapeutic processes in anxiety and depression: from mechanisms to predictions.

    Science.gov (United States)

    Lueken, Ulrike; Hahn, Tim

    2016-01-01

    The review provides an update of functional neuroimaging studies that identify neural processes underlying psychotherapy and predict outcomes following psychotherapeutic treatment in anxiety and depressive disorders. Following current developments in this field, studies were classified as 'mechanistic' or 'predictor' studies (i.e., informing neurobiological models about putative mechanisms versus aiming to provide predictive information). Mechanistic evidence points toward a dual-process model of psychotherapy in anxiety disorders with abnormally increased limbic activation being decreased, while prefrontal activity is increased. Partly overlapping findings are reported for depression, albeit with a stronger focus on prefrontal activation following treatment. No studies directly comparing neural pathways of psychotherapy between anxiety and depression were detected. Consensus is accumulating for an overarching role of the anterior cingulate cortex in modulating treatment response across disorders. When aiming to quantify clinical utility, the need for single-subject predictions is increasingly recognized and predictions based on machine learning approaches show high translational potential. Present findings encourage the search for predictors providing clinically meaningful information for single patients. However, independent validation as a crucial prerequisite for clinical use is still needed. Identifying nonresponders a priori creates the need for alternative treatment options that can be developed based on an improved understanding of those neural mechanisms underlying effective interventions.

  2. The effect of psychotherapeutic interventions on positive and negative affect in depression: A systematic review and meta-analysis.

    Science.gov (United States)

    Boumparis, Nikolaos; Karyotaki, Eirini; Kleiboer, Annet; Hofmann, Stefan G; Cuijpers, Pim

    2016-09-15

    Depression is a mental disorder characterized by high and dysregulated negative affect in addition to diminished positive affect. To our knowledge, there has been no systematic review of the impact of psychotherapeutic interventions on these affective dimensions. Two comprehensive literature searches for all randomized controlled trials of psychotherapy in adults with depression were performed. The first from 1996 to December 31, 2014 and the second from January 1, 2015 to December 31, 2015. The primary outcome was the mean score of positive and negative affect. Depressive symptoms were measured to be included as a predictor in the meta-regression analyses. Ten studies with 793 adults with depression were included. All studies assessed positive and negative affect. Psychotherapeutic interventions resulted in significantly increased positive affect (g=0.41; 95% CI: 0.16-0.66 p=0.001), and significantly decreased negative affect (g=0.32; 95% CI: 0.15-0.78, p=0.001) in depressed adults. Because of the small number and substantial heterogeneity of the existing studies the meta-regression analyses produced conflicting results. As a consequence, we were unable to sufficiently demonstrate whether NA and depressive symptoms are in fact correlated or not. Given the small number and heterogeneity of the included studies, the findings should be considered with caution. Psychotherapeutic interventions demonstrate low to moderate effects in enhancing positive and reducing negative affect in depressed adults. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions.

    Science.gov (United States)

    Muñoz San José, A; Oreja-Guevara, C; Cebolla Lorenzo, S; Carrillo Notario, L; Rodríguez Vega, B; Bayón Pérez, C

    2016-03-01

    Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Business as usual and nuclear power

    International Nuclear Information System (INIS)

    2000-01-01

    Energy and nuclear policy makers face many challenges as they evaluate options to ensure an adequate supply of electricity while pursuing environmental, economic and energy security goals. Many analysts suggest that nuclear's share of global energy supply could decrease in coming decades. If energy markets and national energy policies continue along 'business as usual' lines, what are the issues that arise? what are the consequences for the long-term availability of nuclear technology and expertise? This book identifies the issues in a series of papers presented at a recent meeting jointly organised by the International Energy Agency and the OECD Nuclear Energy Agency. Senior energy policy makers and industry executives from OECD Member countries contributed these analyses. They offer a realistic assessment of nuclear's potential contribution, and the major challenges awaiting nuclear energy and energy supply in general. For those seeking a review of the current issues facing nuclear power within the broad context of energy policy, this is an essential report. (authors)

  5. Geoengineering, Climate Harm, and Business as Usual

    Science.gov (United States)

    Jankunis, F. J.; Peacock, K.

    2014-12-01

    We define geoengineering (GE) as the intentional use of technology to change the planet's climate. Many people believe GE is different in kind rather than degree from any other organized activity in human history. In fact, humans caused changes in the planet's climate long before the industrial age, and all organisms engineer their environments directly or indirectly. The relevant difference between this cumulative and generally inadvertent activity and GE is the presence of intention. Now that science has revealed the extent to which humans can change the climate, however, even the continuance of Business as Usual (BAU) is, in effect, a form of intentional GE, albeit one that will cause significant climate harm, defined as effects such as sea level rise that will impact human well-being. But as with all forms of engineering, the devil is in the details: what forms of GE should be tried first? Some methods, such as large-scale afforestation, are low risk but have long-term payoffs; others, such as aerosol injection into the stratosphere, could help buy time in a warming crisis but have unknown side-effects and little long-term future. Climate change is a world-wide, inter-generational tragedy of the commons. Rational choice theory, the spatial and temporal extension of the problem, poorly fitted moral frameworks, and political maneuvering are all factors that inhibit solutions to the climate tragedy of the commons. The longer that such factors are allowed to dominate decision-making (or the lack thereof) the more likely it is that humanity will be forced to resort to riskier and more drastic forms of GE. We argue that this fact brings an additional measure of urgency to the search for ways to engineer the climate differently so as to avoid climate harm in the most lasting and least risky way.

  6. Amyloidogenic determinants are usually not buried

    Directory of Open Access Journals (Sweden)

    Karletidi Carolina-Maria

    2009-07-01

    Full Text Available Abstract Background Amyloidoses are a group of usually fatal diseases, probably caused by protein misfolding and subsequent aggregation into amyloid fibrillar deposits. The mechanisms involved in amyloid fibril formation are largely unknown and are the subject of current, intensive research. In an attempt to identify possible amyloidogenic regions in proteins for further experimental investigation, we have developed and present here a publicly available online tool that utilizes five different and independently published methods, to form a consensus prediction of amyloidogenic regions in proteins, using only protein primary structure data. Results It appears that the consensus prediction tool is slightly more objective than individual prediction methods alone and suggests several previously not identified amino acid stretches as potential amyloidogenic determinants, which (although several of them may be overpredictions require further experimental studies. The tool is available at: http://biophysics.biol.uoa.gr/AMYLPRED. Utilizing molecular graphics programs, like O and PyMOL, as well as the algorithm DSSP, it was found that nearly all experimentally verified amyloidogenic determinants (short peptide stretches favouring aggregation and subsequent amyloid formation, and several predicted, with the aid of the tool AMYLPRED, but not experimentally verified amyloidogenic determinants, are located on the surface of the relevant amyloidogenic proteins. This finding may be important in efforts directed towards inhibiting amyloid fibril formation. Conclusion The most significant result of this work is the observation that virtually all, to date, experimentally determined amyloidogenic determinants and the majority of predicted, but not yet experimentally verified short amyloidogenic stretches, lie 'exposed' on the surface of the relevant amyloidogenic proteins, and also several of them have the ability to act as conformational 'switches'. Experiments

  7. What to Do When there is Nothing to Do: The psychotherapeutic value of Meaning Therapy in the treatment of late life depression

    Directory of Open Access Journals (Sweden)

    J. H. Morgan

    2013-11-01

    Full Text Available Psychotherapeutic treatment with the goal of cure, of course, is the standard within the healing professions but when we are dealing with late life depression where there is no hope for longevity, the agenda necessarily must shift from cure to care, from treatment with the goal of renewed healthy living to a focus upon the palliative aspects of a limited prognosis. Here, then, the clinician is faced with the challenge of existential intervention with an emphasis upon the “moment” rather than the future. The encroachment of ennui upon the elderly, particularly and especially those who have been actively engaged in a full life of service such as the clergy, physicians, teachers, and attorneys, can be a traumatic and debilitating experience.When hope for the future is not being sought but rather an effective and celebrative address to the existential realities confronting the elderly patient who is facing decline and death, the quest for those “happy moments” conjured in the patient’s memory constitute a promising field of treatment.Geriatric logotherapy is uniquely constructed to do just that. Normal 0 false false false EN-US X-NONE X-NONE

  8. [Extension of psychotherapeutic activities within a psychiatric ward and the team's occupational background].

    Science.gov (United States)

    Antikainen, R

    1991-01-01

    The importance of democratizing the therapeutic process in a psychiatric ward has been emphasized by Hägglund and Pylkkänen (1980). In spite of different levels of training extensive participating of the team members in performing individual psychotherapy promotes the unity of the therapeutic views of the staff. It prevents the formation of antitherapeutic staff groups. The subjective outcome of the treatment on a psychiatric open ward was examined using a questionnaire to patients. All those patients (N = 55) were selected who during a two years' research period stayed at least three weeks on the ward. Three subsamples were formed according to the therapist's occupation: a. patients of registered psychiatric nurses, b. patients of assistant psychiatric nurses and c. patients of residents, psychologists and social workers. There were no significant differences in the evaluations of the general treatment outcome between these three groups. Instead, the occupational background correlated with the patient's evaluation of the importance of the personal therapeutic relationship. The therapeutic relationship with a registered psychiatric nurse or with an assistant psychiatric nurse was significantly more often evaluated to be very or rather important at the end of the treatment than a relationship with a member of the group c. It was concluded that the goal to delegate the psychotherapeutic activities to the whole staff had been achieved quite well. The patients did not devaluate therapeutic relationships with staff members from a lower level of occupational training, on the contrary. The "non academic" personnel had established good contact with their patients. These observations support the views proposed by Hägglund and Pylkkänen (1980). Individual therapy should not be separated from the therapeutic community and the staff should not be divided into therapists and non-therapists.

  9. Auscultation of Velcro Crackles is Associated With Usual Interstitial Pneumonia.

    Science.gov (United States)

    Sellarés, Jacobo; Hernández-González, Fernanda; Lucena, Carmen M; Paradela, Marina; Brito-Zerón, Pilar; Prieto-González, Sergio; Benegas, Mariana; Cuerpo, Sandra; Espinosa, Gerard; Ramírez, José; Sánchez, Marcelo; Xaubet, Antoni

    2016-02-01

    Auscultation of Velcro crackles has been proposed as a key finding in physical lung examination in patients with interstitial lung diseases (ILDs), especially in idiopathic pulmonary fibrosis (IPF). However, no studies have been carried out to assess the association of Velcro crackles with other clinical variables.We evaluated a cohort of 132 patients, prospectively and consecutively included in our ILD diagnostic program at a tertiary referral center. All patients were auscultated during the physical examination. The patients were divided into 2 groups: "presence" or "nonpresence" of bilateral Velcro crackles.Of all patients assessed, 83 (63%) presented Velcro crackles in the respiratory auscultation. Patients with Velcro crackles usually had more frequently cough and dyspnea at the moment of diagnosis. Forced vital capacity (P = 0.002) and lung diffusion capacity for carbon monoxide (P = 0.04) was lower in these patients. The ILD-GAP index was higher in the group with Velcro crackles (P = 0.01). All patients with usual interstitial pneumonia (UIP) in high-resolution computed tomography and all patients with final IPF diagnosis presented Velcro crackles. In multivariate analysis, the presence of Velcro crackles was independently associated with an UIP pattern.In patients suspected of having ILD, the auscultation of Velcro crackles was associated with UIP, a possibility which must be taken into consideration in early ILD detection in primary care.

  10. Do patients' symptoms and interpersonal problems improve in psychotherapeutic hospital treatment in Germany? A systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Sarah Liebherz

    Full Text Available BACKGROUND: In Germany, inpatient psychotherapy plays a unique role in the treatment of patients with common mental disorders of higher severity. In addition to psychiatric inpatient services, psychotherapeutic hospital treatment and psychosomatic rehabilitation are offered as independent inpatient treatment options. This meta-analysis aims to provide systematic evidence for psychotherapeutic hospital treatment in Germany regarding its effects on symptomatic and interpersonal impairment. METHODOLOGY: Relevant papers were identified by electronic database search and hand search. Randomized controlled trials as well as naturalistic prospective studies (including post-therapy and follow-up assessments evaluating psychotherapeutic hospital treatment of mentally ill adults in Germany were included. Outcomes were required to be quantified by either the Symptom-Checklist (SCL-90-R or short versions or the Inventory of Interpersonal Problems (IIP-64 or short versions. Effect sizes (Hedges' g were combined using random effect models. PRINCIPAL FINDINGS: Sixty-seven papers representing 59 studies fulfilled inclusion criteria. Meta-analysis yielded a medium within-group effect size for symptom change at discharge (g = 0.72; 95% CI 0.68-0.76, with a small reduction to follow-up (g = 0.61; 95% CI 0.55-0.68. Regarding interpersonal problems, a small effect size was found at discharge (g = 0.35; 95% CI 0.29-0.41, which increased to follow-up (g = 0.48; 95% CI 0.36-0.60. While higher impairment at intake was associated with a larger effect size in both measures, longer treatment duration was related to lower effect sizes in SCL GSI and to larger effect sizes in IIP Total. CONCLUSIONS: Psychotherapeutic hospital treatment may be considered an effective treatment. In accordance with Howard's phase model of psychotherapy outcome, the present study demonstrated that symptom distress changes more quickly and strongly than interpersonal problems. Preliminary analyses

  11. Effectiveness and cost-effectiveness of telephone-based support versus usual care for treatment of pressure ulcers in people with spinal cord injury in low-income and middle-income countries: study protocol for a 12-week randomised controlled trial.

    Science.gov (United States)

    Arora, Mohit; Harvey, Lisa Anne; Hayes, Alison Joy; Chhabra, Harvinder Singh; Glinsky, Joanne Valentina; Cameron, Ian Douglas; Lavrencic, Lucija; Arumugam, Narkeesh; Hossain, Sohrab; Bedi, Parneet Kaur

    2015-07-28

    Pressure ulcers are a common and severe complication of spinal cord injury, particularly in low-income and middle-income countries where people often need to manage pressure ulcers alone and at home. Telephone-based support may help people in these situations to manage their pressure ulcers. The aim of this study is to determine the effectiveness and cost-effectiveness of telephone-based support to help people with spinal cord injury manage pressure ulcers at home in India and Bangladesh. A multicentre (3 sites), prospective, assessor-blinded, parallel, randomised controlled trial will be undertaken. 120 participants with pressure ulcers on the sacrum, ischial tuberosity or greater trochanter of the femur secondary to spinal cord injury will be randomly assigned to a Control or Intervention group. Participants in the Control group will receive usual community care. That is, they will manage their pressure ulcers on their own at home but will be free to access whatever healthcare support they can. Participants in the Intervention group will also manage their pressure ulcers at home and will also be free to access whatever healthcare support they can, but in addition they will receive weekly telephone-based support and advice for 12 weeks (15-25 min/week). The primary outcome is the size of the pressure ulcer at 12 weeks. 13 secondary outcomes will be measured reflecting other aspects of pressure ulcer resolution, depression, quality of life, participation and satisfaction with healthcare provision. An economic evaluation will be run in parallel and will include a cost-effectiveness and a cost-utility analysis. Ethical approval was obtained from the Institutional Ethics Committee at each site. The results of this study will be disseminated through publications and presented at national and international conferences. ACTRN12613001225707. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  12. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  13. 19 CFR 134.14 - Articles usually combined.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Articles usually combined. 134.14 Section 134.14... TREASURY COUNTRY OF ORIGIN MARKING Articles Subject to Marking § 134.14 Articles usually combined. (a) Articles combined before delivery to purchaser. When an imported article is of a kind which is usually...

  14. Telehealth 2.0: Preserving Continuity of Behavioral Health Clinical Care to Patients Using Mobile Devices

    Science.gov (United States)

    2017-07-01

    States (OCONUS) temporary duty assignment (TDY) using a relational model of care delivery to complete a course of treatment that the patient sought...process, minimizing disruptions in psychotherapeutic interventions, working collaboratively between remote and local sites for comprehensive care, and...finalize procurement strategy 11 January 2017 D. Phase 1 of the research support services contract solicitation was posted on the Federal Business

  15. Effectiveness of a structured training program in psychotherapeutic skills used in clinical interviews for psychiatry and clinical psychology residents.

    Science.gov (United States)

    Fernandez-Liria, Alberto; Rodriguez-Vega, Beatriz; Ortiz-Sanchez, Deborah; Baldor Tubet, Isabel; Gonzalez-Juarez, Carlos

    2010-01-01

    The authors evaluated a training program based on a structured manual of psychotherapeutic skills, using a randomized controlled design. The experimental group consisted of 135 residents from 12 teaching units in Spain. To control the improvement in therapeutic skills that could be attributed to the training received during the residency, the authors compared the experimental group with a control group of 35 residents from three teaching units. Two types of assessment instruments were used: a paper-and-pencil questionnaire based on clinical cases and a videotape of a role-playing interview. Both were given before and after the experimental group attended the training program. The experimental group shows a statistically significant improvement compared with the control group in both measurements.

  16. Palliative Care in Cancer

    Science.gov (United States)

    ... care is usually provided by palliative care specialists, health care practitioners who have received special training and/or certification in palliative care. They provide holistic care to the patient and family or caregiver ...

  17. Statistical modelling of usual intake. Scientific report submitted to EFSA

    NARCIS (Netherlands)

    Voet, van der H.; Klaveren, van J.D.; Arcella, D.; Bakker, M.; Boeing, H.; Boon, P.E.; Crépét, A.; Dekkers, A.; Boer, de W.; Dodd, K.W.; Ferrari, P.; Goedhart, P.W.; Hart, A.; Heijden, van der G.W.A.M.; Kennedy, M.; Kipnis, V.; Knüppel, S.; Merten, C.; Ocké, M.; Slob, W.

    2010-01-01

    Within the EFSA Article 36 project “European Tool Usual Intake” (ETUI) a workshop was organised in May 2010 where the different available models to calculate usual intake were presented and discussed. This report integrates the workshop background document, the presentations given by experts, and

  18. Comparing four methods to estimate usual intake distributions

    NARCIS (Netherlands)

    Souverein, O.W.; Dekkers, A.L.; Geelen, A.; Haubrock, J.; Vries, de J.H.M.; Ocke, M.C.; Harttig, U.; Boeing, H.; Veer, van 't P.

    2011-01-01

    Background/Objectives: The aim of this paper was to compare methods to estimate usual intake distributions of nutrients and foods. As ‘true’ usual intake distributions are not known in practice, the comparison was carried out through a simulation study, as well as empirically, by application to data

  19. Stress is dominant in patients with depression and chronic low back pain. A qualitative study of psychotherapeutic interventions for patients with non-specific low back pain of 3–12 months’ duration

    Directory of Open Access Journals (Sweden)

    Ellegaard Hanne

    2012-09-01

    Full Text Available Abstract Background There is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP. In this study, Gestalt therapy and the shock trauma method Somatic Experiencing® (SE were used as interventions in parallel with the usual cross-disciplinary approach. The aim was to investigate how these treatments influence a patient’s capacity to cope with CLBP when it is coupled with depression. Methods In this qualitative explorative study, a phenomenological–hermeneutic framework was adopted. Patients were recruited on the basis of following criteria: A moderate depression score of 23–30 according to the Beck Depression Inventory Scale and a pain score of 7–10 (Box scale from 0–10 and attendance at five- six psychotherapeutic sessions. Six patients participated in the study. The data was comprised of written field notes from each session, which were subsequently analysed and interpreted at three levels: naive reading, structural analysis and critical interpretation and discussion. Results Three areas of focus emerged: the significance of previous experiences, restrictions in everyday life and restoration of inner resources during the therapy period. The study revealed a diversity of psychological stressors that related to loss and sorrow, being let down, violations, traumatic events and reduced functioning, which led to displays of distress, powerlessness, reduced self-worth, anxiety and discomfort. Overall, the sum of the stressors together with pain and depression were shown to trigger stress symptoms. Stress was down-played in the psychotherapeutic treatment and inner resources were re-established, which manifested as increased relaxation, presence, self-worth, sense of responsibility and happiness. This, in turn, assisted the patients to better manage their CLBP. Conclusions CLBP is a stress factor in itself but when coupled with depression, they can be

  20. Stress is dominant in patients with depression and chronic low back pain. A qualitative study of psychotherapeutic interventions for patients with non-specific low back pain of 3-12 months' duration.

    Science.gov (United States)

    Ellegaard, Hanne; Pedersen, Birthe D

    2012-09-06

    There is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP). In this study, Gestalt therapy and the shock trauma method Somatic Experiencing® (SE) were used as interventions in parallel with the usual cross-disciplinary approach. The aim was to investigate how these treatments influence a patient's capacity to cope with CLBP when it is coupled with depression. In this qualitative explorative study, a phenomenological-hermeneutic framework was adopted. Patients were recruited on the basis of following criteria: A moderate depression score of 23-30 according to the Beck Depression Inventory Scale and a pain score of 7-10 (Box scale from 0-10) and attendance at five- six psychotherapeutic sessions. Six patients participated in the study. The data was comprised of written field notes from each session, which were subsequently analysed and interpreted at three levels: naive reading, structural analysis and critical interpretation and discussion. Three areas of focus emerged: the significance of previous experiences, restrictions in everyday life and restoration of inner resources during the therapy period. The study revealed a diversity of psychological stressors that related to loss and sorrow, being let down, violations, traumatic events and reduced functioning, which led to displays of distress, powerlessness, reduced self-worth, anxiety and discomfort.Overall, the sum of the stressors together with pain and depression were shown to trigger stress symptoms. Stress was down-played in the psychotherapeutic treatment and inner resources were re-established, which manifested as increased relaxation, presence, self-worth, sense of responsibility and happiness. This, in turn, assisted the patients to better manage their CLBP. CLBP is a stress factor in itself but when coupled with depression, they can be regarded as two symptom complexes that mutually affect each other in negative

  1. Stress is dominant in patients with depression and chronic low back pain. A qualitative study of psychotherapeutic interventions for patients with non-specific low back pain of 3–12 months’ duration

    Science.gov (United States)

    2012-01-01

    Background There is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP). In this study, Gestalt therapy and the shock trauma method Somatic Experiencing® (SE) were used as interventions in parallel with the usual cross-disciplinary approach. The aim was to investigate how these treatments influence a patient’s capacity to cope with CLBP when it is coupled with depression. Methods In this qualitative explorative study, a phenomenological–hermeneutic framework was adopted. Patients were recruited on the basis of following criteria: A moderate depression score of 23–30 according to the Beck Depression Inventory Scale and a pain score of 7–10 (Box scale from 0–10) and attendance at five- six psychotherapeutic sessions. Six patients participated in the study. The data was comprised of written field notes from each session, which were subsequently analysed and interpreted at three levels: naive reading, structural analysis and critical interpretation and discussion. Results Three areas of focus emerged: the significance of previous experiences, restrictions in everyday life and restoration of inner resources during the therapy period. The study revealed a diversity of psychological stressors that related to loss and sorrow, being let down, violations, traumatic events and reduced functioning, which led to displays of distress, powerlessness, reduced self-worth, anxiety and discomfort. Overall, the sum of the stressors together with pain and depression were shown to trigger stress symptoms. Stress was down-played in the psychotherapeutic treatment and inner resources were re-established, which manifested as increased relaxation, presence, self-worth, sense of responsibility and happiness. This, in turn, assisted the patients to better manage their CLBP. Conclusions CLBP is a stress factor in itself but when coupled with depression, they can be regarded as two symptom

  2. P-1139 - Increased utilization of health care services after psychotherapy

    DEFF Research Database (Denmark)

    Fenger, Morten Munthe; Mortensen, Erik Lykke; Poulsen, Stig Bernt

    2012-01-01

    Background Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care...... services for patients referred to psychotherapeutic treatment in 2004 and 2005. Method The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation...... period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment. Results Of the 761 patients, 216 patients did not show up for treatment, while...

  3. Outcomes of usual chiropractic, harm & efficacy, the ouch study: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Walker Bruce F

    2011-10-01

    Full Text Available Abstract Background Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, because of these studies design we do not know the frequency and extent of these events when compared to sham treatment. The principal aims of this study are to establish the frequency and severity of adverse effects from short term usual chiropractic treatment of the spine when compared to a sham treatment group. The secondary aim of this study is to establish the efficacy of usual short term chiropractic care for spinal pain when compared to a sham intervention. Methods One hundred and eighty participants will be randomly allocated to either usual chiropractic care or a sham intervention group. To be considered for inclusion the participants must have experienced non-specific spinal pain for at least one week. The study will be conducted at the clinics of registered chiropractors in Western Australia. Participants in each group will receive two treatments at intervals no less than one week. For the usual chiropractic care group, the selection of therapeutic techniques will be left to the chiropractors' discretion. For the sham intervention group, de-tuned ultrasound and de-tuned activator treatment will be applied by the chiropractors to the regions where spinal pain is experienced. Adverse events will be assessed two days after each appointment using a questionnaire developed for this study. The efficacy of short term chiropractic care for spinal pain will be examined at two week follow-up by assessing pain, physical function, minimum acceptable outcome, and satisfaction with care, with the use of the following outcome measures: Numerical Rating Scale, Functional Rating Index, Neck Disability Index, Minimum Acceptable Outcome Questionnaire, Oswestry Disability Index, and a global measure of treatment satisfaction. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Trial

  4. [Psychotherapeutic treatment of accompanied and unaccompanied minor refugees and asylum seekers with trauma-related disorders in Germany].

    Science.gov (United States)

    Metzner, Franka; Reher, Cornelia; Kindler, Heinz; Pawils, Silke

    2016-05-01

    Germany is one of the most important host countries for minor refugees and asylum seekers in Europe. The number of children who leave their home country has significantly risen worldwide in recent years; a further rise is to be expected due to the increasing number of crisis zones. A literature review demonstrates the state of research on traumatization, post-traumatic stress disorders and psychotherapy in minor refugees and asylum seekers. Many minor refugees and asylum seekers have made mainly interpersonal traumatic experiences within their home country or during their flight and develop simple or complex post-traumatic stress disorders. Left untreated, there is a risk of chronification. The psychotherapeutic treatment of minor refugees and asylum seekers in Germany takes place primarily in specialized psychosocial treatment centers. For an involvement of therapists in private practices, a reduction of organizational barriers as well as evidence-based treatment methods for interpreter-aided psychotherapy of minor refugees and asylum seekers that also consider their developmental state, are still lacking. In research, as well as in practice, there is further need for an early and systematic identification and treatment of minor refugees and asylum seekers with post-traumatic stress disorders or high risk of disease in Germany.

  5. [New aspects of complex chronic tinnitus. II: The lost silence: effects and psychotherapeutic possibilities in complex chronic tinnitus].

    Science.gov (United States)

    Goebel, G; Keeser, W; Fichter, M; Rief, W

    1991-01-01

    "Complex tinnitus" is a diagnostic term denoting a disturbance pattern where the patient hears highly annoying and painful noises or sounds that do not originate from a recognisable external source and can be described only by the patient himself. It seems that the suffering mainly depends upon the extent to which the tinnitus is experienced as a phenomenon that is beyond control. Part I reports on an examination of the treatment success achieved with 28 consecutive patients who had been treated according to an integrative multimodal behavioural medicine concept. This resulted--despite continual loudness--in a decrease in the degree of unpleasantness of the tinnitus, by 17% (p less than 0.01) with corresponding normalisation of decisive symptom factors in Hopkins-Symptom-Check-List (SCL-90-R) and Freiburg Personality-Inventary (FPI-R). On the whole, 19 out of the total of 28 patients showed essential to marked improvement of the disturbance pattern. Part II presents a multidimensional tinnitus model and the essential psychotherapeutic focal points of a multimodal psychotherapy concept in complex chronic tinnitus, as well as the parallel phenomena in the chronic pain syndrome.

  6. Creating Discursive Order at the End of Life: The Role of Genres in Palliative Care Settings

    Science.gov (United States)

    Schryer, Catherine; McDougall, Allan; Tait, Glendon R.; Lingard, Lorelei

    2012-01-01

    This article investigates an emerging practice in palliative care: dignity therapy. Dignity therapy is a psychotherapeutic intervention that its proponents assert has clinically significant positive impacts on dying patients. Dignity therapy consists of a physician asking a patient a set of questions about his or her life and returning to the…

  7. Fibroadenoma with "immature-like" type of usual ductal hyperplasia.

    Science.gov (United States)

    Bezić, Joško; Karaman, Ivana; Kunac, Nenad

    2016-01-01

    We herein report a case of the breast fibroadenoma with foci of so-called immature variant of the conventional ductal hyperplasia. This type of usual ductal hyperplasia is histologically characterised by encircling intraductal proliferation of large cells with pale to amphophilic cytoplasm and large nuclei which vary in shape and in staining quality of the chromatin. We showed here, using the cytokeratin immunohistochemistry, that the proliferating cells were not of immature but rather mature immunohistochemical phenotype. Because of the presented discordance between immature histology and mature immunohistological profile we suggest that this rare type of usual ductal hyperplasia should be called "immature-like".

  8. [Utilization of self-help groups and psychotherapy after psychosomatic-psychotherapeutic in-patient treatment].

    Science.gov (United States)

    Höflich, Anke; Matzat, Jürgen; Meyer, Friedhelm; Knickenberg, Rudolf J; Bleichner, Franz; Merkle, Wolfgang; Reimer, Christian; Franke, Wolfram; Beutel, Manfred E

    2007-05-01

    Until now little is known about the role of participation in self-help groups alone or combined with psychotherapy in post-in-patient care. In the present study 2933 patients were questioned about their experience of self-help groups and psychotherapy after discharge from a clinic for psychosomatic medicine and psychotherapy. Nearly 8 % of them utilized self-help groups (mostly combined with out-patient psychotherapy), and altogether 68 % out-patient psychotherapy following in-patient treatment. Patients without out-patient treatment were psychologically less burdened and had better resources than participants of self-help groups or psychotherapy. Self-help group members differed from patients in out-patient psychotherapy by expressing a more positive opinion of groupwork and higher openness to new experiences. Additionly, they had discussed the topic of self-help groups more frequently with their therapists. This may be a starting-point for promoting more self-help activities of patients in the future.

  9. Association of usual intake of added sugars with nutrient adequacy

    Science.gov (United States)

    Recommendations for intakes of added sugars have varied considerably and the scientific basis supporting these recommendations has been inconsistent. The goal of this study was to examine the association of usual intake (UI) of added sugars and nutrient adequacy in those participating in NHANES 2009...

  10. Recirculation usually precedes malignant edema in middle cerebral artery infarcts

    DEFF Research Database (Denmark)

    Nielsen, T H; Ståhl, N; Schalén, W

    2012-01-01

    In patients with large middle cerebral artery (MCA) infarcts, maximum brain swelling leading to cerebral herniation and death usually occurs 2-5 days after onset of stroke. The study aimed at exploring the pattern of compounds related to cerebral energy metabolism in infarcted brain tissue....

  11. [Guideline-conform psychiatric psychotherapeutic treatment for patients with schizophrenia : A normative evaluation of necessary personnel requirements].

    Science.gov (United States)

    Mehl, S; Falkai, P; Berger, M; Löhr, M; Rujescu, D; Wolff, J; Kircher, T

    2016-03-01

    Although national treatment guidelines and current publications of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recommend cognitive behavior therapy for all patients with schizophrenia, the implementation of these recommendations in current inpatient and outpatient treatment is only rudimentary. The aim of this study was to systematically search randomized controlled studies (RCTs), meta-analyses and the guidelines of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) and the British National Institute for Health and Clinical Excellence (NICE) in order to assess the number of personnel necessary for psychiatric and therapeutic inpatient treatment in line with present guidelines. Moreover, the number of staff required was compared with the personnel resources designated by the German psychiatry personnel regulations (Psych-PV). The German and NICE guidelines, RCTs and meta-analyses were analyzed and an adequate weekly treatment plan for an inpatient unit was developed. Moreover, the number of personnel necessary to realize the treatment plan was calculated. In order to realize adequate inpatient treatment approximately 107 min extra for medical psychotherapeutic personnel per patient and week (of which 72 min for psychotherapy) and another 60 min for nursing staff per patient and week are required in addition to the current Psych-PV regulations. Thus, implementation in an open ward with 20 inpatients would require 3.62 positions for physicians, 0.7 positions in psychology and 12.85 positions for nursing staff (including management positions and night shifts). These evidence-based recommendations for precise specifications of inpatient treatment should lead to improved inpatient treatment in line with present guidelines. Moreover, outpatients and day patients could be included in this treatment model. The results should be considered in the construction of the future prospective payment system for

  12. Protocol for the mWellcare trial: a multicentre, cluster randomised, 12-month, controlled trial to compare the effectiveness of mWellcare, an mHealth system for an integrated management of patients with hypertension and diabetes, versus enhanced usual care in India.

    Science.gov (United States)

    Jha, Dilip; Gupta, Priti; Ajay, Vamadevan S; Jindal, Devraj; Perel, Pablo; Prieto-Merino, David; Jacob, Pramod; Nyong, Jonathan; Venugopal, Vidya; Singh, Kavita; Goenka, Shifalika; Roy, Ambuj; Tandon, Nikhil; Patel, Vikram; Prabhakaran, Dorairaj

    2017-08-11

    Rising burden of cardiovascular disease (CVD) and diabetes is a major challenge to the health system in India. Innovative approaches such as mobile phone technology (mHealth) for electronic decision support in delivering evidence-based and integrated care for hypertension, diabetes and comorbid depression have potential to transform the primary healthcare system. METHODS AND ANALYSIS: mWellcare trial is a multicentre, cluster randomised controlled trial evaluating the clinical and cost-effectiveness of a mHealth system and nurse managed care for people with hypertension and diabetes in rural India. mWellcare system is an Android-based mobile application designed to generate algorithm-based clinical management prompts for treating hypertension and diabetes and also capable of storing health records, sending alerts and reminders for follow-up and adherence to medication. We recruited a total of 3702 participants from 40 Community Health Centres (CHCs), with ≥90 at each of the CHCs in the intervention and control (enhanced care) arms. The primary outcome is the difference in mean change (from baseline to 1 year) in systolic blood pressure and glycated haemoglobin (HbA1c) between the two treatment arms. The secondary outcomes are difference in mean change from baseline to 1 year in fasting plasma glucose, total cholesterol, predicted 10-year risk of CVD, depression, smoking behaviour, body mass index and alcohol use between the two treatment arms and cost-effectiveness. The study has been approved by the institutional Ethics Committees at Public Health Foundation of India and the London School of Hygiene and Tropical Medicine. Findings will be disseminated widely through peer-reviewed publications, conference presentations and other mechanisms. mWellcare trial is registered with Clinicaltrial.gov (Registration number NCT02480062; Pre-results) and Clinical Trial Registry of India (Registration number CTRI/2016/02/006641). The current version of the protocol is

  13. Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment.

    Science.gov (United States)

    Imani, Saeed; Atef Vahid, Mohammad Kazem; Gharraee, Banafsheh; Noroozi, Alireza; Habibi, Mojtaba; Bowen, Sarah

    2015-06-01

    This study investigated the effectiveness of mindfulness-based group therapy (MBGT) compared to the usual opioid dependence treatment (TAU).Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS) were randomly assigned into experimental (Mindfulness-Based Group Therapy) and control groups (the Usual Treatment).The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program. The Five Factor Mindfulness Questionnaire (FFMQ) and the Addiction Sevier Index (ASI) were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders.

  14. Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment

    Directory of Open Access Journals (Sweden)

    Saeed Imani

    2015-11-01

    Full Text Available  Objective: This study investigated the effectiveness of mindfulness-based group therapy (MBGT compared to the usual opioid dependence treatment (TAU.Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS were randomly assigned into experimental (Mindfulness-Based Group Therapy and control groups (the Usual Treatment.The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program.  Methods:The Five Factor Mindfulness Questionnaire (FFMQ and the Addiction Sevier Index (ASI were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. Results:The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. Conclusion:The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders.

  15. Predicting therapy success for treatment as usual and blended treatment in the domain of depression.

    Science.gov (United States)

    van Breda, Ward; Bremer, Vincent; Becker, Dennis; Hoogendoorn, Mark; Funk, Burkhardt; Ruwaard, Jeroen; Riper, Heleen

    2018-06-01

    In this paper, we explore the potential of predicting therapy success for patients in mental health care. Such predictions can eventually improve the process of matching effective therapy types to individuals. In the EU project E-COMPARED, a variety of information is gathered about patients suffering from depression. We use this data, where 276 patients received treatment as usual and 227 received blended treatment, to investigate to what extent we are able to predict therapy success. We utilize different encoding strategies for preprocessing, varying feature selection techniques, and different statistical procedures for this purpose. Significant predictive power is found with average AUC values up to 0.7628 for treatment as usual and 0.7765 for blended treatment. Adding daily assessment data for blended treatment does currently not add predictive accuracy. Cost effectiveness analysis is needed to determine the added potential for real-world applications.

  16. Un esquema clasificatorio para las intervenciones en terapia interpersonal A classificatory schema for psychotherapeutic interventions In interpersonal therapy

    Directory of Open Access Journals (Sweden)

    Ignacio Etchebarne

    2008-12-01

    Full Text Available En el presente artículo exponemos la evolución de las tareas que, como miembros de EIPSI (Equipo de Investigación en Psicología Clínica, venimos desarrollando sobre la evaluación de las intervenciones clínicas de distintos marcos teóricos. En trabajos anteriores hemos descripto la estructura general para la clasificación de intervenciones en tratamientos psicoterapéuticos adherentes a los marcos teóricos psicoanalítico, por un lado, y cognitivo-conductual, por el otro (para mayor información ver: Roussos, Etchebarne y Waizmann, 2006; y Roussos, Waizmann y Etchebarne, 2003. En el presente artículo, presentamos su expansión hacia un nuevo marco teórico: el marco teórico de la Terapia Interpersonal (TIP. Por lo cual, se detalla y se discute la metodología empleada para integrar nuevos elementos específicos sobre un marco de evaluación ya organizado (obstáculos y formas de solucionarlo y se presentan las tablas para la clasificación de intervenciones específicas interpersonales. Asimismo se presentan los resultados preliminares obtenidos mediante la aplicación de la presente metodología de evaluación de intervenciones en los tratamientos cognitivos y los tratamientos psicoanalíticos.The present paper exposes the evolution of the tasks that we have developed, as members of EIPSI (Equipo de Investigación en Psicología Clínica, about the assessment of clinical interventions from different theoretical frameworks. In previous papers we have described the general structure for the classification of interventions in psychotherapeutic treatments adherent to the psychoanalytic theoretical framework on the one side, and to the cognitive-behavioral, on the other (for more information read: Etchebarne & Waizmann, 2006; and Roussos, Waizmann & Etchebarne, 2003. In the present article we present its expansion toward a new theoretical framework: the Interpersonal Therapy's (IPT theoretical framework. Thus, the methodology employed to

  17. Business as Usual? Not for These Middle-Grades Students

    Science.gov (United States)

    Crawford, Heather; Wiest, Lynda

    2011-01-01

    A perpetual dilemma of schooling is how to help students develop skills needed for everyday life, including the work world. Quantitative literacy, also called numeracy, involves an ability to apply essential mathematics skills to authentic or near-authentic tasks. Carefully planned classroom activities can help students develop these important…

  18. Unusual behaviour of usual materials in shock waves

    International Nuclear Information System (INIS)

    Kanel, G I

    2014-01-01

    Exotic results of investigations of inelastic deformation and fracture under shock wave loading are presented and briefly discussed. Temperature effects on the flow stress at high strain rate may differ even in sign from those we observe at low and moderate strain rates. Investigations of the temperature-rate dependence of the yield stress at shock compression demonstrate intense multiplication of dislocations. At the highest strain rates, so-called ideal (ultimate) shear and tensile strength is reached in experiments with picosecond durations of shock loading. Although grain boundaries, in general, reduce resistance to fracture as compared to single crystals, the spall strength of ultra-fine-grained metals usually slightly exceeds that of coarse-grain samples. Failure wave phenomena have been observed in shock-compressed glasses.

  19. Consolidity: Moving opposite to built-as-usual systems practices

    Directory of Open Access Journals (Sweden)

    Hassen Taher Dorrah

    2013-06-01

    Full Text Available With the recent uncovering of the mystery of consolidity as an inner property of systems, it is demonstrated that this notion is an indispensable pillar of systems modeling, analysis, design and building. Based on the opposite mathematical relation between consolidity versus stability and controllability, a new conceptual life cycle (change pathway graph for natural and man-made built-as-usual systems is presented and thoroughly discussed. For the conceptual cycle development progress, it is logically conceived that system behavior changes rate has not accidentally happened, but is relatively influenced at the point of progress by the associated direct system consolidity index corresponding to the acting on-the-spot varying environments or effects. Such conceptual graph represents a real research advancement indicating that we have to move opposite to current systems building practices for solving many real life enigmatic problems. It is illustrated using stabilization of inverted pendulum problem that it is amenable by cleverly manipulating systems structure and parameters to attain new designed systems with aggregates of superiority of consolidity, stability and controllability principle. It is recommended that we have to seek new generation of innovative non-conventional systems structures moving opposite to conventional built-as-usual system practices that can enable providing directly such three aggregates of superiority requirements as their built-in self property. This will open the door towards solving many real life challenging dilemmas in various sciences and disciplines, such as engineering, space sciences, medicine, pharmacology, biology, ecology, life sciences, economy, operations research, humanities and social sciences that are believed to be attributed due to their systems inferior consolidity.

  20. Business as usual--at the state mental hospital.

    Science.gov (United States)

    Fowlkes, M R

    1975-02-01

    Despite official policy and professional emphasis to the contrary, the custodial mental hospital continues to exist as a major form of state-provided mental health care. In this paper, one such institution, "New England State Hospital", is described, and the various features of hospital organization that sustain a system of custodial care are discussed. Although the custodial hospital offers little to its patients, its persistent survival can be explained by the number of non-patient vested interests that are well served by the state hospital, precisely in its existing custodial form. The case study of New England State Hospital suggests that reform of state mental institutions depends less on a programmatic formulation of desired changes than on an understanding of the structured resistance to such changes.

  1. Not the usual suspects: addressing layers of vulnerability.

    Science.gov (United States)

    Luna, Florencia; Vanderpoel, Sheryl

    2013-07-01

    This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of 'usual suspects', focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different approaches to 'vulnerability' are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities. © 2013 John Wiley & Sons Ltd.

  2. Treatment-Based Classification versus Usual Care for Management of Low Back Pain

    Science.gov (United States)

    2017-10-01

    tion with low back pain, it has been shown to be a valid and reliable tool [33] for assessing sleep in other settings and populations [32, 34–37...chronic back pain and quality of sleep [38, 39]. Sleep deprivation is com- monly seen in the active duty population with a high operational tempo...treatment-based classification system for subgrouping people with low back pain. J Orthop Sports Phys Ther. 2012;42:797–805. 18. Fairbank JC, Couper J

  3. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

    DEFF Research Database (Denmark)

    Hansen, Tina; Zwisler, Ann Dorthe; Berg, Selina Kikkenborg

    2017-01-01

    and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality......Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following...... heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training...

  4. Treatment-Based Classification versus Usual Care for Management of Low Back Pain

    Science.gov (United States)

    2014-08-01

    Acknowledgment: The authors thank Dr. David Brown, sports medi- cine physician, who administered the CSIs in this trial. Grant Support: By Cardon Rehabilitation...DATES COVERED 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e...Primary Funding Source: Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists. Ann Intern Med. 2014;161:161

  5. Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion

    DEFF Research Database (Denmark)

    Afshari, Arash; Wikkelsø, Anne; Brok, Jesper Sune

    2011-01-01

    Severe bleeding and coagulopathy as a result of massive transfusion are serious clinical conditions that are associated with high mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are increasingly used to guide transfusion strategy but their roles remain disputed....

  6. Randomized trial of proactive rapid genetic counseling versus usual care for newly diagnosed breast cancer patients.

    Science.gov (United States)

    Schwartz, Marc D; Peshkin, Beth N; Isaacs, Claudine; Willey, Shawna; Valdimarsdottir, Heiddis B; Nusbaum, Rachel; Hooker, Gillian; O'Neill, Suzanne; Jandorf, Lina; Kelly, Scott P; Heinzmann, Jessica; Zidell, Aliza; Khoury, Katia

    2018-04-02

    Breast cancer patients who carry BRCA1/BRCA2 gene mutations may consider bilateral mastectomy. Having bilateral mastectomy at the time of diagnosis not only reduces risk of a contralateral breast cancer, but can eliminate the need for radiation therapy and yield improved reconstruction options. However, most patients do not receive genetic counseling or testing at the time of their diagnosis. In this trial, we tested proactive rapid genetic counseling and testing (RGCT) in newly diagnosed breast cancer patients in order to facilitate pre-surgical genetic counseling and testing. We recruited newly diagnosed breast cancer patients at increased risk for carrying a BRCA1/2 mutation. Of 379 eligible patients who completed a baseline survey, 330 agreed to randomization in a 2:1 ratio to RGCT (n = 220) versus UC (n = 108). Primary outcomes were genetic counseling and testing uptake and breast cancer surgical decisions. RGCT led to higher overall (83.8% vs. 54.6%; p genetic counseling uptake compared to UC. Despite higher rates of genetic counseling, RGCT did not differ from UC in overall (54.1% vs. 49.1%, p > 0.10) or pre-surgical (30.6% vs. 27.4%, p > 0.10) receipt of genetic test results nor did they differ in uptake of bilateral mastectomy (26.6% vs. 21.8%, p > 0.10). Although RGCT yielded increased genetic counseling participation, this did not result in increased rates of pre-surgical genetic testing or impact surgical decisions. These data suggest that those patients most likely to opt for genetic testing at the time of diagnosis are being effectively identified by their surgeons.

  7. Health Care "as Usual": The Insertion of Positive Psychology in Canadian Mental Health Discourse

    Science.gov (United States)

    Jhangiani, Surita Jassal; Vadeboncoeur, Jennifer A.

    2010-01-01

    The recent shift to a "positive psychological" approach that emphasizes a "health model," rather than a "disease model," in mental health discourses is intended both to reduce the stigma around mental health issues and to enable people to play a role in monitoring their own mental health. As a component of a larger…

  8. PRECISE - pregabalin in addition to usual care for sciatica: Study protocol for a randomised controlled trial

    NARCIS (Netherlands)

    S. Mathieson (Stephanie); C. Maher (Chris); A.J. McLachlan (Andrew); J. Latimer (Jane); B.W. Koes (Bart); M.J. Hancock (Mark J.); I. Harris (Ian); R.N. Day (Richard); J. Pik (Justin); S. Jan (Stephen); L. Billot (Laurent); C.-W.C. Lin (Chung-Wei Christine)

    2013-01-01

    textabstractBackground: Sciatica is a type of neuropathic pain that is characterised by pain radiating into the leg. It is often accompanied by low back pain and neurological deficits in the lower limb. While this condition may cause significant suffering for the individual, the lack of evidence

  9. The Glycoprofile Patterns of Endothelial Cells in Usual Interstitial Pneumonia

    Directory of Open Access Journals (Sweden)

    A Barkhordari

    2014-09-01

    Full Text Available [THIS ARTICLE HAS BEEN RETRACTED FOR DUPLICATE PUBLICATION] Background: The pathological classification of cryptogenic fibrosing alveolitis has been a matter of debate and controversy for histopathologists. Objective: To identify and specify the glycotypes of capillary endothelial cells in usual interstitial pneumonia (UIP compared to those found in normal tissue. Methods: Sections of formalin-fixed, paraffin-embedded blocks from 16 cases of UIP were studied by lectin histochemistry with a panel of 27 biotinylated lectins and an avidin-peroxidase revealing system. Results: High expression of several classes of glycan was seen de novo in capillary endothelial cells from patients with UIP including small complex and bi/tri-antennary bisected complex N-linked sequences bolund by Concanavalin A and erythro-phytohemagglutinin, respectively, GalNAca1 residues bound by Helix pomatia and Maclura pomifera agglutinins, and L-fucosylated derivatives of type II glycan chains recognized by Ulex europaeus agglutinin-I. Glycans bound by agglutinins from Lycopersicon esculentum (β1,4GlcNAc and Wisteria floribunda (GalNAc as well as GlcNAc oligomers bound by Phytolacca americana and succinylated Wheat Germ agglutinin were also seen in the capillary endothelial cells of UIP. In contrast, L-fucosylated derivatives of type I glycan chains were absent in cells from cases of UIP when Anguilla anguilla agglutinin was applied, unlike the situation in normal tissue. Conclusion: These results may indicate existence of two distinct populations of endothelial cell in UIP with markedly different patterns of glycosylation, reflecting a pattern of differentiation and angiogenesis, which is not detectable morphologically.

  10. [A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years].

    Science.gov (United States)

    Uhlenbrock, Judith; Hinrichs, Jens; Heuft, Gereon

    2017-09-01

    A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years Objectives: Both the public and the legislative have developed an increasingly critical awareness for the fact that expert witnesses need to be independent. In contrast, to date there have been few studies concerning the quantity and the results of psychosomatic-psychotherapeutic expert opinions for public and private clients. In a retrospective study design, 285 expert opinions of a psychosomatic-psychotherapeutic university hospital stemming from consecutive, unselected random sampling over a 12-year time period (1990-2011) were analyzed using a predefined list of criteria. Besides client data, the study also noted the type and the objectives of the expertise, the sociodemographic data of the subjects, the biographic data of the subjects, the size of records, the particular psychopathological findings including conflict and structural diagnostics via the Operationalized Psychodynamic Diagnostics (OPD-2, Research Group 2006), syndromic diagnostics according to ICD-10 (WHO) including the related Impairment Scale Score (ISS, Schepank 1995), and the Global Assessment of Functioning-Scale (GAF, Heuft 2016). 54% of the subjects were men. All subjects were 46 years old at the time of examination; on average symptomatology had existed for 7 years, which made assessment of causality difficult. Most assignments referred to the effects of diseases or accidents in private contexts, followed by pension reports. Among the expert opinions related to possible implications of acts of violence, 95% were women. In 43.2% (n = 123) of the cases, the assessment had occurred in the context of legal action. In 65 cases at least one party had requested a supplemental written report during further procedure. In 17.8% (n = 22) of the cases sought by the courts, the expert witness was requested by at least one party to present the

  11. Manual for the psychotherapeutic treatment of acute and post-traumatic stress disorders following multiple shocks from implantable cardioverter defibrillator (ICD).

    Science.gov (United States)

    Jordan, Jochen; Titscher, Georg; Peregrinova, Ludmila; Kirsch, Holger

    2013-01-01

    In view of the increasing number of implanted cardioverter defibrillators (ICD), the number of people suffering from so-called "multiple ICD shocks" is also increasing. The delivery of more than five shocks (appropriate or inappropriate) in 12 months or three or more shocks (so called multiple shocks) in a short time period (24 hours) leads to an increasing number of patients suffering from severe psychological distress (anxiety disorder, panic disorder, adjustment disorder, post-traumatic stress disorder). Untreated persons show chronic disease processes and a low rate of spontaneous remission and have an increased morbidity and mortality. Few papers have been published concerning the psychotherapeutic treatment for these patients. The aim of this study is to develop a psychotherapeutic treatment for patients with a post-traumatic stress disorder or adjustment disorder after multiple ICD shocks. Explorative feasibility study: Treatment of 22 patients as a natural design without randomisation and without control group. The period of recruitment was three years, from March 2007 to March 2010. The study consisted of two phases: in the first phase (pilot study) we tested different components and dosages of psychotherapeutic treatments. The final intervention programme is presented in this paper. In the second phase (follow-up study) we assessed the residual post-traumatic stress symptoms in these ICD patients. The time between treatment and follow-up measurement was 12 to 30 months. Thirty-one patients were assigned to the Department of Psychocardiology after multiple shocks. The sample consisted of 22 patients who had a post-traumatic stress disorder or an adjustment disorder and were willing and able to participate. They were invited for psychological treatment. 18 of them could be included into the follow-up study. After the clinical assessment at the beginning and at the end of the inpatient treatment a post-treatment assessment with questionnaires followed. In

  12. Towards mHealth Systems for Support of Psychotherapeutic Practice: A Qualitative Study of Researcher-Clinician Collaboration in System Design and Evaluation

    Directory of Open Access Journals (Sweden)

    Karin Halje

    2016-01-01

    Full Text Available We examined clinicians’ and researchers’ experiences from participation in collaborative research on the introduction of Internet and mobile information systems (mHealth systems in psychotherapeutic routines. The study used grounded theory methodology and was set in a collaboration that aimed to develop and evaluate mHealth support of psychotherapy provided to young people. Soundness of the central objects developed in the design phase (the collaboration contract, the trial protocol, and the system technology was a necessary foundation for successful collaborative mHealth research; neglect of unanticipated organizational influences during the trial phase was a factor in collaboration failure. The experiences gained in this study can be used in settings where collaborative research on mHealth systems in mental health is planned.

  13. THE PSYCHOTHERAPEUTIC EFFECT OF FAIRY TALES H. CH. ANDERSEN ON THE FORMATION OF THE PERSONALITY THROUGH THE PRISM OF CHRISTIANITY, IN THE CULTURAL AND HISTORICAL SPACE

    Directory of Open Access Journals (Sweden)

    DANILOVA Elena Sergeevna

    2017-05-01

    Full Text Available The article is devoted to the study of the psychotherapeutic effect provided by the fairytales of G. Kh. Andersen on the development and personalityfoundation, especially on moral, ethical and highly spiritual qualities establishment of a human being. In the masterworks of G. Kh. Andersen'sA has been revealed a profound, psychological, Christian-philosophical aspect, in gratitude being formed a special psychocultural environment, which influences on the development and personalityformation. G. Kh. Andersen fairytales texts are conceptual and have deep Christian-philosophical overtones based on humanistic principles that are awakened in every person. This overtones brings together the thoughts and feelings to the comprehension and rethinking of our spiritual values. The fairytales of G. Kh. Andersen is an indicator of personality spiritual culture.

  14. Changes in interpersonal problems in the psychotherapeutic treatment of depression as measured by the Inventory of Interpersonal Problems: A systematic review and meta-analysis.

    Science.gov (United States)

    McFarquhar, Tara; Luyten, Patrick; Fonagy, Peter

    2018-01-15

    Interpersonal problems are commonly reported by depressed patients, but the effect of psychotherapeutic treatment on them remains unclear. This paper reviews the effectiveness of psychotherapeutic interventions for depression on interpersonal problems as measured by the Inventory of Interpersonal Problems (IIP). An electronic database search identified articles reporting IIP outcome scores for individual adult psychotherapy for depression. A systematic review and, where possible, meta-analysis was conducted. Twenty-eight studies met inclusion criteria, 10 of which could be included in a meta-analysis investigating changes in the IIP after brief psychotherapy. Reasons for exclusion from the meta-analysis were too few participants with a diagnosis of depression (n=13), IIP means and SDs unobtainable (n=3) and long-term therapy (n=2). A large effect size (g=0.74, 95% CI=0.56-0.93) was found for improvement in IIP scores after brief treatment. Paucity of IIP reporting and treatment type variability mean results are preliminary. Heterogeneity for improvement in IIP after brief psychotherapy was high (I 2 =75%). Despite being central to theories of depression, interpersonal problems are infrequently included in outcome studies. Brief psychotherapy was associated with moderate to large effect sizes in reduction in interpersonal problems. Of the dimensions underlying interpersonal behaviour, the dominance dimension may be more amenable to change than the affiliation dimension. Yet, high pre-treatment affiliation appeared to be associated with better outcomes than low affiliation, supporting the theory that more affiliative patients may develop a better therapeutic relationship with the therapist and consequently respond more positively than more hostile patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Why Third World urban employers usually prefer men.

    Science.gov (United States)

    Anker, R; Hein, C

    1985-01-01

    Males outnumber female employees by 3 to 1 in the modern sector of developing countries; moreover, women tend to be concentrated in a limited number of occupations. This underrepresentation of women in employment in Third World countries is generally attributed to the restricted supply of qualified women willing and able to work away from home in modern sector occupations. However, this approach pays insufficient attention to the demand for labor and the recruitment policy of employers. Employer concerns and perceptions that limit the overall demand for women workers and thereby reduce their employment opportunities include the need for pregnancy and maternity leave and protection, absenteeism, turnover, and cultural restrictions. Among the factors that contribute to the sexual segmentation of the labor market are protective legislation that excludes women from certain sectors of the labor market, sex-typing of jobs, and employer perceptions that women lack muscular strength, are not effective supervisors, and cannot work well with men. At the same time, women are preferred for certain jobs because of their greater docility, acceptance of lower wages, household-type skills, and sex appeal. The general factor limiting employment opportunities for women is the employer's perception that women are more costly and less productive than male employees. This perception is directly related to women's role in childbearing and rearing, and is reinforced by legislation that places the costs of maternity leave, nursing breaks, and child care directly on the employer. Thus, women's childbearing and family responsibilities not only limit their availability for work but also discourage employers from hiring them.

  16. [Dignity in the care of terminal ill and dying patients. Definitions and supportive interventions in palliative care].

    Science.gov (United States)

    Mehnert, A; Schröder, A S; Puhlmann, K; Müllerleile, U; Koch, U

    2006-11-01

    Most patients, family members, health care professional as well as volunteers would agree that dignified care and being allowed to die with dignity are superior and unquestionable goals of palliative care. Although the majority of people have a more or less vague concept of dignity and despite its significance for palliative care, only a few empirical approaches to describe the sense of dignity from patients' and health care professionals' perspectives have been undertaken. However, individual descriptions of the dignity concept and definitions can serve as an impetus to improve the current palliative care practice by the development and evaluation of psychotherapeutic interventions for patients near the end of life and the allocation of resources. This article considers an internationally developed empirical-based model of dignity in severe and terminal ill patients by Chochinov et al. Furthermore, it illustrates the understanding of dignity as well as self-perceived exertions of influence on a patient's dignity from the perspective of health care professionals and volunteers. Psychotherapeutic interventions and strategies are introduced that can help conserve the sense of dignity of patients during palliative care.

  17. No more 'business as usual' with audit and feedback interventions: towards an agenda for a reinvigorated intervention.

    Science.gov (United States)

    Ivers, Noah M; Sales, Anne; Colquhoun, Heather; Michie, Susan; Foy, Robbie; Francis, Jill J; Grimshaw, Jeremy M

    2014-01-17

    Audit and feedback interventions in healthcare have been found to be effective, but there has been little progress with respect to understanding their mechanisms of action or identifying their key 'active ingredients.' Given the increasing use of audit and feedback to improve quality of care, it is imperative to focus further research on understanding how and when it works best. In this paper, we argue that continuing the 'business as usual' approach to evaluating two-arm trials of audit and feedback interventions against usual care for common problems and settings is unlikely to contribute new generalizable findings. Future audit and feedback trials should incorporate evidence- and theory-based best practices, and address known gaps in the literature. We offer an agenda for high-priority research topics for implementation researchers that focuses on reviewing best practices for designing audit and feedback interventions to optimize effectiveness.

  18. Palliative or Comfort Care

    Science.gov (United States)

    ... is not under control Need help understanding your situation and coordinating care PALLIATIVE CARE Often a team of specialists provides palliative care. The team usually includes: Palliative care doctors and nurses Social workers and chaplains Pharmacists and nutritionists Counselors and others ...

  19. Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Sabina Sanghera

    Full Text Available OBJECTIVE: To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device ('LNG-IUS' and usual medical treatment for women with menorrhagia in primary care; and compare the cost-effectiveness findings using two alternative measures of quality of life. METHODS: 571 women with menorrhagia from 63 UK centres were randomised between February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or usual medical treatment, after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment. The treatment was specified prior to randomisation. For the economic evaluation we developed a state transition (Markov model with a 24 month follow-up. The model structure was informed by the trial women's pathway and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year (QALY estimated using both EQ-5D and SF-6D. RESULTS: Using EQ-5D, LNG-IUS was the most cost-effective treatment for menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated 0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical treatment was the most cost-effective treatment. Usual medical treatment was both less costly (£100 and generated 0.002 more QALYs. CONCLUSION: Impact on quality of life is the primary indicator of treatment success in menorrhagia. However, the most cost-effective treatment differs depending on the quality of life measure used to estimate the QALY. Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial.

  20. Alleviation of Psychological Distress and the Improvement of Quality of Life in Patients With Amyotrophic Lateral Sclerosis: Adaptation of a Short-Term Psychotherapeutic Intervention

    Directory of Open Access Journals (Sweden)

    Moritz Caspar Franz Oberstadt

    2018-04-01

    Full Text Available Amyotrophic lateral sclerosis (ALS is a progressive neurodegenerative disease that is inevitably fatal. To be diagnosed with a terminal illness such as ALS deeply affects one’s personal existence and goes along with significant changes regarding the physical, emotional, and social domains of the patients’ life. ALS patients have to face a rapidly debilitating physical decline which restrains mobility and impairs all activities of daily living. This progressive loss of autonomy may lead to a sense of hopelessness and loss of quality of life, which in turn may even result in thoughts about physician-assisted suicide. Here, we would like to propose a psychotherapeutic manualized, individual, semi-structured intervention to relieve distress and promote psychological well-being in ALS patients. This short-term intervention was originally developed for advanced cancer patients. “Managing Cancer and Living Meaningfully (CALM” focuses on the four dimensions: (i symptom management and communication with healthcare providers, (ii changes in self and relations with close others, (iii spirituality, sense of meaning and purpose and (iv thinking of the future, hope, and mortality. We suggest to supplement the concept by two additional dimensions which take into account specific issues of ALS patients: (v communication skills, and (vi emotional expression and control. This therapeutic concept named “ManagIng Burden in ALS and Living Meaningfully (mi-BALM” may be a further treatment option to help improving quality of life of ALS patients.

  1. Anorexia nervosa e bulimia nervosa: abordagem cognitivo-construtivista de psicoterapia Anorexia nervosa and bulimia nervosa: a psychotherapeutic cognitive-constructivist approach

    Directory of Open Access Journals (Sweden)

    Cristiano Nabuco de Abreu

    2004-01-01

    Full Text Available Dos transtornos alimentares, a anorexia nervosa e a bulimia nervosa são os que mais têm levado pacientes adolescentes, geralmente do sexo feminino e cada vez mais jovens, a buscar ajuda. Essa ajuda se dá através de um tratamento multidisciplinar envolvendo médicos psiquiatras, psicólogos e nutricionistas. A psicoterapia tem se mostrado um componente eficaz para a melhora dessas pacientes. O presente artigo tem por objetivo expor uma proposta de tratamento psicoterápico a partir da abordagem cognitivo-construtivista.Among the eating disorders, anorexia nervosa and bulimia nervosa are the ones that have made adolescent patients - often females and aged younger and younger - seek for help. This help is provided through a multidisciplinary treatment involving psychiatrists, psychologists and dietists. Psychotherapy has shown to be an efficient component for these patients' improvement. The present article aims at presenting a proposal of psychotherapeutic treatment based on a cognitive-constructivist approach.

  2. The Effects of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Analysis System of Psychotherapy added to Treatment as Usual on suicidal ideation in chronic depression: Results of a randomized-clinical trial.

    Science.gov (United States)

    Forkmann, Thomas; Brakemeier, Eva-Lotta; Teismann, Tobias; Schramm, Elisabeth; Michalak, Johannes

    2016-08-01

    Suicidal ideation (SI) is common in chronic depression, but only limited evidence exists for the assumption that psychological treatments for depression are effective for reducing SI. In the present study, the effects of Mindfulness-based Cognitive Therapy (MBCT; group version) plus treatment-as-usual (TAU: individual treatment by either a psychiatrist or a licensed psychotherapist, including medication when indicated) and Cognitive Behavioral Analysis System of Psychotherapy (CBASP; group version) plus TAU on SI was compared to TAU alone in a prospective, bi-center, randomized controlled trial. The sample consisted of 106 outpatients with chronic depression. Multivariate regression analyses revealed different results, depending on whether SI was assessed via self-report (Beck Depression Inventory suicide item) or via clinician rating (Hamilton Depression Rating Scale suicide item). Whereas significant reduction of SI emerged when assessed via clinician rating in the MBCT and CBASP group, but not in the TAU group while controlling for changes in depression, there was no significant effect of treatment on SI when assessed via self-report. SI was measured with only two single items. Because all effects were of small to medium size and were independent of effects from other depression symptoms, the present results warrant the application of such psychotherapeutical treatment strategies like MBCT and CBASP for SI in patients with chronic depression. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Usual coffee intake in Brazil: results from the National Dietary Survey 2008-9.

    Science.gov (United States)

    Sousa, Alessandra Gaspar; da Costa, Teresa Helena Macedo

    2015-05-28

    Coffee is central to the economy of many developing countries, as well as to the world economy. However, despite the widespread consumption of coffee, there are very few available data showing the usual intake of this beverage. Surveying usual coffee intake is a way of monitoring one aspect of a population's usual dietary intake. Thus, the present study aimed to characterise the usual daily coffee intake in the Brazilian population. We used data from the National Dietary Survey collected in 2008-9 from a probabilistic sample of 34,003 Brazilians aged 10 years and older. The National Cancer Institute method was applied to obtain the usual intake based on two nonconsecutive food diaries, and descriptive statistical analyses were performed by age and sex for Brazil and its regions. The estimated average usual daily coffee intake of the Brazilian population was 163 (SE 2.8) ml. The comparison by sex showed that males had a 12% greater usual coffee intake than females. In addition, the highest intake was recorded among older males. Among the five regions surveyed, the North-East had the highest usual coffee intake (175 ml). The most common method of brewing coffee was filtered/instant coffee (71%), and the main method of sweetening beverages was with sugar (87%). In Brazil, the mean usual coffee intake corresponds to 163 ml, or 1.5 cups/d. Differences in usual coffee intake according to sex and age differed among the five Brazilian regions.

  4. Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB)

    DEFF Research Database (Denmark)

    Beck, Emma; Bo, Sune; Gondan, Matthias

    2016-01-01

    Background Evidence-based outpatient psychotherapeutic programs are first-line treatment of borderline personality disorder (BPD). Early and effective treatment of BPD is crucial to the prevention of its individual, psychosocial, and economic consequences. However, in spite of recent advantages...

  5. Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality

    DEFF Research Database (Denmark)

    Graudal, Niels; Jürgens, Gesche; Baslund, Bo

    2014-01-01

    BACKGROUND: The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (<115 mmol), usual sodium (low usual so...

  6. 22 CFR 92.85 - Service of legal process usually prohibited.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Service of legal process usually prohibited. 92... RELATED SERVICES Quasi-Legal Services § 92.85 Service of legal process usually prohibited. The service of process and legal papers is not normally a Foreign Service function. Except when directed by the...

  7. Marlboro and Other Usual Brand Choices by Youth Smokers in Middle Eastern Countries

    Science.gov (United States)

    Page, Randy M.

    2012-01-01

    This study analyzed data from 118,743 adolescents completing 30 different Global Youth Tobacco Surveys conducted in 15 different Middle Eastern countries between 1999 and 2007 to determine the proportion of young smokers who usually smoked Marlboro, other cigarette brands, or no usual brand smoked in these countries. Marlboro was the most…

  8. Novel loci associated with usual sleep duration: the CHARGE Consortium Genome-Wide Association Study

    NARCIS (Netherlands)

    Gottlieb, D.J.; Hek, K.; Chen, T.H.; Watson, N.F.; Eiriksdottir, G.; Byrne, E.M.; Cornelis, M.; Warby, S.C.; Bandinelli, S.; Cherkas, L.; Evans, D.S.; Grabe, H.J.; Lahti, J.; Li, M.; Lehtimäki, T.; Lumley, T.; Marciante, K.; Pérusse, L.; Psaty, B.M.; Robbins, J.; Tranah, G.; Vink, J.M.; Wilk, J.B.; Stafford, J.M.; Bellis, M.; Biffar, R.; Bouchard, C.; Cade, B.; Curhan, G.C.; Eriksson, J.G.; Ewert, R.; Ferrucci, L.; Fülöp, T.; Gehrman, P.R.; Goodloe, R.; Harris, T.B.; Heath, A.C.; Hernandez, D.; Hofman, A.; Hottenga, J.J.; Hunter, D.J.; Jensen, M.K.; Johnson, A.D.; Kähönen, M.; Kao, L.; Kraft, P.; Larkin, E.K.; Lauderdale, D.S.; Luik, A.I.; Medici, M.; Montgomery, G.W.; Palotie, A.; Patel, S.R.; Pistis, G.; Porcu, E.; Quaye, L.; Raitakari, O.; Redline, S.; Rimm, E.B.; Rotter, J.I.; Smith, A.V.; Spector, T.D.; Teumer, A.; Uitterlinden, A.G.; Vohl, M.-C.; Widén, E.; Willemsen, G.; Young, T.; Zhang, X.; Liu, Y.; Blanger, J.; Boomsma, D.I.; Gudnason, V.; Hu, F.; Mangino, M.; Martin, N.G.; O'Connor, G.T.; Stone, K.L.; Tanaka, T.; Viikari, J.; Gharib, S.A.; Punjabi, N.M.; Räikkönen, K.; Völzke, H.; Mignot, E.; Tiemeier, H.

    2015-01-01

    Usual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study (GWAS) of usual sleep duration was conducted using 18 population-based

  9. Novel loci associated with usual sleep duration: The CHARGE Consortium Genome-Wide Association Study

    NARCIS (Netherlands)

    D.J. Gottlieb (Daniel J); K. Hek (Karin); T.-H. Chen; N.F. Watson; G. Eiriksdottir (Gudny); E.M. Byrne; M. Cornelis (Marilyn); S.C. Warby; S. Bandinelli; L. Cherkas (Lynn); D.S. Evans (Daniel); H.J. Grabe (Hans Jörgen); J. Lahti (Jari); M. Li (Man); T. Lehtimäki (Terho); T. Lumley (Thomas); K. Marciante (Kristin); L. Perusse (Louis); B.M. Psaty (Bruce); J. Robbins; G.J. Tranah (Gregory); J.M. Vink; J.B. Wilk; J.M. Stafford; C. Bellis (Claire); R. Biffar; C. Bouchard (Claude); B. Cade; G.C. Curhan (Gary); J. Eriksson; R. Ewert; L. Ferrucci (Luigi); T. Fülöp; P.R. Gehrman (Philip); R. Goodloe (Robert); T.B. Harris (Tamara); A.C. Heath (Andrew C.); D.G. Hernandez (Dena); A. Hofman (Albert); J.J. Hottenga (Jouke Jan); D. Hunter (David); M.K. Jensen (Majken K.); A.D. Johnson (Andrew); M. Kähönen (Mika); W.H.L. Kao (Wen); P. Kraft (Peter); E.K. Larkin; D.S. Lauderdale; A.I. Luik (Annemarie I); M. Medici; G.W. Montgomery (Grant W.); A. Palotie; S.R. Patel (Sanjay); G. Pistis (Giorgio); E. Porcu; L. Quaye (Lydia); O. Raitakari (Olli); S. Redline (Susan); E.B. Rimm (Eric B.); J.I. Rotter; A.V. Smith; T.D. Spector (Timothy); A. Teumer (Alexander); A.G. Uitterlinden (André); M.-C. Vohl (Marie-Claude); E. Widen; G.A.H.M. Willemsen (Gonneke); T.L. Young (Terri L.); X. Zhang; Y. Liu; J. Blangero (John); D.I. Boomsma (Dorret); V. Gudnason (Vilmundur); F. Hu; M. Mangino; N.G. Martin (Nicholas); G.T. O'Connor (George); K.L. Stone (Katie L); T. Tanaka; J. Viikari (Jorma); S.A. Gharib (Sina); N.M. Punjabi (Naresh); K. Räikkönen (Katri); H. Völzke (Henry); E. Mignot; H.W. Tiemeier (Henning)

    2015-01-01

    textabstractUsual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study (GWAS) of usual sleep duration was conducted using 18

  10. Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders.

    Science.gov (United States)

    Barfar, Eshagh; Sharifi, Vandad; Amini, Homayoun; Mottaghipour, Yasaman; Yunesian, Masud; Tehranidoost, Mehdi; Sobhebidari, Payam; Rashidian, Arash

    2017-09-01

    There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery. The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran. This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period. There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year. Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively

  11. Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Beck, Emma; Bo, Sune; Gondan, Matthias; Poulsen, Stig; Pedersen, Liselotte; Pedersen, Jesper; Simonsen, Erik

    2016-07-12

    Evidence-based outpatient psychotherapeutic programs are first-line treatment of borderline personality disorder (BPD). Early and effective treatment of BPD is crucial to the prevention of its individual, psychosocial, and economic consequences. However, in spite of recent advantages in diagnosing adolescent BPD, there is a lack of cost-effective evidence-based treatment programs for adolescents. Mentalization-based treatment is an evidence-based program for BPD, originally developed for adults. We will investigate whether a specifically designed mentalization-based treatment in groups is an efficacious treatment for adolescents with BPD or subthreshold BPD compared to treatment as usual. The trial is a four-center, two-armed, parallel-group, assessor-blinded randomized clinical superiority trial. One hundred twelve patients aged 14 to 17 referred to Child and Adolescent Psychiatric Clinics in Region Zealand are randomized to 1 year of either mentalization-based treatment in groups or treatment as usual. Patients will be included if they meet at least four DSM-5 criteria for BPD. The primary outcome is self-reported borderline features at discharge. Secondary outcomes will include self-harm, depression, BPD criteria, externalizing and internalizing symptoms, and social functioning, together with parental reports on borderline features, externalizing and internalizing symptoms. Measures of attachment and mentalization will be included as mediational variables. Follow-up assessment will take place at 3 and 12 months after end of treatment. This is the first randomized controlled trial to test the efficacy of a group-based mentalization-based treatment for adolescents with BPD or subthreshold BPD. If the results confirm our hypothesis, this trial will add to the treatment options of cost-effective treatment of adolescent BPD. Clinicaltrials.gov NCT02068326 , February 19, 2014.

  12. Adult Day Care

    Science.gov (United States)

    ... Finding a Center Not all states license and regulate adult day care centers. There may be a ... is not usually covered by Medicare insurance, some financial assistance may be available through a federal or ...

  13. Memory reconsolidation and psychotherapeutic process.

    Science.gov (United States)

    Liberzon, Israel; Javanbakht, Arash

    2015-01-01

    Lane et al. propose a heuristic model in which distinct, and seemingly irreconcilable, therapies can coexist. Authors postulate that memory reconsolidation is a key common neurobiological process mediating the therapeutic effects. This conceptualization raises a set of important questions regarding neuroscience and translational aspects of fear memory reconsolidation. We discuss the implications of the target article's memory reconsolidation model in the development of more effective interventions, and in the identification of less effective, or potentially harmful approaches, as well as concepts of contextualization, optimal arousal, and combined therapy.

  14. The Stock Market's Reaction to Unemployment News: Why Bad News is Usually Good for Stocks

    OpenAIRE

    John H. Boyd; Ravi Jagannathan; Jian Hu

    2001-01-01

    We find that on average an announcement of rising unemployment is 'good news' for stocks during economic expansions and 'bad news' during economic contractions. Thus stock prices usually increase on news of rising unemployment, since the economy is usually in an expansion phase. We provide an explanation for this phenomenon. Unemployment news bundles two primitive types of information relevant for valuing stocks: information about future interest rates and future corporate earnings and divide...

  15. Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual.

    Science.gov (United States)

    Soares, William E; Wilson, Donna; Rathlev, Niels; Lee, Joshua D; Gordon, Michael; Nunes, Edward V; O'Brien, Charles P; Friedmann, Peter D

    2018-02-01

    Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up. This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63-1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32-2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30-1.00, p=0.05) during the course of the entire study. XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders. Copyright © 2018

  16. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding

    DEFF Research Database (Denmark)

    Wikkelsø, Anne; Wetterslev, Jørn; Møller, Ann Merete

    2016-01-01

    . The original search was run in October 2010. SELECTION CRITERIA: We included all RCTs, irrespective of blinding or language, that compared transfusion guided by TEG or ROTEM to transfusion guided by clinical judgement, guided by standard laboratory tests, or a combination. We also included interventional......BACKGROUND: Severe bleeding and coagulopathy are serious clinical conditions that are associated with high mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are increasingly used to guide transfusion strategy but their roles remain disputed. This review was first published in 2011...... and sensitivity analyses, examined the role of bias, and applied trial sequential analyses (TSAs) to examine the amount of evidence gathered so far. SEARCH METHODS: In this updated review we identified randomized controlled trials (RCTs) from the following electronic databases: Cochrane Central Register...

  17. A Randomized Clinical Trial of the Collaborative Assessment and Management of Suicidality vs. Enhanced Care as Usual for Suicidal Soldiers

    Science.gov (United States)

    2016-04-01

    upset about had resolved and therefore she saw no need for therapy. The Soldier stated that there was no reason for her to be on study either, as she was...NC Marines (N=23) Comtois 29 Palms (N=25) Luxton Madigan Army MC (N=185) Luxton VA Palo Alto (N=317) Luxton Navy MC San Diego (N=184...1985 (13.0) - 33 Variable Jobes Fort Stewart (N=154) Comtois Fort Bragg (N=143) Comtois NC Marines (N=23) Comtois 29 Palms (N=25

  18. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland

    NARCIS (Netherlands)

    Retèl, Valesca P.; van den Boer, Cindy; Steuten, Lotte M. G.; Okła, Sławomir; Hilgers, Frans J.; van den Brekel, Michiel W.

    2015-01-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore,

  19. Study protocol: cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care.

    NARCIS (Netherlands)

    Neelemaat, F.; Thijs, A.; Seidell, J.C.; Bosmans, J.E.; van Bokhorst-de van der Schueren, M.A.E.

    2010-01-01

    Background. Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness

  20. A Randomized Clinical Trial of the Collaborative Assessment and Management of Suicidality vs. Enhanced Care as Usual for Sucidal Soldiers

    Science.gov (United States)

    2017-06-01

    Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should...questionnaires (i.e., CD-RISC and OQ-45). Independent assessors conducted the “blind and non-blind” assessments. Remuneration . By regulation it

  1. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease (Review)

    NARCIS (Netherlands)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul; Frith, Peter A.; Zwerink, Marlies; Monninkhof, Evelyn M.; van der Palen, J.A.M.; Effing, Tanja

    2017-01-01

    Background  Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals ofmotivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease.

  2. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul D.L.P.M.; Frith, Peter A.; Zwerink, Marlies; Monninkhof, Evelyn M.; van der Palen, Job; Effing-Tijdhof, Tanja W

    2017-01-01

    Background: Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease.

  3. Internet-based self-management plus education compared with usual care in asthma: a randomized trial

    NARCIS (Netherlands)

    van der Meer, Victor; Bakker, Moira J.; van den Hout, Wilbert B.; Rabe, Klaus F.; Sterk, Peter J.; Kievit, Job; Assendelft, Willem J. J.; Sont, Jacob K.; Assendelft, W. J. J.; Thiadens, H. A.; Bakker, M. J.; van den Hout, W. B.; Kievit, J.; van der Meer, V.; Sont, J. K.; Kaptein, A. A.; Rikkers-Mutsaerts, E. R. V. M.; Rabe, K. F.; Bel, E. H. D.; Detmar, S. B.; Otten, W.; van Stel, H. F.; Roldaan, A. C.; de Jongste, J. C.; Toussaint, P. J.

    2009-01-01

    BACKGROUND: The Internet may support patient self-management of chronic conditions, such as asthma. OBJECTIVE: To evaluate the effectiveness of Internet-based asthma self-management. DESIGN: Randomized, controlled trial. SETTING: 37 general practices and 1 academic outpatient department in the

  4. Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema : The RENEW Randomized Clinical Trial

    NARCIS (Netherlands)

    Sciurba, Frank C.; Criner, Gerard J.; Strange, Charlie; Shah, Pallav L.; Michaud, Gaetane; Connolly, Timothy A.; Deslee, Gaetan; Tillis, William P.; Delage, Antoine; Marquette, Charles-Hugo; Krishna, Ganesh; Kalhan, Ravi; Ferguson, J. Scott; Jantz, Michael; Maldonado, Fabien; McKenna, Robert; Majid, Adnan; Rai, Navdeep; Gay, Steven; Dransfield, Mark T.; Angel, Luis; Maxfield, Roger; Herth, Felix J. F.; Wahidi, Momen M.; Mehta, Atul; Slebos, Dirk-Jan

    2016-01-01

    IMPORTANCE Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation. OBJECTIVE To determine the effectiveness and safety of

  5. Ballistic strength training compared with usual care for improving mobility following traumatic brain injury: protocol for a randomised, controlled trial

    Directory of Open Access Journals (Sweden)

    Gavin Williams

    2016-07-01

    Discussion: Strength training in neurological rehabilitation is highly topical because muscle weakness has been identified as the primary impairment leading to mobility limitations in many neurological populations. This project represents the first international study of ballistic strength training after traumatic brain injury. The novelty of ballistic strength training is that the exercises attempt to replicate how lower limb muscles work, by targeting the high angular velocities attained during walking and higher level activities.

  6. Inpatient Massage Therapy Versus Music Therapy Versus Usual Care: A Mixed-methods Feasibility Randomized Controlled Trial.

    Science.gov (United States)

    Roseen, Eric J; Cornelio-Flores, Oscar; Lemaster, Chelsey; Hernandez, Maria; Fong, Calvin; Resnick, Kirsten; Wardle, Jon; Hanser, Suzanne; Saper, Robert

    2017-01-01

    Little is known about the feasibility of providing massage or music therapy to medical inpatients at urban safety-net hospitals or the impact these treatments may have on patient experience. To determine the feasibility of providing massage and music therapy to medical inpatients and to assess the impact of these interventions on patient experience. Single-center 3-arm feasibility randomized controlled trial. Urban academic safety-net hospital. Adult inpatients on the Family Medicine ward. Massage therapy consisted of a standardized protocol adapted from a previous perioperative study. Music therapy involved a preference assessment, personalized compact disc, music-facilitated coping, singing/playing music, and/or songwriting. Credentialed therapists provided the interventions. Patient experience was measured with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) within 7 days of discharge. We compared the proportion of patients in each study arm reporting "top box" scores for the following a priori HCAHPS domains: pain management, recommendation of hospital, and overall hospital rating. Responses to additional open-ended postdischarge questions were transcribed, coded independently, and analyzed for common themes. From July to December 2014, 90 medical inpatients were enrolled; postdischarge data were collected on 68 (76%) medical inpatients. Participants were 70% females, 43% non-Hispanic black, and 23% Hispanic. No differences between groups were observed on HCAHPS. The qualitative analysis found that massage and music therapy were associated with improved overall hospital experience, pain management, and connectedness to the massage or music therapist. Providing music and massage therapy in an urban safety-net inpatient setting was feasible. There was no quantitative impact on HCAHPS. Qualitative findings suggest benefits related to an improved hospital experience, pain management, and connectedness to the massage or music therapist.

  7. Study protocol : cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care

    NARCIS (Netherlands)

    Neelemaat, Floor; Thijs, Abel; Seidell, Jaap C; Bosmans, Judith E; van Bokhorst-de van der Schueren, Marian A E

    2010-01-01

    BACKGROUND: Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness

  8. Inpatient Massage Therapy Versus Music Therapy Versus Usual Care: A Mixed-methods Feasibility Randomized Controlled Trial

    Science.gov (United States)

    Cornelio-Flores, Oscar; Lemaster, Chelsey; Hernandez, Maria; Fong, Calvin; Resnick, Kirsten; Wardle, Jon; Hanser, Suzanne; Saper, Robert

    2017-01-01

    Background Little is known about the feasibility of providing massage or music therapy to medical inpatients at urban safety-net hospitals or the impact these treatments may have on patient experience. Objective To determine the feasibility of providing massage and music therapy to medical inpatients and to assess the impact of these interventions on patient experience. Design Single-center 3-arm feasibility randomized controlled trial. Setting Urban academic safety-net hospital. Patients Adult inpatients on the Family Medicine ward. Interventions Massage therapy consisted of a standardized protocol adapted from a previous perioperative study. Music therapy involved a preference assessment, personalized compact disc, music-facilitated coping, singing/playing music, and/or songwriting. Credentialed therapists provided the interventions. Measurements Patient experience was measured with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) within 7 days of discharge. We compared the proportion of patients in each study arm reporting “top box” scores for the following a priori HCAHPS domains: pain management, recommendation of hospital, and overall hospital rating. Responses to additional open-ended postdischarge questions were transcribed, coded independently, and analyzed for common themes. Results From July to December 2014, 90 medical inpatients were enrolled; postdischarge data were collected on 68 (76%) medical inpatients. Participants were 70% females, 43% non-Hispanic black, and 23% Hispanic. No differences between groups were observed on HCAHPS. The qualitative analysis found that massage and music therapy were associated with improved overall hospital experience, pain management, and connectedness to the massage or music therapist. Conclusions Providing music and massage therapy in an urban safety-net inpatient setting was feasible. There was no quantitative impact on HCAHPS. Qualitative findings suggest benefits related to an improved hospital experience, pain management, and connectedness to the massage or music therapist. PMID:29085740

  9. Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial.

    Science.gov (United States)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah; Haahr, Jens Peder; Frich, Lars Henrik; Andrea, Linda Christie; Svendsen, Susanne Wulff

    2016-06-01

    Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. A multicenter randomized controlled trial was conducted. The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. A standardized exercise program consisting of physical therapist-supervised individual training sessions and home training was used. The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=-0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. The nature of the exercise intervention did not allow blinding of patients and care providers. The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and

  10. Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis

    DEFF Research Database (Denmark)

    Rosenbaum, Bent; Harder, Susanne; Knudsen, Per

    2012-01-01

    manualized individual supportive psychodynamic psychotherapy (SPP) in addition to treatment as usual or with treatment as usual alone (TaU). Symptoms and functional outcomes were measured using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning scale (GAF). The study.......000) and GAF(symptom) (p = 0.010) significantly favored SPP in combination with TaU over TaU alone. In spite of limitations, this study speaks in favor of including supportive psychodynamic psychotherapy in the treatment for patients with schizophrenic first-episode psychoses....

  11. “Psychosomatic consultation in the workplace” – a new model of care at the interface of company-supported mental health care and consultation-liaison psychosomatics: design of a mixed methods implementation study

    Directory of Open Access Journals (Sweden)

    Rothermund Eva

    2012-09-01

    Full Text Available Abstract Background Mental health issues are gaining in importance in society and the economic system. At the same time, the accessibility and stigmatisation of the mental health care system in Germany can obstruct help-seeking behavior and delay early psychotherapeutic interventions. Therefore, new models of care are being established at the interface of company-supported health promotion and conventional health insurance sponsored outpatient care for people developing mental illnesses. Two large industrial companies, in cooperation with two psychosomatic clinics, have recently established a model of “psychosomatic consultation in the workplace“. This new model of care offers the opportunity for a first psychotherapeutic door to door consultation with occupational medicine within the industrial workplace. The main empirical goals of this study are: 1 Describing the differences between patients who use this new diagnostic and therapeutic offer within the industrial workplace vs. patients who visit a conventional regional outpatient clinic, especially in regard to symptom duration and severity, work ability, and demographic characteristics, and 2 A first evaluation of how patients may benefit more from this new model of care compared to those first seen by standard outpatient care. In the qualitative part of the study, occupational physicians, psychosomatic therapists, involved personnel and select employees of the involved companies will be asked to comment on their experiences with this new approach. Methods/Design The implementation study will take place in Ulm and in Stuttgart, with each site looking at one regional conventional psychosomatic outpatient clinic and one psychosomatic consultation offer within the workplace. 70 consecutive patients in each setting will be recruited (overall n = 280. For the cross-sectional study and pre-post comparison we will use established and validated survey instruments (PHQ, SF-12, WAI, MBI, IS as

  12. Mandometer Treatment Not Superior to Treatment as Usual for Anorexia Nervosa

    NARCIS (Netherlands)

    van Elburg, Annemarie A.; Hillebrand, Jacquelien J. G.; Huyser, Chaim; Snoek, Maartje; Kas, Martien; Hoek, Hans W.; Adan, Roger A. H.

    Objective: A comparison of the efficacy of a novel treatment method for anorexia nervosa (AN), the Mandometer treatment (MT), with treatment as usual (TAU). Method: During treatment data were collected to determine weight recovery and outcome as assessed by the Morgan Russell Outcome Assessment

  13. Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial

    NARCIS (Netherlands)

    van de Port, I.G.L.; Wevers, L.E.G.; Lindeman, E.; Kwakkel, G.

    2012-01-01

    Objective: To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home. Design: Randomised controlled trial with follow-up to 24 weeks.

  14. Treatment-as-usual (TAU) is anything but usual: a meta-analysis of CBT versus TAU for anxiety and depression.

    Science.gov (United States)

    Watts, Sarah E; Turnell, Adrienne; Kladnitski, Natalie; Newby, Jill M; Andrews, Gavin

    2015-04-01

    There were three aims of this study, the first was to examine the efficacy of CBT versus treatment-as-usual (TAU) in the treatment of anxiety and depressive disorders, the second was to examine how TAU is defined in TAU control groups for those disorders, and the third was to explore whether the type of TAU condition influences the estimate of effects of CBT. A systematic search of Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL was conducted. 48 studies of CBT for depressive or anxiety disorders (n=6926) that specified that their control group received TAU were identified. Most (n=45/48) provided an explanation of the TAU group however there was significant heterogeneity amongst TAU conditions. The meta-analysis showed medium effects favoring CBT over TAU for both anxiety (g=0.69, 95% CI 0.47-0.92, pCBT is superior to TAU and the size of the effect of CBT compared to TAU depends on the nature of the TAU condition. The term TAU is used in different ways and should be more precisely described. The four key details to be reported can be thought of as "who, what, how many, and any additional treatments?" Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Benzodiazepines II: Waking Up on Sedatives: Providing Optimal Care When Inheriting Benzodiazepine Prescriptions in Transfer Patients

    Directory of Open Access Journals (Sweden)

    Jeffrey Guina

    2018-01-01

    Full Text Available This review discusses risks, benefits, and alternatives in patients already taking benzodiazepines when care transfers to a new clinician. Prescribers have the decision—sometimes mutually agreed-upon and sometimes unilateral—to continue, discontinue, or change treatment. This decision should be made based on evidence-based indications (conditions and timeframes, comorbidities, potential drug-drug interactions, and evidence of adverse effects, misuse, abuse, dependence, or diversion. We discuss management tools involved in continuation (e.g., monitoring symptoms, laboratory testing, prescribing contracts, state prescription databases, stages of change and discontinuation (e.g., tapering, psychotherapeutic interventions, education, handouts, reassurance, medications to assist with discontinuation, and alternative treatments.

  16. Primary care ... where?

    Science.gov (United States)

    Adcock, G B

    1999-07-01

    Corporate-based nurse managed centers are not the national norm. More prevalent is the use of an occupational health or physician-directed medical model of care. The author describes how a 14-year-old primary care center at a North Carolina computer software company is just "business as usual" when viewed in the context of the company's philosophy, goals, and culture. Included are considerations for nurse practitioners interested in the successful transplantation of this primary care model to other settings.

  17. The effects of cognitive therapy versus 'treatment as usual' in patients with major depressive disorder

    DEFF Research Database (Denmark)

    Jakobsen, Janus Christian; Lindschou Hansen, Jane; Storebø, Ole Jakob

    2011-01-01

    BACKGROUND: Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Cognitive therapy may be an effective treatment option for major depressive disorder, but the effects have only had limited assessment in systematic reviews....... METHODS/PRINCIPAL FINDINGS: Cochrane systematic review methodology, with meta-analyses and trial sequential analyses of randomized trials, are comparing the effects of cognitive therapy versus 'treatment as usual' for major depressive disorder. To be included the participants had to be older than 17 years....... Meta-analysis on the data from the Hamilton Rating Scale for Depression showed that cognitive therapy compared with 'treatment as usual' significantly reduced depressive symptoms (mean difference -2.15 (95% confidence interval -3.70 to -0.60; P

  18. The Kramers-Kronig relations for usual and anomalous Poisson-Nernst-Planck models

    OpenAIRE

    Evangelista, Luiz Roberto; Lenzi, Ervin Kaminski; Barbero, Giovanni

    2013-01-01

    The consistency of the frequency response predicted by a class of electrochemical impedance expressions is analytically checked by invoking the Kramers-Kronig (KK) relations. These expressions are obtained in the context of Poisson-Nernst-Planck usual (PNP) or anomalous (PNPA) diffusional models that satisfy Poisson's equation in a finite-length situation. The theoretical results, besides being successful in interpreting experimental data, are also shown to obey the KK relations when these re...

  19. The Kramers–Kronig relations for usual and anomalous Poisson–Nernst–Planck models

    International Nuclear Information System (INIS)

    Evangelista, Luiz Roberto; Lenzi, Ervin Kaminski; Barbero, Giovanni

    2013-01-01

    The consistency of the frequency response predicted by a class of electrochemical impedance expressions is analytically checked by invoking the Kramers–Kronig (KK) relations. These expressions are obtained in the context of Poisson–Nernst–Planck usual or anomalous diffusional models that satisfy Poisson’s equation in a finite length situation. The theoretical results, besides being successful in interpreting experimental data, are also shown to obey the KK relations when these relations are modified accordingly. (paper)

  20. The Kramers-Kronig relations for usual and anomalous Poisson-Nernst-Planck models.

    Science.gov (United States)

    Evangelista, Luiz Roberto; Lenzi, Ervin Kaminski; Barbero, Giovanni

    2013-11-20

    The consistency of the frequency response predicted by a class of electrochemical impedance expressions is analytically checked by invoking the Kramers-Kronig (KK) relations. These expressions are obtained in the context of Poisson-Nernst-Planck usual or anomalous diffusional models that satisfy Poisson's equation in a finite length situation. The theoretical results, besides being successful in interpreting experimental data, are also shown to obey the KK relations when these relations are modified accordingly.

  1. H eat transfer betw een tw o surfaces usually in- creases w h en th e ...

    Indian Academy of Sciences (India)

    Srimath

    H eat transfer betw een tw o surfaces usually in- creases w h en th e tem p eratu re d i® eren ce b etw een the tw o surfaces increases. H ere w e highlight an unusual situation in radiation heat transfer w herein the heat transfer decreases w hen the tem perature di®erence increases. In tro d u ctio n. In 1701,N ew ton ...

  2. Do you really know precise radiologic–pathologic correlation of usual interstitial pneumonia?

    Energy Technology Data Exchange (ETDEWEB)

    Johkoh, Takeshi, E-mail: johkoht@aol.com [Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami (Japan); Sumikawa, Hiromotsu [Department of Radiology, Osaka University Graduate School of Medicine, Suita (Japan); Fukuoka, Junya; Tanaka, Tomonori [Department of Pathology, Nagasaki University Graduate School of Medicine, Toyama (Japan); Fujimoto, Kiminori [Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume (Japan); Takahashi, Masashi [Department of Radiology, Shiga Medical University, Otsu (Japan); Tomiyama, Noriyuki [Department of Radiology, Osaka University Graduate School of Medicine, Suita (Japan); Kondo, Yasuhiro; Taniguchi, Hiroyuki [Department of Respiratory and Allergic Medicine, Tosei General Hospital, Seto (Japan)

    2014-01-15

    Although usual interstitial pneumonia (UIP) is the most common chronic interstitial pneumonia, understanding of pathologic backgrounds of CT findings has still not been enough. Since honeycombing on either scanning microgram or CT is essential for diagnosis of UIP in 2010 ATS-ERS-JRS-ALAT guide line, the role of radiologists has become much more important. We will summarize common and uncommon CT findings with radiologic–pathological correlation.

  3. Therapy recommendation "act as usual" in patients with whiplash injuries QTF I°.

    Science.gov (United States)

    Dehner, Christoph; Kraus, Michael; Schöll, Hendrik; Schneider, Florian; Richter, Peter; Kramer, Michael

    2012-08-20

    Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation "act as usual" has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation "act as usual" and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values < 2). This is consistent with a chronification rate of 3.1%. After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values < 1). The therapy recommendation "act as usual" in combination with an adapted pain treatment is sufficient. Usually patients with whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes.

  4. Usual Dietary Energy Density Distribution Is Positively Associated with Excess Body Weight in Mexican Children.

    Science.gov (United States)

    Aburto, Tania C; Cantoral, Alejandra; Hernández-Barrera, Lucia; Carriquiry, Alicia L; Rivera, Juan A

    2015-07-01

    Studies suggest a positive association between dietary energy density (DED) and body weight in adults, but evidence in children is inconclusive. The objective of this study was to compare usual DED distributions of nonoverweight vs. overweight or obese (OW/O) Mexican children. The study used 24-h recall (24HR) data from 2367 children aged 5-11 y from the 2012 Mexican National Health and Nutrition Survey (ENSANUT 2012). Repeated 24HR measures were obtained in a random sample (∼10%) to estimate usual intake distributions by using the Iowa State University (PC-Side) method. Implausible dietary reports were identified. Multivariate linear regression models were used to evaluate the relation between DED and body mass index status and to compare results with and without PC-Side adjustment and restriction to plausible reporters. A total of 35.1% of the children in the sample were OW/O. The usual DED mean was ∼175 kcal/100 g in both the complete sample and the plausible reporters subsample. Regression models adjusted by PC-Side and for potential confounders showed higher DED in OW/O relative to nonoverweight children for both plausible reporters (9.7 kcal/100 g; n = 1452, P 0.10). A positive association between usual DED and OW/O was found in Mexican children. The association was stronger when only plausible reporters were considered. This suggests that there is a need for strategies to reduce energy density in the diet of Mexican children. © 2015 American Society for Nutrition.

  5. Future reef decalcification under a business-as-usual CO2 emission scenario.

    Science.gov (United States)

    Dove, Sophie G; Kline, David I; Pantos, Olga; Angly, Florent E; Tyson, Gene W; Hoegh-Guldberg, Ove

    2013-09-17

    Increasing atmospheric partial pressure of CO2 (pCO2) is a major threat to coral reefs, but some argue that the threat is mitigated by factors such as the variability in the response of coral calcification to acidification, differences in bleaching susceptibility, and the potential for rapid adaptation to anthropogenic warming. However the evidence for these mitigating factors tends to involve experimental studies on corals, as opposed to coral reefs, and rarely includes the influence of multiple variables (e.g., temperature and acidification) within regimes that include diurnal and seasonal variability. Here, we demonstrate that the inclusion of all these factors results in the decalcification of patch-reefs under business-as-usual scenarios and reduced, although positive, calcification under reduced-emission scenarios. Primary productivity was found to remain constant across all scenarios, despite significant bleaching and coral mortality under both future scenarios. Daylight calcification decreased and nocturnal decalcification increased sharply from the preindustrial and control conditions to the future scenarios of low (reduced emissions) and high (business-as-usual) increases in pCO2. These changes coincided with deeply negative carbonate budgets, a shift toward smaller carbonate sediments, and an increase in the abundance of sediment microbes under the business-as-usual emission scenario. Experimental coral reefs demonstrated highest net calcification rates and lowest rates of coral mortality under preindustrial conditions, suggesting that reef processes may not have been able to keep pace with the relatively minor environmental changes that have occurred during the last century. Taken together, our results have serious implications for the future of coral reefs under business-as-usual environmental changes projected for the coming decades and century.

  6. Do you really know precise radiologic–pathologic correlation of usual interstitial pneumonia?

    International Nuclear Information System (INIS)

    Johkoh, Takeshi; Sumikawa, Hiromotsu; Fukuoka, Junya; Tanaka, Tomonori; Fujimoto, Kiminori; Takahashi, Masashi; Tomiyama, Noriyuki; Kondo, Yasuhiro; Taniguchi, Hiroyuki

    2014-01-01

    Although usual interstitial pneumonia (UIP) is the most common chronic interstitial pneumonia, understanding of pathologic backgrounds of CT findings has still not been enough. Since honeycombing on either scanning microgram or CT is essential for diagnosis of UIP in 2010 ATS-ERS-JRS-ALAT guide line, the role of radiologists has become much more important. We will summarize common and uncommon CT findings with radiologic–pathological correlation.

  7. Adequacy of Usual Vitamin and Mineral Intake in Spanish Children and Adolescents: ENALIA Study

    Directory of Open Access Journals (Sweden)

    Ana M. López-Sobaler

    2017-02-01

    Full Text Available Background: The National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA provides data to assess the usual micronutrient intake among Spanish infants, children, and adolescents. Methods: Cross-sectional survey (November 2012–July 2014 of a representative sample of Spanish children and adolescents (six months–17 years (n = 1862. Dietary information was collected using two non-consecutive one-day food diaries (six months–10 years old or two 24 h dietary recalls (11 years and older separated by at least 14 days. Estimates were calculated using the Iowa State University method and PC-SIDE software (version 1.0, department of statistics, center for agricultural and rural development, Ames, IA, USA to account for within- and between-person variation. Results: Usual intake of vitamin D was insufficient in practically all individuals. Vitamin E, folate, and calcium were insufficient, especially from nine years of age, and magnesium and iodine from 14 years of age. The percentage of subjects with insufficient intakes was higher among females. Sodium intake was excessive in a considerable percentage of the population, especially in males, and it increased with age. Finally, over half of children under four years of age had zinc usual intakes that exceeded the Tolerable Upper Level. Conclusion: Vitamin and mineral intake in Spain should be improved, especially in late childhood and adolescence. Nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies in Spanish children and adolescents.

  8. Usual Dietary Intakes: SAS Macros for Estimating Ratios of Two Dietary Components that are Consumed Nearly Every Day

    Science.gov (United States)

    The following SAS macros can be used to create a bivariate distribution of usual intake of two dietary components that are consumed nearly every day and to calculate percentiles of the population distribution of the ratio of usual intakes.

  9. Usual Choline Intakes Are Associated with Egg and Protein Food Consumption in the United States

    Directory of Open Access Journals (Sweden)

    Taylor C. Wallace

    2017-08-01

    Full Text Available Choline is an essential nutrient with critical roles in several biological processes including neuronal development, cell signaling, nerve impulse transmission, and lipid transport and metabolism. The National Cancer Institute method was used to assess usual intakes of choline from foods according to data for participants enrolled in the National Health and Nutrition Examination Survey 2009–2014 datasets and pregnant women in the 2005–2014 datasets. Suboptimal intakes of choline are present across many gender and life-stage subpopulations, as well as pregnant women in the U.S. Only 8.03 ± 0.56% of adults and 8.51 ± 2.89% pregnant women meet the AI for choline. Children 2–3 years were the most likely to meet their gender and life-stage specific AI, followed by children 4–8 years. Adults 19+ years who consume eggs were more likely to meet their gender and life-stage AI as compared to non-consumers (57.3 ± 1.45% and 2.43 ± 0.28%. Consumers of eggs had almost double the usual intake of choline as compared to non-consumers (525 ± 5.17 mg/d and 294 ± 1.98; p < 0.0001. Protein food (meat, poultry and seafood consumption also increased usual choline intakes compared to non-consumers (345 ± 2.21 mg/day and 235 ± 8.81; p < 0.0001 to a lesser degree, but did not result in substantial increases in the percent of individuals meeting the AI. No subpopulation exceeded the UL for choline. This research illustrates that it is extremely difficult to achieve the AI for choline without consuming eggs or taking a dietary supplement.

  10. Comparative experimental and numerical studies of usual insulation materials and PCMs in buildings at Casablanca

    Science.gov (United States)

    Mourid, Amina; El Alami, Mustapha

    2018-05-01

    In this paper, we present a comparative thermal study of the usual insulation materials used in the building as well as the innovate one like phase change materials (PCMs). Both experimental study and numerical approach were applied in this work for summer season. In the experimental study the PCM was installed on the outer surface on the ceiling of one of two full-scale rooms located at FSAC, Casablanca. A simulation model was performed with TRNSYS’17 software. We have established as a criterion of comparison the internal temperatures. An economic study also has been carried out. Based on this latter, that the PCM is most efficient.

  11. Business as usual in spite of the CO2 trade of the EU

    International Nuclear Information System (INIS)

    Wellander, Dag

    2004-01-01

    The trade system that is going to be launched by the EU at the turn of the year (2004/2005) has some serious shortcomings as it was originally formulated. It is limited to the EU. It is only partial; it applies only to emission sources in the energy sector and some energy-intensive sectors. Both limitations raise the costs of cutting down on the emissions, which would have hit the EU unilaterally. According to the author, work is now in progress to make the trade system as inefficient as possible, aiming at ''business as usual''. The climate problems cannot be solved without global cooperation, which is not in sight

  12. Giant solitary fibrous tumour of the pleura: a rare but usually benign intrathoracic neoplasm

    DEFF Research Database (Denmark)

    Bodtger, Uffe; Pedersen, Jesper Holst; Skov, Birgit Guldhammer

    2009-01-01

    BACKGROUND: Low forced expiratory volume (FEV(1)) and low performance status usually preclude surgical treatment of lung neoplasms. Earlier case reports have suggested that curative, safe surgery is possible in extrapulmonal intrathoracic neoplasms. METHODS: A case report of an 83-year-old women...... with progressing dyspnoea secondary to a huge left-side neoplasm. RESULTS: Work-up reveal an FEV(1) of 0.4 L, and a giant solitary fibrous tumor of the pleura. The tumor was surgically removed in toto without complications: weighting approximately 3 kg, and benign histology. The patient was without dyspnoea...

  13. Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review

    Directory of Open Access Journals (Sweden)

    Emma J Schneider

    2016-10-01

    Full Text Available Questions: In people receiving rehabilitation aimed at reducing activity limitations of the lower and/or upper limb after stroke, does adding extra rehabilitation (of the same content as the usual rehabilitation improve activity? What is the amount of extra rehabilitation that needs to be provided to achieve a beneficial effect? Design: Systematic review with meta-analysis of randomised trials. Participants: Adults aged 18 years or older that had a diagnosis of stroke. Intervention: Extra rehabilitation with the same content as usual rehabilitation aimed at reducing activity limitations of the lower and/or upper limb. Outcome measures: Activity measured as lower or upper limb ability. Results: A total of 14 studies, comprising 15 comparisons, met the inclusion criteria. Pooling data from all the included studies showed that extra rehabilitation improved activity immediately after the intervention period (SMD = 0.39, 95% CI 0.07 to 0.71, I2 = 66%. When only studies with a large increase in rehabilitation (> 100% were included, the effect was greater (SMD 0.59, 95% CI 0.23 to 0.94, I2 = 44%. There was a trend towards a positive relationship (r = 0.53, p = 0.09 between extra rehabilitation and improved activity. The turning point on the ROC curve of false versus true benefit (AUC = 0.88, p = 0.04 indicated that at least an extra 240% of rehabilitation was needed for significant likelihood that extra rehabilitation would improve activity. Conclusion: Increasing the amount of usual rehabilitation aimed at reducing activity limitations improves activity in people after stroke. The amount of extra rehabilitation that needs to be provided to achieve a beneficial effect is large. Trial registration: PROSPERO CRD42012003221. [Schneider EJ, Lannin NA, Ada L, Schmidt J (2016 Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. Journal of Physiotherapy 62: 182–187

  14. Usual alcohol consumption and suicide mortality among the Korean elderly in rural communities: Kangwha Cohort Study.

    Science.gov (United States)

    Yi, Sang-Wook; Jung, Myoungjee; Kimm, Heejin; Sull, Jae-Woong; Lee, Eunsook; Lee, Kwang Ok; Ohrr, Heechoul

    2016-08-01

    The evidence from prospective studies on whether greater usual alcohol consumption is associated with a higher risk of death by suicide in the general population is inconclusive. 6163 participants (2635 men; 3528 women) in a 1985 survey among rural residents in Korea aged 55 years and above were followed until 2008. A Cox model was used to calculate HRs of suicide death after adjustment for demographic, socioeconomic and health-related confounders. 37 men and 24 women died by suicide. Elderly persons who consumed alcohol daily, 70 g alcohol (5 drinks) or more per drinking day, or 210 g alcohol (15 drinks) or more per week had higher suicide mortality (prisk of suicide death, respectively. Women had a higher relative risk of suicide death associated with alcohol consumption, compared with men. A greater frequency and amount of usual alcohol consumption was linearly associated with higher suicide death. Given the same amount of alcohol consumption, women might have a higher relative risk of suicide than men. Our findings support 'the lower the better' for alcohol intake, no protective effect of moderate alcohol consumption, and a sex-specific guideline (lower alcohol threshold for women) as actions to prevent suicide death. 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/

  15. Depressed mood, usual activity level, and continued employment after starting dialysis.

    Science.gov (United States)

    Kutner, Nancy G; Zhang, Rebecca; Huang, Yijian; Johansen, Kirsten L

    2010-11-01

    When patients start dialysis, their employment rate declines and disability benefits are an option. With patient sociodemographic and clinical characteristics including disability income status controlled, we investigated the significance of depressed mood and usual activity level as predictors of patients' continued employment after dialysis start. Incident patients from 296 randomly selected dialysis clinics were surveyed in the Comprehensive Dialysis Study (CDS). Participants provided information about employment status, disability income status, education, depressive symptoms measured by the Patient Health Questionnaire-2 (PHQ-2), and usual activity level/energy expenditure measured by the Human Activity Profile. Age, gender, race, insurance, diabetes, inability to ambulate or transfer, chronic obstructive pulmonary disease, cardiovascular conditions, and hemoglobin and serum albumin values at treatment start were obtained from US Renal Data System files. Dialysis modality was defined at time of interview. Among 585 CDS participants who worked in the previous year, 191 (32.6%) continued working after dialysis start. On the basis of the PHQ-2 cutoff score ≥3, 12.1% of patients who remained employed had possible or probable depression, compared with 32.8% of patients who were no longer employed. In adjusted analyses, higher Human Activity Profile scores were associated with increased likelihood of continued employment, and there was a borderline association between lower PHQ-2 scores and continued employment. Screening and management of depressive symptoms and support for increased activity level may facilitate patients' opportunity for continued employment after dialysis start, along with generally improving their overall quality of life.

  16. Mindfulness based cognitive therapy versus treatment as usual in adults with attention deficit hyperactivity disorder (ADHD).

    Science.gov (United States)

    Janssen, Lotte; Kan, Cornelis C; Carpentier, Pieter J; Sizoo, Bram; Hepark, Sevket; Grutters, Janneke; Donders, Rogier; Buitelaar, Jan K; Speckens, Anne E M

    2015-09-15

    Adults with attention deficit hyperactivity disorder (ADHD) often present with a lifelong pattern of core symptoms that is associated with impairments of functioning in daily life. This has a substantial personal and economic impact. In clinical practice there is a high need for additional or alternative interventions for existing treatments, usually consisting of pharmacotherapy and/or psycho-education. Although previous studies show preliminary evidence for the effectiveness of mindfulness-based interventions in reducing ADHD symptoms and improving executive functioning, these studies have methodological limitations. This study will take account of these limitations and will examine the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) in further detail. A multi-centre, parallel-group, randomised controlled trial will be conducted in N = 120 adults with ADHD. Patients will be randomised to MBCT in addition to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline and at three, six and nine months after baseline. Primary outcome measure will be severity of ADHD symptoms rated by a blinded clinician. Secondary outcome measures will be self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. In addition, a cost-effectiveness analysis will be conducted. This trial will offer valuable information about the clinical and cost-effectiveness of MBCT in addition to TAU compared to TAU alone in adults swith ADHD. ClinicalTrials.gov NCT02463396. Registered 8 June 2015.

  17. Medical teleconferencing with high-definition video presentation on the 'usual' Internet.

    Science.gov (United States)

    Obuchi, Toshiro; Shima, Hiroji; Iwasaki, Akinori

    2013-06-01

    Although medical teleconferences on advanced academic networks have been common (Telemed J E Health 15:112-117, 1; Asian J Endosc Surg 3:185-188, 2; Surg Today 41:1579-1581, 3; Telemedicine development center of Asia. http://www.aqua.med.kyushu-u.ac.jp/eg/index.html . Accessed 6 March 2013, 4), reports regarding 'usual' Internet teleconferences or tele-lectures employing a telecommunication system for business use are very rare. Medical teleconferences and tele-lectures on the Internet were held three times between our institutions and other institutions, using the 'HD Com' made by Panasonic (HD Com. http://panasonic.biz/com/visual/ . Accessed 6 March 2013, 5), which is a high-definition telecommunication system for business tele-meeting. All of our medical telecommunications were successfully completed without any troubles. This system allows for all kinds of presentations using personal computers to be made from each station, so that discussions with high-definition surgical video presentation, which has recently been developed, could be effortlessly established despite the distance between institutions. Unlike telecommunication using advanced academic networks, this system can run without any need for specific engineering support, on the usual Internet. Medical telecommunication employing this system is likely to become common among ordinary hospitals in the near future.

  18. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension.

    Science.gov (United States)

    Rothwell, Peter M

    2010-03-13

    Although hypertension is the most prevalent treatable vascular risk factor, how it causes end-organ damage and vascular events is poorly understood. Yet, a widespread belief exists that underlying usual blood pressure can alone account for all blood-pressure-related risk of vascular events and for the benefits of antihypertensive drugs, and this notion has come to underpin all major clinical guidelines on diagnosis and treatment of hypertension. Other potentially informative measures, such as variability in clinic blood pressure or maximum blood pressure reached, have been neglected, and effects of antihypertensive drugs on such measures are largely unknown. Clinical guidelines recommend that episodic hypertension is not treated, and the potential risks of residual variability in blood pressure in treated hypertensive patients have been ignored. This Review discusses shortcomings of the usual blood-pressure hypothesis, provides background to accompanying reports on the importance of blood-pressure variability in prediction of risk of vascular events and in accounting for benefits of antihypertensive drugs, and draws attention to clinical implications and directions for future research. Copyright 2010 Elsevier Ltd. All rights reserved.

  19. 020. Coexistence of lung adenocarcinoma and usual interstitial pneumonia: a case report

    Science.gov (United States)

    Baliaka, Aggeliki; Papaemmanouil, Styliani; Spyratos, Dionysis; Zarogoulidis, Paul; Sakkas, Leonidas

    2015-01-01

    Background Usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) is a chronic fibrosing interstitial pneumonia of unknown cause. The most common symptoms are progressively increased shortness of breath and dry cough. Some studies suggest an association between usual interstitial pneumonia and lung cancer through different pathogenetic mechanisms. Objective The case presentation of a patient with lung adenocarcinoma and UIP. Methods A 66-year-old male presented with persistent dry cough, hemoptysis and dyspnea. The chest radiographs revealed a mass in the lower lobe of the left lung, measuring 3 cm, as well as diffuse interstitial changes in the same lobe. Two partial lobectomies were performed. Results Histological examination of the mass showed moderately differentiated adenocarcinoma, focally with bronchoalveolar pattern (Immunohistochemical detection of EGFR: positive). The rest lung parenchyma presented histological appearance of UIP. Conclusions According to clinicopathological studies, the prevalence of lung cancer among patients with UIP/IPF varies between 4% and 9%. The overall median survival of IPF-Ca patients is seven months in comparison with IPF only patients (14 months).

  20. [Tailored Care for Functional Vertigo/Dizziness - An Integrative Group Psychotherapy Approach].

    Science.gov (United States)

    Radziej, Katharina; Schmid-Mühlbauer, Gabriele; Limburg, Karina; Lahmann, Claas

    2017-06-01

    Functional vertigo and dizziness (VD) symptoms are highly prevalent and usually accompanied by a strong impairment of quality in everyday and working life. The complaints are often associated with various psychiatric disorders, particularly phobic and other anxiety disorders, depressive or somatoform disorders. Despite this clinical relevance of VD symptoms, studies towards psychotherapeutic treatment options for patients with functional VD are still rare. Thus, the present study outlines a manual for outpatient group therapy for patients with functional VD symptoms. Our approach aims to assist patients in developing an understanding of the interaction between bodily complaints and psychosocial factors while detracting from a purely symptom based focus. The integrative-psychotherapeutic treatment program consists of 16 weekly sessions and includes a regular vestibular rehabilitation training as well as disorder-oriented modules towards anxiety and panic disorder, depression, and somatisation. We are currently conducting a randomised controlled trial in order to evaluate the short- and long-term effectiveness of the program in reducing VD and further bodily symptoms, vertigo-related social and physical handicap as well as anxiety and depressive complaints. A previously completed pilot trial has led to small to large pre-follow-up-effects on primary and secondary outcome measures. Conclusions regarding acceptance and feasibility of the therapy concept are discussed. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Predicting therapy success for treatment as usual and blended treatment in the domain of depression

    NARCIS (Netherlands)

    van Breda, Ward; Bremer, Vincent; Becker, Dennis; Hoogendoorn, Mark; Funk, Burkhardt; Ruwaard, Jeroen; Riper, Heleen

    2017-01-01

    In this paper, we explore the potential of predicting therapy success for patients in mental health care. Such predictions can eventually improve the process of matching effective therapy types to individuals. In the EU project E-COMPARED, a variety of information is gathered about patients

  2. Survey of Usual Practice: Dysphagia Therapy in Head & Neck Cancer Patients

    Science.gov (United States)

    Krisciunas, Gintas P.; Sokoloff, William; Stepas, Katherine; Langmore, Susan E.

    2012-01-01

    There is no standardized dysphagia therapy for head and neck cancer patients and scant evidence to support any particular protocol, leaving institutions and individual speech language pathologists (SLPs) to determine their own protocols based on “typical” practices or anecdotal evidence. To gain an understanding of current usual practices, a national internet-based survey was developed and disseminated to SLPs who treat HNC patients. From a random sample of 4,000 ASHA SID 13 members, 1,931 fit the inclusion criteria, and 759 complete responses were recorded for a 39.3% response rate. Results were analyzed by institution type as well as by individual clinical experience. While some interesting trends emerged from the data, a lack of uniformity and consensus regarding best practices was apparent. This is undoubtedly due to a paucity of research adequately addressing the efficacy of any one therapy for dysphagia in the HNC population. PMID:22456699

  3. From Sustainability-as-usual to Sustainability Excellence in Local Bioenergy Business

    Directory of Open Access Journals (Sweden)

    Heli Kasurinen

    2017-06-01

    Full Text Available Bioenergy business operators can significantly contribute to the sustainability of bioenergy systems. While research has addressed the maturity of corporate responsibility for sustainability, the maturity levels of bioenergy business have not been determined. The objectives of this research were to characterise the maturity levels of bioenergy corporate responsibility for sustainability and outline an approach by which companies can operate at the most mature sustainability excellence level. Literature, three workshops attended by bioenergy experts and a case study on biobutanol production in Brazil were used to develop the maturity model and approach. The results characterise the profitability, acceptability, and sustainability orientation maturity levels through sustainability questions and methods, and list the components of a systemic, holistic approach. Although the shift of business mindset from sustainability-as-usual to sustainability excellence is challenging, a systemic approach is necessary to broadly identify sustainability questions and a multitude of methods by which they can be answered.

  4. A 'business-as-usual' energy scenario for France at the 2020 vista

    International Nuclear Information System (INIS)

    Giraud, P.N.

    2000-01-01

    A 'business-as-usual' energy scenario is the most probable scenario where the energy demand follows the trends of the past and where no new energy policy is implemented. This work is a complement to the three contrasted energy scenarios built in 1998 by the 'Energy 2010-2020' prospective group of the French general commission of national development. The scenario built in this study is only a reference which allows the measure the efforts made to reach political goals. The main conclusion of this scenario is the increase of the CO 2 emissions under the double effect of the economic growth and of the cessation of the nuclear program which becomes non-competitive with respect to the gas prices and actualization rates retained in the scenario. The main constraint of the energy future is incontestably the necessary fight against the greenhouse effect. (J.S.)

  5. Allocation of energy resources for power generation in India: Business as usual and energy efficiency

    International Nuclear Information System (INIS)

    Mallah, Subhash; Bansal, N.K.

    2010-01-01

    This paper deals with MARKAL allocations for various energy sources, in India, for Business As Usual (BAU) scenario and for the case of exploitation of energy saving potential in various sectors of economy. In the BAU scenario, the electrical energy requirement will raise up to 5000 bKwh units per year or 752 GW of installed capacity with major consumers being in the industry, domestic and service sectors. This demand can be met by a mix of coal, hydro, nuclear and wind technologies. Other reneawbles i.e. solar and biomass will start contributing from the year 2040 onwards. By full exploitation of energy saving potential, the annual electrical energy demand gets reduced to 3061 bKwh (or 458 GW), a reduction of 38.9%.The green house gas emissions reduce correspondingly. In this scenario, market allocations for coal, gas and large hydro become stagnant after the year 2015.

  6. How to distinguish between 'business as usual' and 'significant business disruptions' and plan accordingly.

    Science.gov (United States)

    Halliwell, Peter

    2008-01-01

    This paper seeks to provide an insight into Air New Zealand and how business continuity is managed in an industry with inherent disruptions. The differences between 'business as usual' and 'significant business disruptions' are outlined along with their associated criteria, response and escalation processes. The paper describes why the company incorporates the four 'R's of the Civil Defence Emergency Management Act within its BCM framework and how this aids resilience. A case study is provided that details a 'significant disruption' that occurred in November 2006. This event resulted in the total loss of a sales office and cargo shed after unrest in the Kingdom of Tonga escalated to widespread rioting, looting and destruction of their central business district. The lessons from this event have been captured and provide some essential mitigation measures that will assist in future events.

  7. Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT

    International Nuclear Information System (INIS)

    Hartman, T.E.; Primack, S.L.; Kang, E.Y.

    1997-01-01

    Objective. To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). Materials and methods. Twelve patients with biopsy specimen-proved UIP and 11 patients with biopsy specimen-proved DIP who had initial and follow-up HRCT scans (median interval, 10 months) were reviewed. Eleven patients with UIP and 11 with DIP received treatment between the initial and follow-up CT scans. The scans were evaluated for the presence and extent of ground-glass attenuation, irregular linear opacities and honeycombing, and overall extent of parenchymal involvement. Results. On initial CT scans, all 12 patients with UIP had areas of ground-glass attenuation (mean±SD extent, 30±16%) and irregular lines (mean±SD extent, 17±7%) and 10 patients had honeycombing (mean±SD extent, 10±6%). All 11 patients with DIP had areas of ground-glass attenuation on initial HRCT scans (mean±SD extent, 51±26%), 5 patients had irregular linear opacities (mean±SD extent, 5±5%), and 1 patient had honeycombing. Nine of the 12 patients with UIP showed increase in the extent of ground-glass attenuation (n=6) or progression to irregular lines (n=2) or honeycombing (n=4) on follow-up as compared with only 2 patients with DIP who showed progression to irregular lines (n=1) or honeycombing (n=1) (p 2 test). Conclusion. In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment. Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment. (authors)

  8. Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING] : study protocol of a non-inferiority randomized trial

    NARCIS (Netherlands)

    Massoudi, Btissame; Blanker, Marco H; van Valen, Evelien; Wouters, Hans; Bockting, Claudi L H; Burger, Huibert

    2017-01-01

    BACKGROUND: The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to

  9. Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING] : Study protocol of a non-inferiority randomized trial

    NARCIS (Netherlands)

    Massoudi, Btissame; Blanker, Marco H.; van Valen, Evelien; Wouters, Hans; Bockting, Claudi L. H.; Burger, Huibert

    2017-01-01

    BACKGROUND: The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to

  10. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997.

    Science.gov (United States)

    Uhlenhuth, E H; Balter, M B; Ban, T A; Yang, K

    1999-01-01

    To assemble expert clinical experience and judgment regarding the treatment of anxiety disorders in a systematic, quantitative manner, particularly with respect to changes during the preceding five years. A panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depression was constituted by multistage peer nomination. Sixty-six completed a questionnaire in 1992, and 51 of those completed a follow-up questionnaire in 1997. This report focuses on the experts' responses to questions about therapeutic options relevant to seven vignettes describing typical cases of different anxiety disorders. The preferred initial treatment strategy in 1992 was a combination of medication with a psychological therapy for all vignettes except simple phobia, where a psychological procedure alone was favored. There was little change in 1997, primarily some decrease in the choice of psychological therapy and some increase in the choice of medication for social phobia. Experts recommending a medication in 1992 most often chose as first-line treatment a benzodiazepine anxiolytic (BZ) for panic disorder (PD), generalized anxiety disorder (GAD), simple phobia, and adjustment disorder. They recommended a beta-blocker most often for social phobia and a tricyclic anti-depressant (TCA) for agoraphobia and obsessive-compulsive disorder (OCD). Nearly a fourth chose a combination of medications, usually a TCA plus a BZ. In 1997, the expert panel's most frequent recommendation for agoraphobia, PD, and OCD changed to a specific serotonin reuptake inhibitor (SSRI); and they also recommended these compounds more often for GAD, social phobia, and simple phobia. Fewer experts chose BZs or TCAs. However, in 1997 many again chose a combination of medications, often a BZ plus a SSRI, so that, overall, there was only a small decline in recommendations for BZs. As second-line medications (1997 only), the experts recommended SSRIs most often for most vignettes, but a TCA for PD and

  11. Neuroeconomics and Integrated Care

    DEFF Research Database (Denmark)

    Larsen, Torben

    2012-01-01

    Background: Fragmented specialized care for the frail elderly as claimed by WHO needs horizontal integration across settings. The home of the patient seems to be a promising place to integrate hospital care, primary care and social services for high-risk discharges where the quality...... of rehabilitation makes a difference. Objective: The study aims to reveal how integrated home care may be organised to improve quality of care as compared to usual hospital care. Method: A qualitative case study of the use of a neuroeconomic model in relation to multidisciplianry collaboration on a RCT...... of integrated home care for stroke patients. Results: (1) The classical understanding of CNS is that of a dual system of ANS and Cortex. The new neuroeconomic understanding is that of a reciprocal balance of Limbic System (LS) and Neocortex (NC). This applies directly in favour of integrated homecare compared...

  12. [Medicine behind bars. Illness is usual not grounds for modifying imprisonment].

    Science.gov (United States)

    Schwarzkopf, A; Zenker, M

    2002-05-16

    The article describes the possibilities of medical care in prison as exemplified by the Kassel 1 prison with its attached central hospital facility. The main areas of medical care covered there are the treatment of wounds, conservative treatment of fractures, ophthalmology, ENT, urology, dentistry and, via external consultant physicians, also internal medicine, pneumology, dermatology and gynecology. Such infections as hepatitis B and C, syphilis, and tuberculosis have a greater prevalence among prisoners--in contrast to other infections afflicting people housed under similar living conditions, such as in communal living facilities, which show no such increased prevalence. Furthermore, there is a relatively high percentage of injuries, including those that are self-inflicted. The problem of certifying a prisoner medically unfit to tolerate imprisonment is discussed.

  13. INFLUENCE OF USUAL AND DUAL WHEELS ON SOIL PENETRATION RESISTANCE: THE GIS-APPROACH

    Directory of Open Access Journals (Sweden)

    Zhukov A. V.

    2015-12-01

    Full Text Available GIS-APPROACH application has allowed establishing that usual wheels of machine-tractor units carry out considerable influence on soil which exceeds visible borders of a track of wheels on the dimensions. This influence shows in augmentation of soil penetration resistance at 100-155 % in comparison with the control on depth of 0-10 cm and on 20-30 % on depth of 45-50 %. It is impossible to exclude that influence of wheels proceeds more deeply, than tests have been conducted. Critical for cultivated plants value of soil penetration resistance in 3 MPa under the influence of usual wheels of agricultural machinery comes nearer practically to a surface. Character of profile changes of hardness in various regions influences of wheels allows assuming the long season of a relaxation of soil for achievement of background values of soil penetration resistance. The further researches are necessary for an establishment of concrete indicators of dynamics. Negative influence of an overstocking does not confine only deterioration of conditions of growth of assemblages of rootlets of plants. Infringement of processes of moving of moisture in the soil, the accelerated evaporation and the slowed down processes of a filtration and an infiltration, destruction of modular frame, activization of erosive processes is possible. The understanding of these processes will give the chance volume understanding of real influence of running systems of machine-tractor devices on bedrock. Region intensive influence of dual wheels is circumscribed by the top soil layers (0-15 cm. The major feature of influence of dual wheels is absence of an overstocking above critical levels. It is impossible to exclude possible positive influence of moderate inspissations of soil under the influence of dual wheels for growth of agricultural crops and moisture conservation in soil. The cumulative negative effect on soil crossed vehicles traces is probable. The long season of a relaxation of

  14. Effects of business-as-usual anthropogenic emissions on air quality

    Directory of Open Access Journals (Sweden)

    A. Pozzer

    2012-08-01

    Full Text Available The atmospheric chemistry general circulation model EMAC has been used to estimate the impact of anthropogenic emission changes on global and regional air quality in recent and future years (2005, 2010, 2025 and 2050. The emission scenario assumes that population and economic growth largely determine energy and food consumption and consequent pollution sources with the current technologies ("business as usual". This scenario is chosen to show the effects of not implementing legislation to prevent additional climate change and growing air pollution, other than what is in place for the base year 2005, representing a pessimistic (but plausible future.

    By comparing with recent observations, it is shown that the model reproduces the main features of regional air pollution distributions though with some imprecisions inherent to the coarse horizontal resolution (~100 km and simplified bottom-up emission input.

    To identify possible future hot spots of poor air quality, a multi pollutant index (MPI, suited for global model output, has been applied. It appears that East and South Asia and the Middle East represent such hotspots due to very high pollutant concentrations, while a general increase of MPIs is observed in all populated regions in the Northern Hemisphere. In East Asia a range of pollutant gases and fine particulate matter (PM2.5 is projected to reach very high levels from 2005 onward, while in South Asia air pollution, including ozone, will grow rapidly towards the middle of the century. Around the Persian Gulf, where natural PM2.5 concentrations are already high (desert dust, ozone levels are expected to increase strongly.

    The population weighted MPI (PW-MPI, which combines demographic and pollutant concentration projections, shows that a rapidly increasing number of people worldwide will experience reduced air quality during the first half of the 21st century. Following this business as usual

  15. Human performance breakdowns are rarely accidents: they are usually very poor choices with disastrous results

    International Nuclear Information System (INIS)

    Besco, Robert O.

    2004-01-01

    When human error is involved in the error chain of accidents in complex systems, the causes of the errors are very seldom the result of: - a random slip,; - one inadvertent oversight,; - a single unintended action,; - one mis-perceived event,; - simple mal-performance of a complex action, or; - a poor training program for the human operators. Invariably, the cause of the break down is in a very poor conscious choice by someone from the operator back through system designer, the supervision, management and leadership through the entire organization. Usually the operator bears the burden of the blame and is either rebuked, retrained or replaced. In systems such as commercial aviation, complex manufacturing systems, power plants, process control systems, information-processing systems and communications networks, the replacement or retraining of individuals or even classes of individuals usually does not result in any long-term improvement of the safety or effectiveness of the system. What is needed is a system that identifies the reasons why the operators made the errors. Further a system is needed that can recommend what can be done to improve the future performance within the system. The professional performance analysis system (PPAS) has been developed and applied to more than 50 major aircraft accidents in the past 30 years. The PPAS is a direct outgrowth of the human performance analysis system developed by Robert Mager over 45 years ago. The PPAS system is applied after a complete and unbiased definition and description of the events of the accident or incident has been developed by the teams of accident investigation and accident reconstruction professionals. The PPAS then uses a systematic protocol and algorithm to determine the reasons as to why the humans committed the errors or why they performed at subnormal performance levels. This process is based on quantitative behavioral science principles and findings that have been demonstrated valid for many

  16. Effect of usual lead apron in decreasing dose rate in nuclear medicine department

    Energy Technology Data Exchange (ETDEWEB)

    Momennezhad, M.; Ghazikhanloo, K.; Zakavi, S.R. [Mashhad Univ. of Medical Sciences (Iran, Islamic Republic of)

    2006-07-01

    Full text of publication follows: Introduction: In a busy nuclear medicine department personnel exposure to radiation is inevitable during patient positioning and radiotracer preparation. There is controversy regarding usage of usual lead aprons with respect to penetrating gamma rays used in nuclear medicine departments as well as production of characteristic lead x-ray from aprons.This study tries to evaluate the effect of 0.5 mm lead apron on dose reduction. Methods and materials: We used three point sources usual radioisotopes used in nuclear medicine departments (99 mTc, 201 Tl and 131 I) and a single head L.F.O.V. gamma camera (S.M.V., D.S.X.) was used for counting purposes. The count rate for each source was about 20 K count/sec in air and in a brain water phantom. All point sources were placed at a distance of 3 meters, parallel to the center of the detector. The collimator was removed and imaging was performed for 1 min with and without lead apron on the detector. Lead apron covered all field of view of the detector. Each imaging was repeated 3 times and mean count was obtained for each radioisotope. The measurements were accomplished from full spectrum and specific region of spectrum such as characteristic lead x rays region (88 keV 20%) with and without apron. Result and Discussion: The measurement and comparison of count rates (count/min) for each source in different conditions (with and without apron source in air and in water phantom) showed that count rates were reduced in air about 77.3%, 84.2% and 40.8% for 99 mTc, 201 Tl and 131 I respectively. The reduction in count rates when sources placed in brain water phantom were 83.5%, 87% and 53.7% for the same isotope respectively. As the main source of radiation for personnel is from scattered photon and with respect to about 83% of count rate reduction using lead aprons for 99 mTc, it is expected that wearing lead apron significantly decrease dose rate. Conclusion: Our study showed that lead aprons

  17. Effect of usual lead apron in decreasing dose rate in nuclear medicine department

    International Nuclear Information System (INIS)

    Momennezhad, M.; Ghazikhanloo, K.; Zakavi, S.R.

    2006-01-01

    Full text of publication follows: Introduction: In a busy nuclear medicine department personnel exposure to radiation is inevitable during patient positioning and radiotracer preparation. There is controversy regarding usage of usual lead aprons with respect to penetrating gamma rays used in nuclear medicine departments as well as production of characteristic lead x-ray from aprons.This study tries to evaluate the effect of 0.5 mm lead apron on dose reduction. Methods and materials: We used three point sources usual radioisotopes used in nuclear medicine departments (99 mTc, 201 Tl and 131 I) and a single head L.F.O.V. gamma camera (S.M.V., D.S.X.) was used for counting purposes. The count rate for each source was about 20 K count/sec in air and in a brain water phantom. All point sources were placed at a distance of 3 meters, parallel to the center of the detector. The collimator was removed and imaging was performed for 1 min with and without lead apron on the detector. Lead apron covered all field of view of the detector. Each imaging was repeated 3 times and mean count was obtained for each radioisotope. The measurements were accomplished from full spectrum and specific region of spectrum such as characteristic lead x rays region (88 keV 20%) with and without apron. Result and Discussion: The measurement and comparison of count rates (count/min) for each source in different conditions (with and without apron source in air and in water phantom) showed that count rates were reduced in air about 77.3%, 84.2% and 40.8% for 99 mTc, 201 Tl and 131 I respectively. The reduction in count rates when sources placed in brain water phantom were 83.5%, 87% and 53.7% for the same isotope respectively. As the main source of radiation for personnel is from scattered photon and with respect to about 83% of count rate reduction using lead aprons for 99 mTc, it is expected that wearing lead apron significantly decrease dose rate. Conclusion: Our study showed that lead aprons

  18. Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Mayumi; Matsuzaki, Kenji; Yoshida, Shusaku; Nishitani, Hiromu [University of Tokushima, Department of Radiology, Tokushima (Japan); Uehara, Hisanori [University of Tokushima, Department of Molecular and Environmental Pathology, Tokushima (Japan); Shimazu, Hideki [Oe Kyoudo Hospital, Department of Radiology (Japan)

    2005-11-01

    The endometrial cavity may demonstrate various imaging manifestations such as normal, reactive, inflammatory, and benign and malignant neoplasms. We evaluated usual and unusual magnetic resonance imaging (MRI) findings of the uterine endometrial cavity, and described the diagnostic clues to differential diagnoses. Surgically proven pathologies of the uterine endometrial cavity were evaluated retrospectively with pathologic correlation. The pathologies included benign endometrial neoplasms such as endometrial hyperplasia and polyp, malignant endometrial neoplasms such as endometrial carcinoma and carcinosarcoma, endometrial-myometrial neoplasm such as endometrial stromal sarcoma, pregnancy-related lesions in the endometrial cavity such as gestational trophoblastic diseases (hydatidiform mole, invasive mole and choriocarcinoma) and placental polyp, myometrial lesions simulating endometrial lesions such as submucosal leiomyoma and some adenomyosis, endometrial neoplasms simulating myometrial lesions such as adenomyomatous polyp and endometrial lesions arising in the hemicavity of a septate/bicornate uterus, and fluid collections in the uterine cavity (hydro/hemato/pyometra). It is important to recognize various imaging findings in these diseases, in order to make a correct preoperative diagnosis. (orig.)

  19. Usual water-related behaviour and 'near-drowning' incidents in young adults.

    Science.gov (United States)

    Gulliver, Pauline; Begg, Dorothy

    2005-06-01

    To describe usual water-related behaviour and 'near-drowning' incidents in a cohort of young New Zealand adults. This was a cross-sectional study based on data collected as part of the Dunedin Multidisciplinary Health and Development Study, which is the study of a cohort (n = 1,037) born between 1 April 1972 and 31 March 1973 in Dunedin, New Zealand. The data analysed were collected at age 21 (1993/94). Each study member was given a face-to-face interview using a structured questionnaire. Males reported a higher level of water confidence, exposure to risk behaviours, and exposure to unsafe locations, and more 'near-drowning' incidents, than the females, but protective behaviour did not differ. Males and females who were 'confident' in the water were more likely to be exposed to unsafe water locations, and water-confident males were more likely to drink alcohol before water activities, but not boating. A total of 169 'near-drowning' incidents were reported by 141 study members (63% males). 'Near-drowning' incidents were associated with unsafe swimming environments for males (p near-drowning' incidents among a high-risk age group. Larger case-control studies are required to further investigate risk factors for 'near-drowning'. IMPLICATIONS FOR PRACTITIONERS: Further investigation is required to determine the effectiveness of providing water skills acquisition in both safe and unsafe environments on 'near-drowning' experience.

  20. European Gas in the Next Century. Fundamental Changes or Business as Usual?

    Energy Technology Data Exchange (ETDEWEB)

    Norvik, Harald [Statoil, Stavanger (Norway)

    1999-07-01

    The oil price development is surprising. As soon as a consensus has been formed, it moves in some direction opposite of what was expected. Producers should be prepared to meet a future with declining rather than increasing prices in real terms. In this presentation, the President and Chief Executive Officer of Statoil focuses on some aspects he believes to be important for the evolution of current and future natural gas trade: Demand, supply and prices, Innovation, Geopolitical environment. The European gas industry is moving into the next century after a remarkable development with extensive infrastructure and solid trade patterns established. The future will bring new challenges. The market will be more transparent and more competitive. Cost efficiency and capacity utilization of existing infrastructure will be key factors in order to exploit production at competitive costs. Big reserves are available, although at more remote locations which call for strong commercial players and strong relations between the producers and the distributors if new big supply projects shall be lifted. Norway has gained a competitive position, but new measures will be needed in order to ensure a competitive position for the commercial companies also in the future. The shape of the gas business has developed continuously and market changes will keep it doing so. Therefore, Business as usual will never be a winning strategy in a world of change.

  1. P63 marker Expression in Usual Skin Cancers Compared With Non Tumoral Skin Lesions

    Directory of Open Access Journals (Sweden)

    Abdolhamid Esmaili

    2017-07-01

    Full Text Available Background: Non-melanoma skin cancers including basal cell carcinoma and squamous cell carcinoma are the most common cancers in human. The aim of this study was to determine the expression of P63 marker in usual skin cancers compared with non-tomoral skin lesions. Materials and Methods: In this cross-sectional study, sampling was performed from archival blocks of Shahid Mohammadi hospital patients during 2010-2011. 60 samples (including 30 samples of non tumoral skin lesions and 30 samples of basal cell carcinoma and squamous cell carcinoma were studied and evaluation of p63 gene expression was done with Immunohistochemistry method. T-test and Chi-square were used for analysis of data. Results: P63 gene were expressed in 4 cases (13.33 % of non tumoral lesions and all tumoral lesions (100 %. In tumoral lesions, 5 cases (16.66 % showed 1+ severity experssion, 11 cases (36.66% 2 + severity experssion and 14 cases (46.66 % 3+severity experssion. All 4 non tumoral lesions shoed 1+ severity experssion of P63gene. Conclusion: The results of this study indicated that the incidence and severity of gene expression of P63 can be use for differentiation between basal cell carcinoma and squamous cell carcinoma as well as non-tumoral skin lesions. 

  2. European Gas in the Next Century. Fundamental Changes or Business as Usual?

    International Nuclear Information System (INIS)

    Norvik, Harald

    1999-01-01

    The oil price development is surprising. As soon as a consensus has been formed, it moves in some direction opposite of what was expected. Producers should be prepared to meet a future with declining rather than increasing prices in real terms. In this presentation, the President and Chief Executive Officer of Statoil focuses on some aspects he believes to be important for the evolution of current and future natural gas trade: Demand, supply and prices, Innovation, Geopolitical environment. The European gas industry is moving into the next century after a remarkable development with extensive infrastructure and solid trade patterns established. The future will bring new challenges. The market will be more transparent and more competitive. Cost efficiency and capacity utilization of existing infrastructure will be key factors in order to exploit production at competitive costs. Big reserves are available, although at more remote locations which call for strong commercial players and strong relations between the producers and the distributors if new big supply projects shall be lifted. Norway has gained a competitive position, but new measures will be needed in order to ensure a competitive position for the commercial companies also in the future. The shape of the gas business has developed continuously and market changes will keep it doing so. Therefore, Business as usual will never be a winning strategy in a world of change

  3. The potential of telehealth for 'business as usual' in outpatient clinics.

    Science.gov (United States)

    Day, Karen; Kerr, Patricia

    2012-04-01

    A six-month pilot study was conducted to ascertain the value of using high-definition videoconferencing equipment in an outpatients' setting. The videoconferencing equipment, which included digital biometric equipment, was installed in the outpatient clinics of a remote health service in New Zealand. Use of the equipment was evaluated using action research techniques. Clinicians were interviewed about their assessment of the equipment's usefulness. Patients and their carers completed questionnaires about their clinic experience. During the pilot trial, 109 patients were seen in 25 clinics of six different specialities. Questionnaire results showed that patients and their companions had a good user experience, similar to a face-to-face appointment. Clinicians found that the large screen, sense of proximity, video clarity and definition, and lack of sound/picture lag worked well for certain types of outpatients' clinics, e.g. methadone maintenance clinics. The need for process changes made it difficult to turn telehealth into business as usual in an environment built for face-to-face appointments. We conclude that videoconference equipment has potential to become integral to outpatients' clinics.

  4. Correlation of pulmonary function and usual interstitial pneumonia computed tomography patterns in idiopathic pulmonary fibrosis.

    Science.gov (United States)

    Arcadu, Antonella; Byrne, Suzanne C; Pirina, Pietro; Hartman, Thomas E; Bartholmai, Brian J; Moua, Teng

    2017-08-01

    Little is known about presenting 'inconsistent' or 'possible' usual interstitial pneumonia (UIP) computed tomography (CT) patterns advancing to 'consistent' UIP as disease progresses in idiopathic pulmonary fibrosis (IPF). We hypothesized that if 'consistent' UIP represented more advanced disease, such a pattern on presentation should also correlate with more severe pulmonary function test (PFT) abnormalities. Consecutive IPF patients (2005-2013) diagnosed by international criteria with baseline PFT and CT were included. Presenting CTs were assessed by three expert radiologists for consensus UIP pattern ('consistent', 'possible', and 'inconsistent'). Approximation of individual and combined interstitial abnormalities was also performed with correlation of interstitial abnormalities and UIP CT pattern made with PFT findings and survival. Three-hundred and fifty patients (70% male) were included with a mean age of 68.3 years. Mean percent predicted forced vital capacity (FVC%) and diffusion capacity (DLCO%) was 64% and 45.5% respectively. Older age and male gender correlated more with 'consistent' UIP CT pattern. FVC% was not associated with any UIP pattern but did correlate with total volume of radiologist assessed interstitial abnormalities. DLCO% was lower in those with 'consistent' UIP pattern. A 'consistent' UIP CT pattern was also not independently predictive of survival after correction for age, gender, FVC%, and DLCO%. PFT findings appear to correlate with extent of radiologic disease but not specific morphologic patterns. Whether such UIP patterns represent different stages of disease severity or radiologic progression is not supported by coinciding pulmonary function decline. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Managing Nature–Business as Usual: Resource Extraction Companies and Their Representations of Natural Landscapes

    Directory of Open Access Journals (Sweden)

    Mark Brown

    2015-11-01

    Full Text Available This article contributes to knowledge of how one category of business organization, very large, British-based, natural resource extraction corporations, has begun to manage its operations for sustainability. The object of study is a large volume of texts that make representations of the managing-for-sustainability practices of these multinational corporations (MNCs. The macro-level textual analysis identifies patterns in the wording of the representations of practice. Hajer’s understanding of discourse, in which ideas are contextualized within social processes of practice, provides the theoretical approach for discourse analysis that gives an insight into how they understand and practice sustainability. Through this large-scale discourse analysis, illustrated in the article with specific textual examples, one can see that these natural resource MNCs are developing a vocabulary and a “grammar” which enables them to manage natural spaces in the same way that they are able to manage their own far-flung business operations. They make simplified representations of the much more complex natural landscapes in which their operations are sited and these models of nature can then be incorporated into the corporations’ operational management processes. Their journey towards sustainability delivers, in practice, the management of nature as business continues as usual.

  6. The Impact of Automation on Employment: Just the Usual Structural Change?

    Directory of Open Access Journals (Sweden)

    Ben Vermeulen

    2018-05-01

    Full Text Available We study the projected impact of automation on employment in the forthcoming decade, both at the macro-level and in actual (types of sectors. Hereto, we unite an evolutionary economic model of multisectoral structural change with labor economic theory. We thus get a comprehensive framework of how displacement of labor in sectors of application is compensated by intra- and intersectoral countervailing effects and notably mopped up by newly created, labor-intensive sectors. We use several reputable datasets with expert projections on employment in occupations affected by automation (and notably by the introduction of robotics and AI to pinpoint which and how sectors and occupations face employment shifts. This reveals how potential job loss due to automation in “applying” sectors is counterbalanced by job creation in “making” sectors as well in complementary and quaternary, spillover sectors. Finally, we study several macro-level scenarios on employment and find that mankind is facing “the usual structural change” rather than the “end of work”. We provide recommendations on policy instruments that enhance the dynamic efficiency of structural change.

  7. Increased utilization of health care services after psychotherapy: a register based study

    DEFF Research Database (Denmark)

    Fenger, Morten Munthe; Poulsen, Stig Bernt; Mortensen, Erik Lykke

    2012-01-01

    services for patients referred to psychotherapeutic treatment in 2004 and 2005. Method The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation...... period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment. Results Of the 761 patients, 216 patients did not show up for treatment, while...... 545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients increased their use of all health care services with 296% (ES=0.58) in the four year pre-post comparison, while the control...

  8. Patient care and radiation protection

    International Nuclear Information System (INIS)

    Sharko, G.A.

    1987-01-01

    This chapter deals with important aspects of patient care, which may become the radiographer's responsibility in the absence of dedicated nursing staff. Although large pediatric centers usually employ nurses for bedside patient management, the general radiographer should be familiar with some aspects of routine patient care. This knowledge guarantees the safety and well-being of children entrusted to the technologist

  9. Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Seonah; Suh, Sang-Il; Ha, Su Min; Seol, Hae-Young [Korea University Guro Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Byeon, Jung Hye; Eun, Baik-Lin [Korea University Guro Hospital, Korea University College of Medicine, Department of Pediatrics, Seoul (Korea, Republic of); Lee, Young Hen; Seo, Hyung Suk [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan (Korea, Republic of); Eun, So-Hee [Korea University Ansan Hospital, Korea University College of Medicine, Department of Pediatrics, Ansan (Korea, Republic of)

    2012-03-15

    Most enterovirus (EV) 71 infections manifest as mild cases of hand-foot-mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection. Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients. MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images. EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71. (orig.)

  10. Variations in area-level disadvantage of Australian registered fitness trainers usual training locations

    Directory of Open Access Journals (Sweden)

    Jason A. Bennie

    2016-07-01

    Full Text Available Abstract Background Leisure-time physical activity and strength training participation levels are low and socioeconomically distributed. Fitness trainers (e.g. gym/group instructors may have a role in increasing these participation levels. However, it is not known whether the training location and characteristics of Australian fitness trainers vary between areas that differ in socioeconomic status. Methods In 2014, a sample of 1,189 Australian trainers completed an online survey with questions about personal and fitness industry-related characteristics (e.g. qualifications, setting, and experience and postcode of their usual training location. The Australian Bureau of Statistics ‘Index of Relative Socioeconomic Disadvantage’ (IRSD was matched to training location and used to assess where fitness professionals trained and whether their experience, qualification level and delivery methods differed by area-level disadvantage. Linear regression analysis was used to examine the relationship between IRSD score and selected characteristics adjusting for covariates (e.g. sex, age. Results Overall, 47 % of respondents worked in areas within the three least-disadvantaged deciles. In contrast, only 14.8 % worked in the three most-disadvantaged deciles. In adjusted regression models, fitness industry qualification was positively associated with a higher IRSD score (i.e. working in the least-disadvantaged areas (Cert III: ref; Cert IV β:13.44 [95 % CI 3.86-23.02]; Diploma β:15.77 [95 % CI: 2.17-29.37]; Undergraduate β:23.14 [95 % CI: 9.41-36.86]. Conclusions Fewer Australian fitness trainers work in areas with high levels of socioeconomic disadvantaged areas than in areas with low levels of disadvantage. A higher level of fitness industry qualifications was associated with working in areas with lower levels of disadvantage. Future research should explore the effectiveness of providing incentives that encourage more fitness trainers and those with

  11. Variations in area-level disadvantage of Australian registered fitness trainers usual training locations.

    Science.gov (United States)

    Bennie, Jason A; Thornton, Lukar E; van Uffelen, Jannique G Z; Banting, Lauren K; Biddle, Stuart J H

    2016-07-11

    Leisure-time physical activity and strength training participation levels are low and socioeconomically distributed. Fitness trainers (e.g. gym/group instructors) may have a role in increasing these participation levels. However, it is not known whether the training location and characteristics of Australian fitness trainers vary between areas that differ in socioeconomic status. In 2014, a sample of 1,189 Australian trainers completed an online survey with questions about personal and fitness industry-related characteristics (e.g. qualifications, setting, and experience) and postcode of their usual training location. The Australian Bureau of Statistics 'Index of Relative Socioeconomic Disadvantage' (IRSD) was matched to training location and used to assess where fitness professionals trained and whether their experience, qualification level and delivery methods differed by area-level disadvantage. Linear regression analysis was used to examine the relationship between IRSD score and selected characteristics adjusting for covariates (e.g. sex, age). Overall, 47 % of respondents worked in areas within the three least-disadvantaged deciles. In contrast, only 14.8 % worked in the three most-disadvantaged deciles. In adjusted regression models, fitness industry qualification was positively associated with a higher IRSD score (i.e. working in the least-disadvantaged areas) (Cert III: ref; Cert IV β:13.44 [95 % CI 3.86-23.02]; Diploma β:15.77 [95 % CI: 2.17-29.37]; Undergraduate β:23.14 [95 % CI: 9.41-36.86]). Fewer Australian fitness trainers work in areas with high levels of socioeconomic disadvantaged areas than in areas with low levels of disadvantage. A higher level of fitness industry qualifications was associated with working in areas with lower levels of disadvantage. Future research should explore the effectiveness of providing incentives that encourage more fitness trainers and those with higher qualifications to work in more socioeconomically

  12. Diagnostic accuracy of computed tomography and histopathology in the diagnosis of usual interstitial pneumonia

    International Nuclear Information System (INIS)

    Aaloekken, Trond Mogens; Mynarek, Georg; Kolbenstvedt, Alf; Naalsund, Anne; Elnaes Berstad, Audun; Solberg, Steinar; Stroem, Erik H.; Scott, Helge; Soeyseth, Vidar

    2012-01-01

    Background: The relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate. Purpose: To analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP. Material and Methods: The study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses. Results: There was good agreement between the readers for the correct first-choice CT diagnosis of UIP (κ = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1). Conclusion: Surgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP

  13. Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings

    International Nuclear Information System (INIS)

    Jang, Seonah; Suh, Sang-Il; Ha, Su Min; Seol, Hae-Young; Byeon, Jung Hye; Eun, Baik-Lin; Lee, Young Hen; Seo, Hyung Suk; Eun, So-Hee

    2012-01-01

    Most enterovirus (EV) 71 infections manifest as mild cases of hand-foot-mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection. Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients. MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images. EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71. (orig.)

  14. Neuronal and microglial regulators of cortical wiring: usual and novel guideposts

    Directory of Open Access Journals (Sweden)

    Paola eSquarzoni

    2015-07-01

    Full Text Available Neocortex functioning relies on the formation of complex networks that begins to be assembled during embryogenesis by highly stereotyped processes of cell migration and axonal navigation. The guidance of cells and axons is driven by extracellular cues, released along by final targets or intermediate targets located along specific pathways. In particular, guidepost cells, originally described in the grasshopper, are considered discrete, specialized cell populations located at crucial decision points along axonal trajectories that regulate tract formation. These cells are usually early-born, transient and act at short-range or via cell-cell contact. The vast majority of guidepost cells initially identified were glial cells, which play a role in the formation of important axonal tracts in the forebrain, such as the corpus callosum, anterior and post-optic commissures as well as optic chiasm. In the last decades, tangential migrating neurons have also been found to participate in the guidance of principal axonal tracts in the forebrain. This is the case for several examples such as guideposts for the lateral olfactory tract (LOT, corridor cells, which open an internal path for thalamo-cortical axons and Cajal-Retzius cells that have been involved in the formation of the entorhino-hippocampal connections. More recently, microglia, the resident macrophages of the brain, were specifically observed at the crossroads of important neuronal migratory routes and axonal tract pathways during forebrain development. We furthermore found that microglia participate to the shaping of prenatal forebrain circuits, thereby opening novel perspectives on forebrain development and wiring. Here we will review the last findings on already known guidepost cells populations and will discuss the role of microglia as a potentially new class of atypical guidepost cells.

  15. Diagnostic accuracy of computed tomography and histopathology in the diagnosis of usual interstitial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Aaloekken, Trond Mogens; Mynarek, Georg; Kolbenstvedt, Alf (Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway)), Email: trond.mogens.aalokken@rikshospitalet.no; Naalsund, Anne (Dept. of Pulmonology, Oslo Univ. Hospital Rikshospitalet (Norway)); Elnaes Berstad, Audun (Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway); Univ. of Oslo (Norway)); Solberg, Steinar (Dept. of Thoracic Surgery, Oslo Univ. Hospital Rikshospitalet (Norway)); Stroem, Erik H.; Scott, Helge (Dept. of Pathology, Oslo Univ. Hospital Rikshospitalet (Norway)); Soeyseth, Vidar (Univ. of Oslo (Norway); Depts. of Pulmonology, Akershus Univ. Hospital, Loerenskog (Norway))

    2012-04-15

    Background: The relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate. Purpose: To analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP. Material and Methods: The study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses. Results: There was good agreement between the readers for the correct first-choice CT diagnosis of UIP (kappa = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1). Conclusion: Surgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP

  16. Fatty Acid and Cholesterol Concentrations in Usually Consumed Fish in Brazil

    Directory of Open Access Journals (Sweden)

    Carlos Scherr

    2015-02-01

    Full Text Available Background: Several studies have demonstrated clinical benefits of fish consumption for the cardiovascular system. These effects are attributed to the increased amounts of polyunsaturated fatty acids in these foods. However, the concentrations of fatty acids may vary according to region. Objective: The goal of this study was to determine the amount of,cholesterol and fatty acids in 10 Brazilian fishes and in a non-native farmed salmon usually consumed in Brazil. Methods: The concentrations of cholesterol and fatty acids, especially omega-3, were determined in grilled fishes. Each fish sample was divided in 3 sub-samples (chops and each one was extracted from the fish to minimize possible differences in muscle and fat contents. Results: The largest cholesterol amount was found in white grouper (107.6 mg/100 g of fish and the smallest in badejo (70 mg/100 g. Omega-3 amount varied from 0.01 g/100 g in badejo to 0.900 g/100 g in weakfish. Saturated fat varied from 0.687 g/100 g in seabass to 4.530 g/100 g in filhote. The salmon had the greatest concentration of polyunsaturated fats (3.29 g/100 g and the highest content of monounsaturated was found in pescadinha (5.98 g/100 g. Whiting and boyfriend had the best omega-6/omega 3 ratios respectively 2.22 and 1.19, however these species showed very little amounts of omega-3. Conclusion: All studied Brazilian fishes and imported salmon have low amounts of saturated fat and most of them also have low amounts of omega-3.

  17. [Spanish collaborative study: Description of usual clinical practice in infant obesity].

    Science.gov (United States)

    Lechuga Sancho, Alfonso; Palomo Atance, Enrique; Rivero Martin, María José; Gil-Campos, Mercedes; Leis Trabazo, Rosaura; Bahíllo Curieses, María Pilar; Bueno Lozano, Gloria

    2018-06-01

    Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of "Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity" issued by the Spanish Ministry of Health. A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Preconception Care and Prenatal Care

    Science.gov (United States)

    ... Twitter Pinterest Email Print About Preconception Care and Prenatal Care What is preconception care? Preconception care is the ... improve the health of your child. What is prenatal care? Prenatal care is the health care a woman ...

  19. Exploring Parental Preferences: Care or Education: What Do Greek Parents Aspire from Day Care Centres?

    Science.gov (United States)

    Rentzou, Konstantina

    2013-01-01

    Early childhood education and care is a multifaceted institution. Based on children's age, a number of different settings operate, which have usually two distinct aims. Kindergartens provide mainly education whereas day care centres provide care. Yet, in recent years, the need to establish programmes which provide both education and care to…

  20. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

    Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

  1. Adult care transitioning for adolescents with special health care needs: a pivotal role for family centered care.

    Science.gov (United States)

    Duke, Naomi N; Scal, Peter B

    2011-01-01

    To examine the relationship between having a usual source of care, family centered care, and transition counseling for adolescents with special health care needs. Data are from 18,198 parents/guardians, of youth aged 12-17 years, who participated in the 2005-2006 National Survey of Children With Special Health Care Needs. Linear and logistic regression models were used to define relationships between parent report of identification of a usual place and provider of medical care for their child and counseling on four transition issues: transfer to adult providers, review of future health needs, maintaining health insurance in adulthood, and youth taking responsibility for care. The direct mediating effect of family centered care was evaluated. Youth having a usual source of care (vs. not) were more likely to receive counseling on future health needs (47.4 vs. 33.6%, P needs (56.3 vs. 39.6%, P needs and 94.9% of the effect of a usual source of care on encouragement to take responsibility for care. Study findings support the development of health care delivery models focusing on family centered care to the same degree as other health care access issues.

  2. Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study

    Directory of Open Access Journals (Sweden)

    Sigurjonsdottir Helga

    2012-09-01

    Full Text Available Abstract Background The existence of unilateral adrenal hyperplasia (AH has been considered a rare cause of primary hyperaldosteronism (PA. Methods In a prospective study we screened for PA in a non-selected (NSP and selected hypertensive population (SP, to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP and two primary care centres, (230 NSP from the same catch-up area. Serum aldosterone and plasma renin activity (PRA were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral. Results After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively. After diagnostic verification, 20 patients (6% had PA, (14.5% SP and 1.4% NSP. Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation. Conclusion The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.

  3. Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol

    Directory of Open Access Journals (Sweden)

    Orrell Martin

    2009-07-01

    Full Text Available Abstract Background The growing number of people with dementia, and the increasing cost of care, provides a major incentive to develop and test methods of supporting them in the community for longer. Most attention has been given to pharmacological interventions, but there is increasing recognition that psychosocial interventions may be equally effective, even preferable where medication has negative side-effects. Reminiscence groups, run by professionals and volunteers, which use photographs, recordings and other objects to trigger personal memories are probably the most popular therapeutic approach to working with people with dementia, but there is little evidence for their effectiveness and cost-effectiveness. The recent inclusion of family carers in groups with people with dementia, notably in our own pilot studies, has generated informal evidence that this joint approach improves relationships between people with dementia and their carers, and benefits both. Design and methods This multi-centre, pragmatic randomised controlled trial (RCT to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family care-givers has two parallel arms – an intervention group and a control group who receive care as usual. The intervention consists of joint reminiscence groups held weekly for twelve consecutive weeks, followed by monthly maintenance sessions for a further seven months. The primary outcome measures are the quality of life of people with dementia, as assessed by QoL-AD, and their care-givers' mental health as assessed by the GHQ-28. Secondary outcomes include: the autobiographical memories of people with dementia; the quality of the relationship between them and their care-givers; and the levels of depression and anxiety felt by them and their care-giver. Using a 5% significance level, comparison of 200 pairs attending joint reminiscence groups with 200 pairs receiving usual treatment

  4. Health-Related Quality of Life, Mental Health and Psychotherapeutic Considerations for Women Diagnosed with a Disorder of Sexual Development: Congenital Adrenal Hyperplasia

    Directory of Open Access Journals (Sweden)

    Lindsey M. Brooks

    2010-01-01

    Full Text Available Little is known about the long-term health-related quality of life (HRQL and mental health outcomes for women diagnosed with congenital adrenal hyperplasia (CAH, a disorder of sex development. Though recommendations for therapists exist, no research has empirically investigated women's experiences in therapy or their recommendations for therapy. Thus the purpose of the study was to investigate HRQL, mental health concerns of women with CAH, and patients' recommendations for therapists. A qualitative methodology, consensual qualitative research, was used to answer these questions. Eight women with CAH participated in the study. Results from their interviews revealed six domains: physical functioning, psychological functioning, interpersonal processes and relationships, healthcare experiences of women with CAH, recommendations for health care professionals, and systemic considerations. Domains were further broken down into categories with results yielding implications for both medical and mental health professionals and shedding light on issues related to normalcy, concerns both related and unrelated to CAH, sex, and gender, and highlighting effective supports and therapeutic interventions.

  5. Health-Related Quality of Life, Mental Health and Psychotherapeutic Considerations for Women Diagnosed with a Disorder of Sexual Development: Congenital Adrenal Hyperplasia

    Directory of Open Access Journals (Sweden)

    Franco Jill

    2010-06-01

    Full Text Available Little is known about the long-term health-related quality of life (HRQL and mental health outcomes for women diagnosed with congenital adrenal hyperplasia (CAH, a disorder of sex development. Though recommendations for therapists exist, no research has empirically investigated women's experiences in therapy or their recommendations for therapy. Thus the purpose of the study was to investigate HRQL, mental health concerns of women with CAH, and patients' recommendations for therapists. A qualitative methodology, consensual qualitative research, was used to answer these questions. Eight women with CAH participated in the study. Results from their interviews revealed six domains: physical functioning, psychological functioning, interpersonal processes and relationships, healthcare experiences of women with CAH, recommendations for health care professionals, and systemic considerations. Domains were further broken down into categories with results yielding implications for both medical and mental health professionals and shedding light on issues related to normalcy, concerns both related and unrelated to CAH, sex, and gender, and highlighting effective supports and therapeutic interventions.

  6. Myositis-associated usual interstitial pneumonia has a better survival than idiopathic pulmonary fibrosis.

    Science.gov (United States)

    Aggarwal, Rohit; McBurney, Christine; Schneider, Frank; Yousem, Samuel A; Gibson, Kevin F; Lindell, Kathleen; Fuhrman, Carl R; Oddis, Chester V

    2017-03-01

    To compare the survival outcomes between myositis-associated usual interstitial pneumonia (MA-UIP) and idiopathic pulmonary fibrosis (IPF-UIP). Adult MA-UIP and IPF-UIP patients were identified using CTD and IPF registries. The MA-UIP cohort included myositis or anti-synthetase syndrome patients with interstitial lung disease while manifesting UIP on high-resolution CT chest and/or a lung biopsy revealing UIP histology. IPF subjects met American Thoracic Society criteria and similarly had UIP histopathology. Kaplan-Meier survival curves compared cumulative and pulmonary event-free survival (event = transplant or death) between (i) all MA-UIP and IPF-UIP subjects, (ii) MA-UIP with biopsy proven UIP (n = 25) vs IPF-UIP subjects matched for age, gender and baseline forced vital capacity (±10%). Cox proportional hazards ratios compared the survival controlling for co-variates. Eighty-one IPF-UIP and 43 MA-UIP subjects were identified. The median cumulative and event-free survival time in IPF vs MA-UIP was 5.25/1.8 years vs 16.2/10.8 years, respectively. Cumulative and event-free survival was significantly worse in IPF-UIP vs MA-UIP [hazards ratio of IPF-UIP was 2.9 (95% CI: 1.5, 5.6) and 5.0 (95% CI: 2.8, 8.7) (P < 0.001), respectively]. IPF-UIP event-free survival (but not cumulative) remained significantly worse than MA-UIP with a hazards ratio of 6.4 (95% CI: 3.0, 13.8) after controlling for age at interstitial lung disease diagnosis, gender, ethnicity and baseline forced vital capacity%. Respiratory failure was the most common cause of death in both groups. A sub-analysis of 25 biopsy-proven MA-UIP subjects showed similar results. MA-UIP patients demonstrated a significant survival advantage over a matched IPF cohort, suggesting that despite similar histological and radiographic findings at presentation, the prognosis of MA-UIP is superior to that of IPF-UIP. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology

  7. Moyamoya syndrome as a risk factor for stroke in Saudi children: Novel and usual associations

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Kentab, Amal Y.; Murshid, Waleed R.; Elgamal, Essam A.; Al-Salman, Mussaad M.; Abdel-Gader, Abdel-Galil M.; Alorainy, Ibrahim A.; Hassan, Hamdy H.; Othman, Saleh A.; El-Desouki, Mahmoud I.; Maldergem, L. V.

    2006-01-01

    To report on moyamoya syndrome (MMS) as a risk factor for stroke in a prospective and retrospective cohort of Saudi children. The usual and novel associations of MMS in this cohort will also be described. Children with stroke were evaluated at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the periods July 1992 to February 2001 (retrospective study) and February201 to March 2003 (retrospective study). Investigations for suspected cases included hemostatic assays, biochemical, and serological tests. Neuroimaging included CT, MRI, magnetic resonance angiography (MRA), single photon computerized tomography (SPECT) brain scan and conventional cerebral angiography. Moyamoya syndrome was the underlying risk factor for stroke in 6 (5.8%) of the 104 children (aged one month to 12 years). They were 4 females and 2 males. Their first cerebral ischemic event occurred at a mean age of 45 months (median = 44 months, range 17-66 months). In all 6 cases, MMS was associated with an underlying hematologic abnormality or other diseases. Protein C deficiency was identified in one girl and protein S deficiency in another. Two patients had retrospectively, sickle cell disease (SCD) and sickle cell-b-thalassemia (Sb-thalssemia), which had been associated in the latter with membranous ventricular septal defect. Adams-Oliver syndrome (AOS, OMIM 100300) was associated with MMS in an 18-month-old girl. A 4-year-old boy had wrinkly skin syndrome (WWS, OMIM 278250) phenotype. The association of MMS and protein C deficiency was first reported in this cohort of patients, whereas the association of the syndrome with WWS and AOS has not, hitherto, been described. The 3 patients who had MMS associated with protein C deficiency, SCD, and AOS underwent successful revascularization surgery in the form of encephaloduroarteriosynangiosis. Moyamoya syndrome constitutes an important risk factor of

  8. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial.

    Science.gov (United States)

    Zipfel, Stephan; Wild, Beate; Groß, Gaby; Friederich, Hans-Christoph; Teufel, Martin; Schellberg, Dieter; Giel, Katrin E; de Zwaan, Martina; Dinkel, Andreas; Herpertz, Stephan; Burgmer, Markus; Löwe, Bernd; Tagay, Sefik; von Wietersheim, Jörn; Zeeck, Almut; Schade-Brittinger, Carmen; Schauenburg, Henning; Herzog, Wolfgang

    2014-01-11

    Psychotherapy is the treatment of choice for patients with anorexia nervosa, although evidence of efficacy is weak. The Anorexia Nervosa Treatment of OutPatients (ANTOP) study aimed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa--focal psychodynamic therapy and enhanced cognitive behaviour therapy--versus optimised treatment as usual. The ANTOP study is a multicentre, randomised controlled efficacy trial in adults with anorexia nervosa. We recruited patients from ten university hospitals in Germany. Participants were randomly allocated to 10 months of treatment with either focal psychodynamic therapy, enhanced cognitive behaviour therapy, or optimised treatment as usual (including outpatient psychotherapy and structured care from a family doctor). The primary outcome was weight gain, measured as increased body-mass index (BMI) at the end of treatment. A key secondary outcome was rate of recovery (based on a combination of weight gain and eating disorder-specific psychopathology). Analysis was by intention to treat. This trial is registered at http://isrctn.org, number ISRCTN72809357. Of 727 adults screened for inclusion, 242 underwent randomisation: 80 to focal psychodynamic therapy, 80 to enhanced cognitive behaviour therapy, and 82 to optimised treatment as usual. At the end of treatment, 54 patients (22%) were lost to follow-up, and at 12-month follow-up a total of 73 (30%) had dropped out. At the end of treatment, BMI had increased in all study groups (focal psychodynamic therapy 0·73 kg/m(2), enhanced cognitive behaviour therapy 0·93 kg/m(2), optimised treatment as usual 0·69 kg/m(2)); no differences were noted between groups (mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45, 95% CI -0·96 to 0·07; focal psychodynamic therapy vs optimised treatment as usual -0·14, -0·68 to 0·39; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30

  9. Interpreted consultations as 'business as usual'? An analysis of organisational routines in general practices.

    Science.gov (United States)

    Greenhalgh, Trisha; Voisey, Christopher; Robb, Nadia

    2007-09-01

    UK general practices operate in an environment of high linguistic diversity, because of recent large-scale immigration and of the NHS's commitment to provide a professional interpreter to any patient if needed. Much activity in general practice is co-ordinated and patterned into organisational routines (defined as repeated patterns of interdependent actions, involving multiple actors, bound by rules and customs) that tend to be stable and to persist. If we want to understand how general practices are responding to pressures to develop new routines, such as interpreted consultations, we need to understand how existing organisational routines change. This will then help us to address a second question, which is how the interpreted consultation itself is being enacted and changing as it becomes routinised (or not) in everyday general practice. In seeking answers to these two questions, we undertook a qualitative study of narratives of interpreted primary care consultations in three London boroughs with large minority ethnic populations. In 69 individual interviews and two focus groups, we sought accounts of interpreted consultations from service users, professional interpreters, family member interpreters, general practitioners, practice nurses, receptionists, and practice managers. We asked participants to tell us both positive and negative stories of their experiences. We analysed these data by searching for instances of concepts relating to the organisational routine, the meaning of the interpreted consultation to the practice, and the sociology of medical work. Our findings identified a number of general properties of the interpreted consultation as an organisational routine, including the wide variation in the form of adoption, the stability of the routine, the adaptability of the routine, and the strength of the routine. Our second key finding was that this variation could be partly explained by characteristics of the practice as an organisation, especially

  10. Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project

    Science.gov (United States)

    2014-01-01

    Background Although psychotherapy is considered the treatment of choice for patients with personality disorders (PDs), there is no consensus about the optimal level of care for this group of patients. This study reports the results from the 6-year follow-up of the Ullevål Personality Project (UPP), a randomized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy. Methods The UPP included 113 patients with PDs. Outcome was evaluated after 8 months, 18 months, 3 years and 6 years and was based on a wide range of clinical measures, such as psychosocial functioning, interpersonal problems, symptom severity, and axis I and II diagnoses. Results At the 6-year follow-up, there were no statistically significant differences in outcome between the treatment groups. Effect sizes ranged from medium to large for all outcome variables in both treatment arms. However, patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups; while psychosocial functioning continued to improve in the step-down group during the same period. This difference between groups was statistically significant. Conclusions The findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients. Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase, indicating that longer-term changes were stimulated during treatment. Trial registration NCT00378248. PMID:24758722

  11. Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial.

    Science.gov (United States)

    Wu, Shinyi; Ell, Kathleen; Jin, Haomiao; Vidyanti, Irene; Chou, Chih-Ping; Lee, Pey-Jiuan; Gross-Schulman, Sandra; Sklaroff, Laura Myerchin; Belson, David; Nezu, Arthur M; Hay, Joel; Wang, Chien-Ju; Scheib, Geoffrey; Di Capua, Paul; Hawkins, Caitlin; Liu, Pai; Ramirez, Magaly; Wu, Brian W; Richman, Mark; Myers, Caitlin; Agustines, Davin; Dasher, Robert; Kopelowicz, Alex; Allevato, Joseph; Roybal, Mike; Ipp, Eli; Haider, Uzma; Graham, Sharon; Mahabadi, Vahid; Guterman, Jeffrey

    2018-04-23

    Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5

  12. Association of point-of-purchase tobacco advertising and promotions with choice of usual brand among teenage smokers.

    Science.gov (United States)

    Wakefield, Melanie A; Ruel, Erin E; Chaloupka, Frank J; Slater, Sandy J; Kaufman, Nancy J

    2002-01-01

    The objective is to determine the relationship between brand-specific advertising and promotions in convenience stores for Marlboro and Camel cigarettes and choice of usual brand among school students. A cross-sectional survey was designed that merged records of store tobacco advertising and promotions. The survey was administered to 3,890 U.S. high school smokers with a usual brand, matched to 196 convenience stores. Choice of Marlboro as a usual brand was associated with presence of a Marlboro gift with purchase (p purchase promotions (p > .05) and negatively associated with a greater share of exterior advertising voice for Camel (p < .001). The results are consistent with the notion that Marlboro-specific advertising and promotions may influence choice of Marlboro as a usual brand to smoke among teens, but resultsfor Camel are mixed and inconclusive. Further research is required to confirm and extend these findings.

  13. Cross-sectorial cooperation and supportive care in general practice

    DEFF Research Database (Denmark)

    Lundstrøm, Louise Hyldborg; Johnsen, Anna Thit; Ross, Lone

    2011-01-01

    Background. Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients’ experiences of continuity and support may be related to characteristics of health care, disease or patients. Objectives. To investig......Background. Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients’ experiences of continuity and support may be related to characteristics of health care, disease or patients. Objectives...... patients experienced suboptimal cross-sectorial cooperation and supportive care. Efforts to improve cancer care cooperation may focus on the possible supportive role of the...

  14. Supplement to “Consolidity: Moving opposite to built-as-usual systems practices”

    Directory of Open Access Journals (Sweden)

    Hassen Taher Dorrah

    2013-12-01

    Full Text Available A new updated conceptual systems change pathway graph for natural and man-made built-as-usual physical systems is developed following a joint two-level event-driven (or activity-driven and time-driven framework. The events and activities “on and above” the normal systems operations are recognized in the form of high influencing level (referred to as the “event-driven or upper system layer(s” acting over the ordinary systems state equations denoted as the “time-driven or the basic system layer(s.” This is envisaged through the existence of some sort of an “Event clocklike register” that runs alongside with the ordinary “time clock”. Different than the ordinary continued operation of the time clock, the event clocklike register begins its operation with the original (or initial system state, steps forward only with the occurrence of any coming event affecting the system, and stops at the final (or end system state. The pathway graph reveals also the important finding that each system (including their parts and components has autonomous self-recording consolidity-based scaled intelligent mechanisms (with infinite stacking of their actions through continuously storing parameters changes internally with the occurrences of their varying environments or events. Conversely, it is envisioned that it is amenable under the existence of the reversibility conditions of the change functions to perform backtracking procedure (reversing direction of event clocklike register at the event-driven or upper system layer(s of the history of affected events through sequentially disclosing the internal overlaid stacking arrangements of systems parameters changes corresponding to such effects. The various stack-based system change classifications and categorizations are also scrutinized. The case study of the change pathway of the stabilized inverted pendulum is provided to thoroughly demonstrate the applicability of the suggested theory. Moreover

  15. Factors associated with different cigarette access behaviours among underage smoking youth who usually smoke contraband (native) cigarettes.

    Science.gov (United States)

    Leatherdale, Scott T; Ahmed, Rashid; Vu, Mary

    2011-01-01

    Given that little is known about how youth access contraband cigarettes, the current study seeks to examine factors associated with how underage smoking youth report usually accessing contraband cigarettes. This study used nationally representative data collected from 41,886 students (grades 9 to 12) as part of the 2006-07 Canadian Youth Smoking Survey (YSS). Using data from current smokers who report that their usual brand of cigarettes is contraband, three logistic regression models were used to examine factors associated with buying cigarettes from a store, getting cigarettes from a family member, or getting cigarettes from friends or strangers. In 2006, 7.9% (n = 1 3,300) of Canadian youth who were current smokers reported that their usual brand of cigarettes was contraband. Among these youth, the majority reported that they usually get their cigarettes from a friend or stranger (54.8%), whereas 26.4% report usually getting them from a family member and 18.8% usually buying their own from a store. Boys were more likely to buy contraband cigarettes from a store, whereas youth with a parent who smokes contraband cigarettes were substantially more likely to get contraband cigarettes from a family member and youth with friends who smoke contraband cigarettes were substantially more likely to get contraband cigarettes from a friend or stranger. Ongoing surveillance of contraband cigarette use among youth and how youth access contraband cigarettes is required for guiding future tobacco control policy and programming activities.

  16. Effectiveness of Stepped Care for Chronic Fatigue Syndrome: A Randomized Noninferiority Trial

    Science.gov (United States)

    Tummers, Marcia; Knoop, Hans; Bleijenberg, Gijs

    2010-01-01

    Objective: In this randomized noninferiority study, the effectiveness and efficiency of stepped care for chronic fatigue syndrome (CFS) was compared to care as usual. Stepped care was formed by guided self-instruction, followed by cognitive behavior therapy (CBT) if the patient desired it. Care as usual encompassed CBT after a waiting period.…

  17. Shared Care in Monitoring Stable Glaucoma Patients: A Randomized Controlled Trial

    NARCIS (Netherlands)

    Holtzer-Goor, Kim M.; van Vliet, Ellen J.; van Sprundel, Esther; Plochg, Thomas; Koopmanschap, Marc A.; Klazinga, Niek S.; Lemij, Hans G.

    2016-01-01

    Comparing the quality of care provided by a hospital-based shared care glaucoma follow-up unit with care as usual. This randomized controlled trial included stable glaucoma patients and patients at risk for developing glaucoma. Patients in the Usual Care group (n=410) were seen by glaucoma

  18. Under-humidification and over-humidification during moderate induced hypothermia with usual devices.

    Science.gov (United States)

    Lellouche, François; Qader, Siham; Taille, Solenne; Lyazidi, Aissam; Brochard, Laurent

    2006-07-01

    In mechanically ventilated patients with induced hypothermia, the efficacy of heat and moisture exchangers and heated humidifiers to adequately humidify the airway is poorly known. The aim of the study was to assess the efficacy of different humidification devices during moderate hypothermia. Prospective, cross-over randomized study. Medical Intensive Care Unit in a University Hospital. Nine adult patients hospitalized after cardiac arrest in whom moderate hypothermia was induced (33 degrees C for 24[Symbol: see text]h). Patients were ventilated at admission (period designated "normothermia") with a heat and moisture exchanger, and were randomly ventilated during hypothermia with a heat and moisture exchanger, a heated humidifier, and an active heat and moisture exchanger. Core temperature, inspired and expired gas absolute and relative humidity were measured. Each system demonstrated limitations in its ability to humidify gases in the specific situation of hypothermia. Performances of heat and moisture exchangers were closely correlated to core temperature (r (2)[Symbol: see text]=[Symbol: see text]0.84). During hypothermia, heat and moisture exchangers led to major under-humidification, with absolute humidity below 25[Symbol: see text]mgH(2)O/l. The active heat and moisture exchanger slightly improved humidification. Heated humidifiers were mostly adequate but led to over-humidification in some patients, with inspiratory absolute humidity higher than maximal water content at 33 degrees C with a positive balance between inspiratory and expiratory water content. These results suggest that in the case of moderate hypothermia, heat and moisture exchangers should be used cautiously and that heated humidifiers may lead to over-humidification with the currently recommended settings.

  19. Reflection on care in recurrent sexually transmitted co-infections.

    Science.gov (United States)

    Paparello, Joel Zamora; Beyers, Carl; Por, Jitna

    Reflection is a skill that nurses are expected to practise to help them continually re-evaluate their personal effectiveness in problem solving. This skill is necessary when caring for patients who are experiencing the complex challenges linked to psychosexual and psychosociological behavioural changes associated with HIV infection and recurrent sexually transmitted co-infections (STC-I). The Johns model of structured reflection was used in the reflection described here to aid the critical thinking process in helping a nurse to manage and deliver up-to-date, effective care and to develop a strong nurse-patient therapeutic relationship. A holistic approach is key to delivering care to patients with recurrent STC-I. This involves taking a sexual health history and establishing the correct diagnosis, followed by the administration of pharmaceutical and psychotherapeutic treatments to facilitate psychosexual, psychosocial, and psychological changes. This article uses a reflective learning experience in caring for a patient with recurrent STC-I to give insights on psychosexual and psychosociological behavioural strategies. Used with a diagnosis and pharmacological intervention, these strategies can be put into nursing practice and enhance the quality of nursing care.

  20. Potential Medicaid Cost Savings from Maternity Care Based..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce...

  1. Multidimensional Treatment Foster Care: An Alternative to Residential Treatment for High Risk Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Philip A. Fisher

    2012-07-01

    Full Text Available This paper describes the Multidimensional Treatment Foster Care program (MTFC, an evidence based approach for providing psychotherapeutic treatment for very troubled children and adolescents that is an alternative to residential care. Versions of the MTFC program have been developed and validated for young children with a history of maltreatment as well as for older children and adolescents who are involved with the youth justice system. In the paper we describe the development of the MTFC program and its foundations in the social learning model that originated at the Oregon Social Learning Center in the 1960's and 70's. We present information about program elements. We then review the research that has been conducted on MTFC.

  2. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial.

    Science.gov (United States)

    Richards, David A; Hill, Jacqueline J; Gask, Linda; Lovell, Karina; Chew-Graham, Carolyn; Bower, Peter; Cape, John; Pilling, Stephen; Araya, Ricardo; Kessler, David; Bland, J Martin; Green, Colin; Gilbody, Simon; Lewis, Glyn; Manning, Chris; Hughes-Morley, Adwoa; Barkham, Michael

    2013-08-19

    To compare the clinical effectiveness of collaborative care with usual care in the management of patients with moderate to severe depression. Cluster randomised controlled trial. 51 primary care practices in three primary care districts in the United Kingdom. 581 adults aged 18 years and older who met ICD-10 (international classification of diseases, 10th revision) criteria for a depressive episode on the revised Clinical Interview Schedule. We excluded acutely suicidal patients and those with psychosis, or with type I or type II bipolar disorder; patients whose low mood was associated with bereavement or whose primary presenting problem was alcohol or drug abuse; and patients receiving psychological treatment for their depression by specialist mental health services. We identified potentially eligible participants by searching computerised case records in general practices for patients with depression. Collaborative care, including depression education, drug management, behavioural activation, relapse prevention, and primary care liaison, was delivered by care managers. Collaborative care involved six to 12 contacts with participants over 14 weeks, supervised by mental health specialists. Usual care was family doctors' standard clinical practice. Depression symptoms (patient health questionnaire 9; PHQ-9), anxiety (generalised anxiety disorder 7; GAD-7), and quality of life (short form 36 questionnaire; SF-36) at four and 12 months; satisfaction with service quality (client satisfaction questionnaire; CSQ-8) at four months. 276 participants were allocated to collaborative care and 305 allocated to usual care. At four months, mean depression score was 11.1 (standard deviation 7.3) for the collaborative care group and 12.7 (6.8) for the usual care group. After adjustment for baseline depression, mean depression score was 1.33 PHQ-9 points lower (95% confidence interval 0.35 to 2.31, P=0.009) in participants receiving collaborative care than in those receiving usual

  3. Can shared care deliver better outcomes for patients undergoing total hip replacement?

    NARCIS (Netherlands)

    Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

    2000-01-01

    Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

  4. A study protocol of the effectiveness of PEGASUS: a multi-centred study comparing an intervention to promote shared decision making about breast reconstruction with treatment as usual.

    Science.gov (United States)

    Harcourt, Diana; Paraskeva, Nicole; White, Paul; Powell, Jane; Clarke, Alex

    2017-10-02

    Increasingly, women elect breast reconstruction after mastectomy. However, their expectations of surgery are often not met, and dissatisfaction with outcome and ongoing psychosocial concerns and distress are common. We developed a patient-centered intervention, PEGASUS:(Patients' Expectations and Goals: Assisting Shared Understanding of Surgery) which supports shared decision making by helping women clarify their own, individual goals about reconstruction so that they can discuss these with their surgeon. Our acceptability/feasibility work has shown it is well received by patients and health professionals alike. We now need to establish whether PEGASUS improves patients' experiences of breast reconstruction decision making and outcomes. The purpose of this study is, therefore, to examine the effectiveness of PEGASUS, an intervention designed to support shared decision making about breast reconstruction. A multi-centered sequential study will compare the impact of PEGASUS with usual care, in terms of patient reported outcomes (self-reported satisfaction with the outcome of surgery, involvement in decision making and in the consultation) and health economics. Initially we will collect data from our comparison (usual care) group (90 women) who will complete standardized measures (Breast-Q, EQ5D -5 L and ICECAP- A) at the time of decision making, 3, 6 and 12 months after surgery. Health professionals will then be trained to use PEGASUS, which will be delivered to the intervention group (another 90 women completing the same measures at the time of decision making, and 3, 6 and 12 months after surgery). Health professionals and a purposefully selected sample of participants will be interviewed about whether their expectations of reconstruction were met, and their experiences of PEGASUS (if appropriate). PEGASUS may have the potential to provide health professionals with an easily accessible tool aiming to support shared decision making and improve patients

  5. Life changes among homeless persons with mental illness: a longitudinal study of housing first and usual treatment.

    Science.gov (United States)

    Nelson, Geoffrey; Patterson, Michelle; Kirst, Maritt; Macnaughton, Eric; Isaak, Corinne A; Nolin, Danielle; McAll, Christopher; Stergiopoulos, Vicky; Townley, Greg; MacLeod, Timothy; Piat, Myra; Goering, Paula N

    2015-06-01

    This study compared the life changes of homeless people with mental illness participating in Housing First or treatment as usual and examined factors related to various changes. Semistructured narrative interviews were conducted with 219 participants in five Canadian cities at baseline; 197 were interviewed again at 18 months after random assignment to Housing First (N=119) or treatment as usual (N=78). Interviews were coded across 13 life domains, and each participant was categorized as reporting positive, mixed-neutral, or negative changes. Housing First and treatment as usual participants were compared with respect to change patterns. Thematic analysis was used to examine factors related to various changes. The percentage of participants in Housing First reporting positive changes was more than double that for participants in treatment as usual, and treatment as usual participants were four times more likely than Housing First participants to report negative changes. Factors related to positive changes included having stable good-quality housing, increased control over substance use, positive relationships and social support, and valued social roles. Factors related to negative changes included precarious housing, negative social contacts, isolation, heavy substance use, and hopelessness. Factors related to mixed-neutral changes were similar to those for participants reporting negative changes but were less intense. Housing First with intensive support was related to more positive changes among homeless adults with mental illness across five Canadian cities. Those with poor housing or support, more common in treatment as usual, continued to struggle. These findings are relevant for services and social change to benefit this population.

  6. Interprofessional Care and Role of Team Leaders.

    Science.gov (United States)

    Kaini, B K

    2015-01-01

    Interprofessional care is an essential part of the health service delivery system. It helps to achieve improved care and to deliver the optimal and desired health outcomes by working together, sharing and learning skills. Health care organisation is a collective sum of many leaders and followers. Successful delivery of interprofessional care relies on the contribution of interprofessional care team leaders and health care professionals from all groups. The role of the interprofessional care team leader is vital to ensuring continuity and consistency of care and to mobilise and motivate health care professionals for the effective delivery of health services. Medical professionals usually lead interprofessional care teams. Interprofessional care leaders require various skills and competencies for the successful delivery of interprofessional care.

  7. Brief Strategic Family Therapy versus Treatment as Usual: Results of a Multisite Randomized Trial for Substance Using Adolescents

    Science.gov (United States)

    Robbins, Michael S.; Feaster, Daniel J.; Horigian, Viviana E.; Rohrbaugh, Michael; Shoham, Varda; Bachrach, Ken; Miller, Michael; Burlew, Kathleen A.; Hodgkins, Candy; Carrion, Ibis; Vandermark, Nancy; Schindler, Eric; Werstlein, Robert; Szapocznik, Jose

    2011-01-01

    Objective: To determine the effectiveness of brief strategic family therapy (BSFT; an evidence-based family therapy) compared to treatment as usual (TAU) as provided in community-based adolescent outpatient drug abuse programs. Method: A randomized effectiveness trial in the National Drug Abuse Treatment Clinical Trials Network compared BSFT to…

  8. Effectiveness of Standardized Physiotherapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

    2016-01-01

    BACKGROUND: Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. OBJECTIVE: The purpose of this study w...

  9. Disseminated dendriform pulmonary ossification associated with usual interstitial pneumonia: incidence and thin-section CT-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Sung; Chung, Myung Jin [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea); Han, Joungho [Sungkyunkwan University School of Medicine, Department of Pathology, Seoul (Korea); Chung, Man Pyo [Sungkyunkwan University School of Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul (Korea); Choi, Yong Soo [Sungkyunkwan University School of Medicine, Division of Thoracic Surgery, Seoul (Korea)

    2005-08-01

    The aim of this work was to assess the incidence of disseminated pulmonary dendriform ossification in usual interstitial pneumonia and nonspecific interstitial pneumonia, and to correlate thin-section computed tomography (CT) and histopathologic findings. We retrospectively reviewed thin-section CT and pathologic specimens of biopsy-proven usual interstitial pneumonia (75 patients, 57 men and 18 women, mean age 60 years, range 29-83 years) and nonspecific interstitial pneumonia (44 patients, 9 men and 35 women, mean age 55 years, range 20-73 years). On review of CT and histopathologic specimens, diffuse dendriform ossification was identified in five (four men and one woman, age range 41-68 years, mean 58 years) of 75 patients (6.7%) with usual interstitial pneumonia. It was not seen in any of 44 patients with nonspecific interstitial pneumonia. With thin-section CT (osteoporosis window; window width 818, level 273), disseminated dendriform pulmonary ossification was detected as multiple tiny calcifications in bibasilar subpleural lungs (100% sensitive and 100% specific when compared with histopathologic findings as the gold standard). The thin-section CT finding of multiple tiny calcifications in bibasilar subpleural lungs might be of some help in the differential diagnosis between usual interstitial pneumonia and nonspecific interstitial pneumonia, considering they were not seen in any patients with nonspecific interstitial pneumonia (0%, 0/44) in our series. (orig.)

  10. Disseminated dendriform pulmonary ossification associated with usual interstitial pneumonia: incidence and thin-section CT-pathologic correlation

    International Nuclear Information System (INIS)

    Kim, Tae Sung; Chung, Myung Jin; Han, Joungho; Chung, Man Pyo; Choi, Yong Soo

    2005-01-01

    The aim of this work was to assess the incidence of disseminated pulmonary dendriform ossification in usual interstitial pneumonia and nonspecific interstitial pneumonia, and to correlate thin-section computed tomography (CT) and histopathologic findings. We retrospectively reviewed thin-section CT and pathologic specimens of biopsy-proven usual interstitial pneumonia (75 patients, 57 men and 18 women, mean age 60 years, range 29-83 years) and nonspecific interstitial pneumonia (44 patients, 9 men and 35 women, mean age 55 years, range 20-73 years). On review of CT and histopathologic specimens, diffuse dendriform ossification was identified in five (four men and one woman, age range 41-68 years, mean 58 years) of 75 patients (6.7%) with usual interstitial pneumonia. It was not seen in any of 44 patients with nonspecific interstitial pneumonia. With thin-section CT (osteoporosis window; window width 818, level 273), disseminated dendriform pulmonary ossification was detected as multiple tiny calcifications in bibasilar subpleural lungs (100% sensitive and 100% specific when compared with histopathologic findings as the gold standard). The thin-section CT finding of multiple tiny calcifications in bibasilar subpleural lungs might be of some help in the differential diagnosis between usual interstitial pneumonia and nonspecific interstitial pneumonia, considering they were not seen in any patients with nonspecific interstitial pneumonia (0%, 0/44) in our series. (orig.)

  11. Psychotherapeutic training in an institutional setting.

    Science.gov (United States)

    Bettschart, W

    1990-01-01

    Many child and adolescent psychotherapists are asked to work in specialized institutions (where the children are either interns or externs), with children presenting behaviour problems, learning difficulties, mental handicap or important psychosocial problems. They learn through diverse treatment forms, or parent accompaniment during the child's treatment (bifocal or conjoint treatment more or less regular therapeutic sessions with both parents and children, etc.). The treatment of children within an institution makes the treatment modalities and technique more complicated. The psychotherapist must have a perfect knowledge of the specific environment of the child, and keep in mind the desires and requests of the direction and the people who work directly with the child (teachers, specialized teachers, etc.). How can the problems brought up by the rivalry between the institution and the psychotherapist be canalized: length of therapy, merits (how did the pedagogical intervention help, recognition of a specific action or of work done in conjunction with the educative action)? If these facts are not recognized, the treatment will often be interrupted and the psychotherapist may be excluded from the institution. This will be avoided by ensuring further training of the therapist.

  12. Boundary Transgressions: An Issue In Psychotherapeutic Encounter ...

    African Journals Online (AJOL)

    Boundary transgressions tend to be conceptualized on a continuum ranging from boundary crossings to boundary violations. Boundary crossings (e.g. accepting an inexpensive holiday gift from a client, unintentionally encountering a client in public, or attending a client's special event) are described in the literature as ...

  13. Conversion disorders: psychiatric and psychotherapeutic aspects.

    Science.gov (United States)

    Cottencin, O

    2014-10-01

    Hysteria is still stigmatized and frequently associated with lying or malingering. However, conversion disorder is not malingering, nor factitious disorder. The first step for the clinician faced with suspected conversion disorder is to make a positive diagnosis, which is in fact an integral part of treatment. In the emergency situation, it is important to look for an underlying somatic disorder. Although no specific treatment exists, there is a consensus in favor of a positive role of psychotherapy. First of all, the main problem is to explain to patients that their physical complaint has a psychological cause. In order to deliver the diagnosis in the most appropriate and useful manner, physicians have to first convince themselves before trying to convince patients. Combined consultation (medicine and psychiatry) is a useful tool to help patients. With or without combined consultation, this approach requires patience and open-mindedness to motivate patients to recognize the value of psychotherapy. Coordination between specialists and general practitioners is an important part of this treatment, which frequently requires long-term intervention. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  14. [Dependent patient and interpersonal dependency: psychotherapeutic strategies].

    Science.gov (United States)

    Versaevel, C

    2012-04-01

    This article is a review of psychotherapies for patients suffering from dependent personality and interpersonal dependency. We synthesized articles making reference to this question, notably those written by Bornstein, author who refers to the dependent personality. We highlighted the psychotherapies that have been the object of an evaluation. The research on the subject is sparse: only eight studies permitting assessment of psychotherapies in this indication in 2005. Besides these psychotherapies, we detailed other approaches which are used by practitioners in these indications. The therapy does not aim at autonomy "at all costs", but that the patient finds a dependence "adapted" to his/her environment. Before starting a therapy, an evaluation is useful to specify the type of dependence. First of all, is there a "pathological" dependence? Is the suffering of the patient secondary to his personality or not supportive enough? Does insight exist? What is the reaction of the patient if we suggest the hypothesis of a dependence on his/her part? Does he/she consider this idea or reject it? Finally, is the dependence primary or secondary? For that purpose, it is necessary to study the biography of the patient and the appearance of the comorbidity over time. The primary dependence is seen in childhood and precedes the other psychological disorders. The secondary dependence follows after the comorbidity and events of life that alter self-esteem (depression, for example). Various therapeutic strategies arise from various currents. The therapies of analytical inspiration recommend replaying the relationship of object and explicitly evoking the transfer. The behavioural and cognitive psychotherapies aim at making the patient identify the cognitions which underlie the dependence, then leading the patient to modify his/her cognition and to behave in a more autonomous way, using the theory of learning. The humanist therapies aim at a therapeutic relationship of acceptance and respect for the patient, so that he/she increases self-esteem and finds autonomy. The brief systemic therapy develops tools to deviate from the relationship of dependence in the therapy. It aims at the change through a modification in the beliefs of the patient. The dependence can be envisaged as a way of adapting itself, of compensating for altered self-esteem. In this way, the psychotherapy must also attempt to restore self-esteem in an implicit or explicit way. The evaluation of the type of dependence helps the therapeutic approach. It is necessary to look for the comorbidity and its appearance over time with regard to the dependence. So, in primary dependence, the therapy focuses on the increase of self-esteem. In the secondary dependence, the therapy focuses on the adaptation to this event, the treatment of the mental illness, and then to the accompaniment in restoring and autonomy. If the patient doesn't have insight, it is necessary either to enhance it, or to work in an indirect way. Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  15. A psychotherapeutic approach with elementary school teachers.

    Science.gov (United States)

    Multari, G

    1975-01-01

    The tradional "lectures delivering" approach to classroom teachers used by mental health practitioners is investigated in the present study. An attempt is made to demonstrate the validity of preventative work in helping elementary school teachers as important agents in the promotion of more positive mental hygiene in the classroom and by adding to the lectures the variable of group therapy--"ego-sparing" techniques type. The latter approach seems to promote a teacher's own sense of security in dealing the pupils, an easier acceptance of differences in others, and, finally, it tends to stimulate the development of a teacher's own ability to deal sensibly, more conscientiously, and more realistically with daily problems.

  16. Coffee Drinking Is Widespread in the United States, but Usual Intake Varies by Key Demographic and Lifestyle Factors123

    Science.gov (United States)

    Loftfield, Erikka; Freedman, Neal D; Dodd, Kevin W; Vogtmann, Emily; Xiao, Qian; Sinha, Rashmi; Graubard, Barry I

    2016-01-01

    Background: Despite widespread popularity and possible health effects, the prevalence and distribution of coffee consumption in US adults are poorly characterized. Objective: We sought to estimate usual daily coffee intakes from all coffee-containing beverages, including decaffeinated and regular coffee, among US adults according to demographic, socioeconomic, and health-related factors. Methods: Dietary intake data from ≤2 nonconsecutive 24-h dietary recalls and a food-frequency questionnaire administered during the NHANES 2003–2006 were used to estimate the person-specific probability of consuming coffee on a particular day and the usual amount consumed on consumption days. Trends in population mean coffee consumption over time were evaluated by using multiple linear regression and 1-d 24-h recall data from NHANES 2003–2012. Analyses were weighted to be representative of the US adult population aged ≥20 y. Results: An estimated 154 million adults, or 75% of the US population, aged ≥20 y reported drinking coffee; 49% reported drinking coffee daily. Prevalence did not vary by sex, education, income, or self-reported general health (all P ≥ 0.05) but did vary by age, race/ethnicity, smoking status, and alcohol drinking (all P coffee drinkers, the mean ± SE usual intake was 14.1 ± 0.5 fluid ounces/d (417 ± 15 mL/d). Mean usual intakes were higher in men than women, in older age groups than in those aged 20 to coffee consumption was stable from 2003 to 2012 (P-trend = 0.09). Conclusions: Coffee is widely consumed in the United States, with usual intakes varying by lifestyle and demographic factors, most notably by age. Longitudinal studies are needed to determine whether observed differences by age reflect birth cohort effects or changes in drinking patterns over the lifetime. PMID:27489008

  17. Usual Intake of Added Sugars and Saturated Fats Is High while Dietary Fiber Is Low in the Mexican Population.

    Science.gov (United States)

    López-Olmedo, Nancy; Carriquiry, Alicia L; Rodríguez-Ramírez, Sonia; Ramírez-Silva, Ivonne; Espinosa-Montero, Juan; Hernández-Barrera, Lucia; Campirano, Fabricio; Martínez-Tapia, Brenda; Rivera, Juan A

    2016-09-01

    The Mexican National Health and Nutrition Survey (ENSANUT) was carried out in 2012. Information from the survey is used to design and evaluate food and nutrition policies in Mexico. The objective of this study was to estimate the usual intake of energy and macronutrients in the Mexican population by using the ENSANUT 2012. Twenty-four-hour recall interviews were administered to a nationally representative subsample of 10,096 individuals aged ≥1 y from the ENSANUT 2012. Usual intake distributions and the prevalence of inadequate intakes were estimated by using the Iowa State University method. Student's t tests and tests on the equality of proportions were used to compare usual intakes and prevalence of inadequacy across socioeconomic status, area (rural or urban), and region of residence (North, Center, or South). Energy and macronutrient intakes and indicators of dietary adequacy are presented for children (ages 1-4 y and 5-11 y), adolescents (12-19 y), and adults (≥20 y). At the national level, the estimated mean fiber intake was below the Adequate Intake for all population subgroups, suggesting inadequacies. The estimated proportion with a usual added sugars intake of >10% of total energy intake was >64% in all age groups. The proportion with a usual saturated fat intake of >10% of total energy intake was estimated to be >78% in children, >66% in adolescents, and >50% in adults. Overall, fiber intake was lower and intakes of saturated fat and added sugars were higher in urban compared with rural areas, in the North compared with South regions, and among those with high compared with low socioeconomic status (P 50% of the Mexican population aged ≥1 y. These results highlight the importance of improving the diets of the overall population to reduce the risk of noncommunicable chronic diseases. © 2016 American Society for Nutrition.

  18. Disasters as Usual

    DEFF Research Database (Denmark)

    Albris, Kristoffer

    In this thesis, I explore how citizens and public institutions have adjusted to recent recurring floods in Dresden. As a riverine city, Dresden regularly experienced damaging floods throughout its history, right up until the start of the Second World War. Then something strange happened. Although...... the future as being fraught with uncertainty. This has implications both for how people understand themselves as members of society as well as for the relationship between the state and civil society. In other words, floods in Dresden have a social, political and public life. Rather than seeing disasters...

  19. Beyond business as usual

    Energy Technology Data Exchange (ETDEWEB)

    Popowich, J. [Elk Valley Coal Corporation, Calgary, AB (Canada). Fording Canadian Coal Trust

    2006-07-01

    The average hard coking coal price at Elk Valley Coal for the period 1980-2005 is shown on a graph. Innovation is essential to mining success. A company needs to put together a product that is better than the competition's. Other challenges include global competition, increasingly difficult mining conditions, complexity of the product demanded by the customer, logistics and transportation, personnel shortages, and shortages due to growth demand. Innovation requires observation, communication, and an environment receptive to change. Potential areas for mining innovation include operational excellence, management practices, organizational structure, technology, and people. 10 figs.

  20. Effects of preferred-exercise prescription compared to usual exercise prescription on outcomes for people with non-specific low back pain: a randomized controlled trial [ACTRN12608000524392

    Directory of Open Access Journals (Sweden)

    Keating Jennifer L

    2009-01-01

    Full Text Available Abstract Background Non-specific chronic low back pain (NSCLBP has become a significant problem due to high healthcare utilization, rising costs of care and perceived limitations of effectiveness of many current treatments. Systematic reviews have repeatedly concluded that, on average across participants, exercise for NSCLBP appears effective in decreasing pain and improving function. Not all people with NSCLBP benefit from exercise programs and it would assist care-providers and care-seekers if factors that impact on program effectiveness and success were identified. Methods and design The study will be a randomised controlled trial comparing an exercise rehabilitation program informed by a participant preferences questionnaire compared to a program without this guideline for patients with chronic low back pain. A sample of 150 patients will be recruited in Melbourne, Australia through community-based healthcare clinics that provide supervised exercise rehabilitation programs for people with non-specific chronic low back pain. Clinicians will be randomly assigned to exercise preferences questionnaire or no questionnaire and participants will be allocated in a concealed manner. A qualitative focus group study of exercise instructor feedback about the exercise preferences instrument will be embedded in the research design. Two qualitative focus group studies will also be conducted for participants in the intervention and the control groups to obtain feedback about participants' experiences of the two types of exercise programs. The primary outcomes will be functional ability, pain, fear avoidance, exercise adherence. Discussion This trial will evaluate the effectiveness of individualised exercise prescription compared to usual exercise prescription for NSCLP and, using feedback following the trial, refine the exercise preferences questionnaire.

  1. Improving the quality of depression and pain care in multiple sclerosis using collaborative care: The MS-care trial protocol.

    Science.gov (United States)

    Ehde, Dawn M; Alschuler, Kevin N; Sullivan, Mark D; Molton, Ivan P; Ciol, Marcia A; Bombardier, Charles H; Curran, Mary C; Gertz, Kevin J; Wundes, Annette; Fann, Jesse R

    2018-01-01

    Evidence-based pharmacological and behavioral interventions are often underutilized or inaccessible to persons with multiple sclerosis (MS) who have chronic pain and/or depression. Collaborative care is an evidence-based patient-centered, integrated, system-level approach to improving the quality and outcomes of depression care. We describe the development of and randomized controlled trial testing a novel intervention, MS Care, which uses a collaborative care model to improve the care of depression and chronic pain in a MS specialty care setting. We describe a 16-week randomized controlled trial comparing the MS Care collaborative care intervention to usual care in an outpatient MS specialty center. Eligible participants with chronic pain of at least moderate intensity (≥3/10) and/or major depressive disorder are randomly assigned to MS Care or usual care. MS Care utilizes a care manager to implement and coordinate guideline-based medical and behavioral treatments with the patient, clinic providers, and pain/depression treatment experts. We will compare outcomes at post-treatment and 6-month follow up. We hypothesize that participants randomly assigned to MS Care will demonstrate significantly greater control of both pain and depression at post-treatment (primary endpoint) relative to those assigned to usual care. Secondary analyses will examine quality of care, patient satisfaction, adherence to MS care, and quality of life. Study findings will aid patients, clinicians, healthcare system leaders, and policy makers in making decisions about effective care for pain and depression in MS healthcare systems. (PCORI- IH-1304-6379; clinicaltrials.gov: NCT02137044). This trial is registered at ClinicalTrials.gov, protocol NCT02137044. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Tracheostomy care

    Science.gov (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... Before you leave the hospital, health care providers will teach you how ... and suction the tube Keep the air you breathe moist Clean ...

  3. [Cross-cultural aspects of interaction and communication in mental health care. Barriers and recommendations for action].

    Science.gov (United States)

    Penka, S; Schouler-Ocak, M; Heinz, A; Kluge, U

    2012-09-01

    Mental health care for migrants is often impaired by a lack of policies and provisions in the respective institutions. This article focuses on "communication barriers" in psychosocial and psychotherapeutic settings, where personal communication is of great importance. Barriers that prevent migrants from using health care institutions include translation problems but also more complex misunderstandings based on divergent explanations regarding the causes, course, and adequate treatment of different disorders. The widely recommended intercultural opening of medical and psychosocial institutions involves using interpreters as cultural experts, reflecting on and mediating between divergent explanatory models, and avoiding cultural and ethnic stereotyping as well as encouraging an open, curious, and reflective professional attitude. With respect to institutional settings, rules for the financing of interpreters are as important as tackling barriers that limit migrants' access to medical and psychosocial institutions.

  4. Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy: a pilot randomised controlled trial.

    Science.gov (United States)

    Littlewood, Chris; Malliaras, Peter; Mawson, Sue; May, Stephen; Walters, Stephen J

    2014-03-01

    Rotator cuff tendinopathy is a common source of shoulder pain characterised by persistent and/or recurrent problems for a proportion of sufferers. The aim of this study was to pilot the methods proposed to conduct a substantive study to evaluate the effectiveness of a self-managed loaded exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy. A single-centre pragmatic unblinded parallel group pilot randomised controlled trial. One private physiotherapy clinic, northern England. Twenty-four participants with rotator cuff tendinopathy. The intervention was a programme of self-managed loaded exercise. The control group received usual physiotherapy treatment. Baseline assessment comprised the Shoulder Pain and Disability Index (SPADI) and the Short-Form 36, repeated three months post randomisation. The recruitment target was met and the majority of participants (98%) were willing to be randomised. 100% retention was attained with all participants completing the SPADI at three months. Exercise adherence rates were excellent (90%). The mean change in SPADI score was -23.7 (95% CI -14.4 to -33.3) points for the self-managed exercise group and -19.0 (95% CI -6.0 to -31.9) points for the usual physiotherapy treatment group. The difference in three month SPADI scores was 0.1 (95% CI -16.6 to 16.9) points in favour of the usual physiotherapy treatment group. In keeping with previous research which indicates the need for further evaluation of self-managed loaded exercise for rotator cuff tendinopathy, these methods and the preliminary evaluation of outcome offer a foundation and stimulus to conduct a substantive study. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  5. Protocol for the effect evaluation of independent medical evaluation after six months sick leave: a randomized controlled trial of independent medical evaluation versus treatment as usual in Norway.

    Science.gov (United States)

    Husabo, Elisabeth; Monstad, Karin; Holmås, Tor Helge; Oyeflaten, Irene; Werner, Erik L; Maeland, Silje

    2017-06-14

    It has been discussed whether the relationship between a patient on sick leave and his/her general practitioner (GP) is too close, as this may hinder the GP's objective evaluation of need for sick leave. Independent medical evaluation involves an independent physician consulting the patient. This could lead to new perspectives on sick leave and how to follow-up the patient. The current study is a randomized controlled trial in a Norwegian primary care context, involving an effect evaluation, a cost/benefit analysis, and a qualitative evaluation. Independent medical evaluation will be compared to treatment as usual, i.e., the physicians' and social insurance agencies' current management of long-term sick-listed patients. Individuals aged 18-65 years, sick listed by their GP and on full or partial sick leave for the past 6 months in Hordaland county will be included. Exclusion criteria are pregnancy, cancer, dementia or an ICD-10 diagnosis. A total sample of 3800 will be randomly assigned to either independent medical evaluation or treatment as usual. Official register data will be used to measure the primary outcome; change in sickness benefits at 7, 9 and 12 months. Sick listed in other counties will serve as a second control group, if appropriate under the "common trend" assumption. The Norwegian effect evaluation of independent medical evaluation after 6 months sick leave is a large randomized controlled trial, and the first of its kind, to evaluate this type of intervention as a means of getting people back to work after long-term sickness absence. ClinicalTrials.gov NCT02524392 . Registered June 23, 2015.

  6. Protocol for the effect evaluation of independent medical evaluation after six months sick leave: a randomized controlled trial of independent medical evaluation versus treatment as usual in Norway

    Directory of Open Access Journals (Sweden)

    Elisabeth Husabo

    2017-06-01

    Full Text Available Abstract Background It has been discussed whether the relationship between a patient on sick leave and his/her general practitioner (GP is too close, as this may hinder the GP’s objective evaluation of need for sick leave. Independent medical evaluation involves an independent physician consulting the patient. This could lead to new perspectives on sick leave and how to follow-up the patient. Methods/design The current study is a randomized controlled trial in a Norwegian primary care context, involving an effect evaluation, a cost/benefit analysis, and a qualitative evaluation. Independent medical evaluation will be compared to treatment as usual, i.e., the physicians’ and social insurance agencies’ current management of long-term sick-listed patients. Individuals aged 18–65 years, sick listed by their GP and on full or partial sick leave for the past 6 months in Hordaland county will be included. Exclusion criteria are pregnancy, cancer, dementia or an ICD-10 diagnosis. A total sample of 3800 will be randomly assigned to either independent medical evaluation or treatment as usual. Official register data will be used to measure the primary outcome; change in sickness benefits at 7, 9 and 12 months. Sick listed in other counties will serve as a second control group, if appropriate under the “common trend” assumption. Discussion The Norwegian effect evaluation of independent medical evaluation after 6 months sick leave is a large randomized controlled trial, and the first of its kind, to evaluate this type of intervention as a means of getting people back to work after long-term sickness absence. Trial registration ClinicalTrials.gov NCT02524392 . Registered June 23, 2015.

  7. The effect of interpersonal psychotherapy and other psychodynamic therapies versus 'treatment as usual' in patients with major depressive disorder.

    Directory of Open Access Journals (Sweden)

    Janus Christian Jakobsen

    Full Text Available BACKGROUND: Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Interpersonal psychotherapy and other psychodynamic therapies may be effective interventions for major depressive disorder, but the effects have only had limited assessment in systematic reviews. METHODS/PRINCIPAL FINDINGS: Cochrane systematic review methodology with meta-analysis and trial sequential analysis of randomized trials comparing the effect of psychodynamic therapies versus 'treatment as usual' for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included six trials randomizing a total of 648 participants. Five trials assessed 'interpersonal psychotherapy' and only one trial assessed 'psychodynamic psychotherapy'. All six trials had high risk of bias. Meta-analysis on all six trials showed that the psychodynamic interventions significantly reduced depressive symptoms on the 17-item Hamilton Rating Scale for Depression (mean difference -3.12 (95% confidence interval -4.39 to -1.86;P<0.00001, no heterogeneity compared with 'treatment as usual'. Trial sequential analysis confirmed this result. DISCUSSION: We did not find convincing evidence supporting or refuting the effect of interpersonal psychotherapy or psychodynamic therapy compared with 'treatment as usual' for patients with major depressive disorder. The potential beneficial effect seems small and effects on major outcomes are unknown. Randomized trials with low risk of systematic errors and low risk of random errors are needed.

  8. Patient directed self management of pain (PaDSMaP compared to treatment as usual following total knee replacement: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Donell Simon

    2012-11-01

    Full Text Available Abstract Background In 2009, 665 patients underwent total knee replacements (TKRs at the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH, representing nearly 1% of the national total. Pain control following the operation can be poor, and this can cause poor mobilization and potential long-term adverse events. Although high levels of pain are not associated with patient dissatisfaction, brief periods of pain may lead to neuronal remodeling and sensitization. Patient controlled oral analgesia (PCOA may improve pain relief; however, the evidence to date has been inconclusive. Patient directed self management of pain (PaDSMaP is a single center randomized controlled trial, which aims to establish if patient self-medication improves, or is equivalent to, treatment as usual and to create an educational package to allow implementation elsewhere. Methods/design Patients eligible for a TKR will be recruited and randomized in the outpatient clinic. All patients will undergo their operations according to normal clinical practice but will be randomized into two groups. Once oral medication has commenced, one group will have pain relief administered by nursing staff in the usual way (treatment as usual; TAU, whilst the second group will self manage their pain medication (patient directed self management of pain; PaDSMaP. Those recruited for self-medication will undergo a training program to teach the use of oral analgesics according to the World Health Organization (WHO pain cascade and how to complete the study documentation. The primary endpoint of the trial is the visual analogue scale (VAS pain score at 3 days or discharge, whichever is sooner. The follow-up time is 6 weeks with a planned trial period of 3 years. The secondary objectives are satisfaction with the management of patient pain post-operatively whilst an inpatient after primary TKR; overall pain levels and pain on mobilization; satisfaction with pain management information

  9. Avoidance of Vitamin K-Rich Foods Is Common among Warfarin Users and Translates into Lower Usual Vitamin K Intakes.

    Science.gov (United States)

    Leblanc, Cristina; Dubé, Marie-Pierre; Presse, Nancy; Dumas, Stéphanie; Nguyen, Mimosa; Rouleau-Mailloux, Étienne; Perreault, Sylvie; Ferland, Guylaine

    2016-06-01

    Warfarin users should aim for stable daily vitamin K intakes. However, some studies report that patients are often advised to avoid eating green vegetables. Whether this advice impacts vitamin K intakes is unknown. Our aim was to describe the nature and sources of vitamin K-related dietary recommendations that patients received at the initiation of warfarin therapy, assess their adherence to these recommendations, and examine whether usual vitamin K intakes vary according to these recommendations. We conducted a retrospective cohort study with patients enrolled in the Québec Warfarin Cohort Study. Patients were asked to report dietary recommendations they had received at warfarin initiation and their adherence to these recommendations. Usual vitamin K intakes were assessed using a validated semi-quantitative food frequency questionnaire. Three hundred seventeen patients aged 36 to 97 years who initiated warfarin between 2011 and 2012 and were treated for 12 months or longer with a target international normalized ratio range of 2.0 to 3.0 or 2.5 to 3.5. Patients were classified according to vitamin K-related recommendations reported: limit or avoid vitamin K-rich foods; aim for stable consumption of vitamin K-rich foods; or no vitamin K-related advice. A one-way analysis of covariance was used to compare mean usual vitamin K intakes between patients after adjustment for covariates. Most patients (68%) reported being advised to limit or avoid vitamin K-rich foods, particularly green vegetables, 10% reported being advised to aim for stable consumption of vitamin K-rich foods, and 22% did not recall receiving any vitamin K-related recommendation. Mean usual vitamin K intakes of patients adhering to the recommendation to limit or avoid vitamin K-rich foods was 35% to 46% lower than those of other patients (Pvitamin K-rich foods, which translated into lower usual vitamin K intakes. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All

  10. Effectiveness of Collaborative Care for Depression in Public-Sector Primary Care Clinics Serving Latinos.

    Science.gov (United States)

    Lagomasino, Isabel T; Dwight-Johnson, Megan; Green, Jennifer M; Tang, Lingqi; Zhang, Lily; Duan, Naihua; Miranda, Jeanne

    2017-04-01

    Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics. A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks. Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (ppublic-sector clinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.

  11. Faster return to work after psychiatric consultation for sicklisted employees with common mental disorders compared to care as usual. A randomized clinical trial

    NARCIS (Netherlands)

    van der Feltz-Cornelis, Christina M.; Hoedeman, Rob; de Jong, Fransina J.; Meeuwissen, Jolanda A. C.; Drewes, Hanneke W.; van der Laan, Niels C.; Ader, Herman J.

    2010-01-01

    Introduction: Return to work (RTW) of employees on sick leave for common mental disorders may require a multidisciplinary approach. This article aims to assess time to RTW after a psychiatric consultation providing treatment advice to the occupational physician (OP) for employees on sick leave for

  12. The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care : a randomised controlled trial

    NARCIS (Netherlands)

    Hellemans, Irene M; van Tulder, Maurits W; Heymans, Martijn W; Rauwerda, Jan A; van Rossum, Albert C; Seidell, Jaap C; IJzelenberg, W.

    2012-01-01

    BACKGROUND: The additional benefit of lifestyle interventions in patients receiving cardioprotective drug treatment to improve cardiovascular risk profile is not fully established.The objective was to evaluate the effectiveness of a target-driven multidisciplinary structured lifestyle intervention

  13. Early preventive exercises versus usual care does not seem to reduce trismus in patients treated with radiotherapy for cancer in the oral cavity or oropharynx

    DEFF Research Database (Denmark)

    Høgdal, Nina; Juhl, Carsten Bogh; Aadahl, Mette

    2015-01-01

    ABSTRACT Purpose. In head and neck cancer patients undergoing curative radiotherapy, we investigated the benefi ts and harms of an early exercise regime on trismus. Material and methods. Patients with head and neck cancer undergoing radiotherapy were centrally randomised to exercises 5 – 6 times ...... outcomes. Conclusions. In patients with cancer in the oral cavity or oropharynx, early supervised exercises combined with selfcare treatment focusing on mobility exercises to reduce...

  14. Impact of an Asha Intervention on Depressive Symptoms among Rural Women Living with AIDS in India: Comparison of the Asha-Life and Usual Care Program

    Science.gov (United States)

    Nyamathi, Adeline; Salem, Benissa E.; Meyer, Visha; Ganguly, Kalyan K.; Sinha, Sanjeev; Ramakrishnan, Padma

    2012-01-01

    The purpose of this randomized pilot study is to conduct an intervention with 68 rural women living with AIDS to compare the effectiveness of two different programs on depressive symptoms. The trial was designed to assess the impact of the Asha-Life intervention engaging with an HIV-trained village woman, Asha (Accredited Social Health Activist),…

  15. The ExStroke Pilot Trial: rationale, design, and baseline data of a randomized multicenter trial comparing physical training versus usual care after an ischemic stroke

    DEFF Research Database (Denmark)

    Krarup, L.H.; Gluud, C.; Truelsen, T.

    2008-01-01

    of increasing stroke patients' level of physical activity and secondarily to associate the level of physical activity to the risk of recurrent stroke, myocardial infarction, and all-cause mortality in the two groups. We describe the rationale, design, and baseline data of the ExStroke Pilot Trial. METHODS......INTRODUCTION: A high level of physical activity is associated with a decreased risk of first stroke and physical activity modifies recognized stroke risk factors and is recommended for stroke survivors. Available research shows that stroke patients can increase their level of physical performance...... over a short period. When the intervention period is over, physical performance often declines towards baseline level. Currently, there is no evidence on the association between physical activity and the risk of recurrent stroke. The ExStroke Pilot Trial is a randomized clinical trial with the aim...

  16. Rapid evidence review of the comparative effectiveness, harms, and cost-effectiveness of pharmacogenomics-guided antidepressant treatment versus usual care for major depressive disorder.

    Science.gov (United States)

    Peterson, Kimberly; Dieperink, Eric; Anderson, Johanna; Boundy, Erin; Ferguson, Lauren; Helfand, Mark

    2017-06-01

    This study aims to conduct an evidence review of the effectiveness, harms, and cost-effectiveness of pharmacogenomics-guided antidepressant treatment for major depressive disorder. We searched MEDLINE®, the Cochrane Central Registry of Controlled Trials, and PsycINFO through February 2017. We used prespecified criteria to select studies, abstract data, and rate internal validity and strength of the evidence (PROSPERO number CRD42016036358). We included two randomized trials (RCT), five controlled cohort studies, and six modeling studies of mostly women in their mid-40s with few comorbidities. CNSDose (ABCB1, ABCC1, CYP2C19, CYP2D6, UGT1A1) is the only pharmacogenomics test that significantly improved remission (one additional remitting patient in 12 weeks per three genotyped, 95% CI 1.7 to 3.5) and reduced intolerability in an RCT. ABCB1 genotyping leads to one additional remitting patient in 5 weeks per three genotyped (95% CI 3 to 20), but tolerability was not reported. In an RCT, GeneSight (CYP2D6, CYPC19, CYP1A2, SLC6A4, HTR2A) did not statistically significantly improve remission, and evidence is inconclusive about its tolerability. Evidence is generally low strength because RCTs were few and underpowered. Cost-effectiveness is unclear due to lack of directly observed cost-effectiveness outcomes. We found no studies that evaluated whether pharmacogenomics shortens time to optimal treatment, whether improvements were due to switches to genetically congruent medication, or whether effectiveness varies based on test and patient characteristics. Certain pharmacogenomics tools show promise of improving short-term remission rates in women in their mid-40s with few comorbidities. But, important evidence limitations preclude recommending their widespread use and indicate a need for further research.

  17. A randomised clinical trial of comprehensive cardiac rehabilitation versus usual care for patients treated for infective endocarditis--the CopenHeartIE trial protocol

    DEFF Research Database (Denmark)

    Rasmussen, Trine Bernholdt; Zwisler, Ann-Dorthe; Sibilitz, Kirstine Lærum

    2012-01-01

    Infective endocarditis (IE) is among the most serious infectious diseases in the western world. Treatment requires lengthy hospitalisation, high-dosage antibiotic therapy and possible valve replacement surgery. Despite advances in treatment, the 1-year mortality remains at 20-40%. Studies indicate...

  18. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial

    NARCIS (Netherlands)

    van Gaalen, J.L.; Bakker, M.J.; Bodegom-Vos, L. van; Snoeck-Stroband, J.B.; Assendelft, W.J.J.; Kaptein, A.A.; van der Meer, V.; Taube, C.; Thoonen, B.P.A.; Sont, J.K.; for the, I.s.g.

    2012-01-01

    ABSTRACT: BACKGROUND: Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical

  19. Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice.

    Science.gov (United States)

    Sicras-Mainar, A; Rejas-Gutiérrez, J; Navarro-Artieda, R; Aguado-Jodar, A; Ruíz-Torrejón, A

    2014-10-01

    To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age>75 years, poor/average age for health and difficulty in at least one daily physical activity. morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N=58), solifenacin (N=252) or tolterodine (N=212). The use of absorbent was 20.7%, 29.4% and 33.0% (P=.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, €1,775 (1550-2014) vs. solifenacin €2,062 (1911-2223) and tolterodine €2,149 (1,978-2,307), P=.042, as a result of lower utilization visits and concomitant medication. Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  20. Effectiveness of a Peer Support Programme versus Usual Care in Disease Management of Diabetes Mellitus Type 2 regarding Improvement of Metabolic Control: A Cluster-Randomised Controlled Trial.

    Science.gov (United States)

    Johansson, Tim; Keller, Sophie; Winkler, Henrike; Ostermann, Thomas; Weitgasser, Raimund; Sönnichsen, Andreas C

    2016-01-01

    Testing the effectiveness of peer support additionally to a disease management programme (DMP) for type 2 diabetes patients. Unblinded cluster-randomised controlled trial (RCT) involving 49 general practices, province of Salzburg, Austria. All patients enrolled in the DMP were eligible, n = 337 participated (intervention: 148 in 19 clusters; control: 189 in 20 clusters). The peer support intervention ran over 24 months and consisted of peer supporter recruitment and training, and group meetings weekly for physical exercise and monthly for discussion of diabetes related topics. At two-year follow-up, adjusted analysis revealed a nonsignificant difference in HbA1c change of 0.14% (21.97 mmol/mol) in favour of the intervention (95% CI -0.08 to 0.36%, p = 0.22). Baseline values were 7.02 ± 1.25% in the intervention and 7.08 ± 1.25 in the control group. None of the secondary outcome measures showed significant differences except for improved quality of life (EQ-5D-VAS) in controls (4.3 points on a scale of 100; 95% CI 0.08 to 8.53, p = 0.046) compared to the intervention group. Our peer support intervention as an additional DMP component showed no significant effect on HbA1c and secondary outcome measures. Further RTCs with a longer follow-up are needed to reveal whether peer support will have clinically relevant effects. This trial has been registered with Current Controlled Trials Ltd. (ISRCTN10291077).

  1. Effect of Nurse Home Visits vs. Usual Care on Reducing Intimate Partner Violence in Young High-Risk Pregnant Women: A Randomized Controlled Trial

    NARCIS (Netherlands)

    Mejdoubi, J.; van den Heijkant, S.C.C.M.; van Leerdam, F.J.M.; Heymans, M.W.; Hirasing, R.A.; Crijnen, A.A.M.

    2013-01-01

    Background:Expectant mothers and mothers of young children are especially vulnerable to intimate partner violence (IPV). The nurse-family partnership (NFP) is a home visitation program in the United States effective for the prevention of adverse child health outcomes. Evidence regarding the effect

  2. Return-to-work intervention versus usual care for sick-listed employees : Health-economic investment appraisal alongside a cluster randomised trial

    NARCIS (Netherlands)

    Lokman, S.; Volker, D.; Zijlstra-Vlasveld, M.C.; Brouwers, E.P.M.; Boon, B.; Beekman, A.T.; Smit, F.; van der Feltz-Cornelis, C.M.

    2017-01-01

    To evaluate the health-economic costs and benefits of a guided eHealth intervention (E-health module embedded in Collaborative Occupational healthcare (ECO)) encouraging sick-listed employees to a faster return to work. A two-armed cluster randomised trial with occupational physicians (OPs) (n=62),

  3. Education, night splinting and exercise versus usual care on recovery and conversion to surgery for people awaiting carpal tunnel surgery : A protocol for a randomised controlled trial

    NARCIS (Netherlands)

    Lewis, Karina J.; Ross, Leo; Coppieters, Michel W.; Vicenzino, Bill; Schmid, Annina B.

    2016-01-01

    Introduction Carpal tunnel syndrome (CTS) is a prevalent upper limb condition that results in significant individual and socioeconomic costs. Large patient numbers, long outpatient waiting times and traditional referral pathways in public health systems create delays in accessing treatment for this

  4. Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture.

    Science.gov (United States)

    Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Yang, Ching-Tzu; Chou, Shih-Wei; Chen, Ching-Yen

    2013-02-01

    Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation, depression management, and fall prevention in older persons with hip fracture. The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture. A randomized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models: interdisciplinary care (n = 101), comprehensive care (n = 99), and usual care (n = 99). Interdisciplinary care included geriatric consultation, continuous rehabilitation, and discharge planning with post-hospital services. Comprehensive care consisted of interdisciplinary care plus nutrition consultation, depression management, and fall prevention. Usual care included only in-hospital rehabilitation without geriatric consultation, in-home rehabilitation, and home environmental assessment. Participants in the comprehensive care group had better self-care ability (odds ratio, OR = 3.19, p malnutrition (OR = 0.48, p hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care. Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation, depression management, and fall prevention than simply interdisciplinary care.

  5. Use of a radioactive substance, the depleted uranium, for the fabrication of enamels and usual things and jewels decoration

    International Nuclear Information System (INIS)

    1999-01-01

    This open letter to the ministers and State Secretaries of the public health, the environment and the consumers protection, deals with a complaint against X, lodged by the CRII-RAD. This complaint concerns the use of depleted uranium for the fabrication of enamels and the decoration of usual things and jewels. This utilization constitutes a breach of the decree 66-450, which forbids since 1966 the addition of radioactive substances in food, cosmetic and domestic products. The letter takes into account the hazards for the workers and the consumers, the uranium powder origin and discusses the guaranties forecast under the legislation eye. (A.L.B.)

  6. Response of the Pre-oriented Goal-directed Attention to Usual and Unusual Distractors: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Golnaz Baghdadi

    2017-03-01

    Full Text Available Introduction: In this study, we investigated the distraction power of the unusual and usual images on the attention of 20 healthy primary school children. Methods: Our study was different from previous ones in that the participants were asked to fix the initial position of their attention on a pre-defined location after being presented with unusual images as distractors. The goals were presented in locations, which were far from the attraction basin of distractors. Our expectation was that the pre-orienting of the attention to the position of targets can reduce the attractive effect of unusual images compared to the usual ones. The percentage of correct responses and the reaction time have been measured as behavioral indicators of attention performance. Results: Results showed that using the goal-directed attention, subjects ignored both kinds of distractors nearly the same way. Conclusion: With regard to previous reports about the more attraction towards the unusual images, it is suggested that the dynamics of the visual attention system be sensitive to the initial condition. That is, changing the initial position of the attention can lead to the decrement of the unusual images’ effects. However, several other possibilities such as a probable delay in processing unusual features could explain this observation, too. 

  7. The effect of interpersonal psychotherapy and other psychodynamic therapies versus 'treatment as usual' in patients with major depressive disorder.

    Science.gov (United States)

    Jakobsen, Janus Christian; Hansen, Jane Lindschou; Simonsen, Erik; Gluud, Christian

    2011-04-27

    Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Interpersonal psychotherapy and other psychodynamic therapies may be effective interventions for major depressive disorder, but the effects have only had limited assessment in systematic reviews. Cochrane systematic review methodology with meta-analysis and trial sequential analysis of randomized trials comparing the effect of psychodynamic therapies versus 'treatment as usual' for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included six trials randomizing a total of 648 participants. Five trials assessed 'interpersonal psychotherapy' and only one trial assessed 'psychodynamic psychotherapy'. All six trials had high risk of bias. Meta-analysis on all six trials showed that the psychodynamic interventions significantly reduced depressive symptoms on the 17-item Hamilton Rating Scale for Depression (mean difference -3.12 (95% confidence interval -4.39 to -1.86;Pinterpersonal psychotherapy or psychodynamic therapy compared with 'treatment as usual' for patients with major depressive disorder. The potential beneficial effect seems small and effects on major outcomes are unknown. Randomized trials with low risk of systematic errors and low risk of random errors are needed.

  8. Changes in executive functions and self-efficacy are independently associated with improved usual gait speed in older women

    Directory of Open Access Journals (Sweden)

    Hsu Chun

    2010-05-01

    Full Text Available Abstract Background Improved usual gait speed predicts substantial reduction in mortality. A better understanding of the modifiable factors that are independently associated with improved gait speed would ensure that intervention strategies are developed based on a valid theoretical framework. Thus, we examined the independent association of change in executive functions and change in falls-related self-efficacy with improved gait speed among community-dwelling senior women. Methods A secondary analysis of the 135 senior women aged 65 to 75 years old who completed a 12-month randomized controlled trial of resistance training. Usual gait speed was assessed using a 4-meter walk. Three executive processes were assessed by standard neuropsychological tests: 1 set shifting; 2 working memory; and 3 selective attention and response inhibition. A linear regression model was constructed to determine the independent association of change in executive functions and falls-related self-efficacy with change in gait speed. Results Improved selective attention and conflict resolution, and falls-related self-efficacy, were independently associated with improved gait speed after accounting for age, global cognition, baseline gait speed, and change in quadriceps strength. The total variance explained was 24%. Conclusions Interventions that target executive functions and falls-related self-efficacy, in addition to physical functions, to improve gait speed may be more efficacious than those that do not. Trial Registration ClinicalTrials.gov Identifier: NCT00426881

  9. Evaluation of the Relative Validity of the Short Diet Questionnaire for Assessing Usual Consumption Frequencies of Selected Nutrients and Foods

    Directory of Open Access Journals (Sweden)

    Bryna Shatenstein

    2015-08-01

    Full Text Available A 36-item Short Diet Questionnaire (SDQ was developed to assess usual consumption frequencies of foods providing fats, fibre, calcium, vitamin D, in addition to fruits and vegetables. It was pretested among 30 community-dwelling participants from the Québec Longitudinal Study on Nutrition and Successful Aging, “NuAge” (n = 1793, 52.4% women, recruited in three age groups (70 ± 2 years; 75 ± 2 years; 80 ± 2 years. Following revision, the SDQ was administered to 527 NuAge participants (55% female, distributed among the three age groups, both sexes and languages (French, English prior to the second of three non-consecutive 24 h diet recalls (24HR and validated relative to the mean of three 24HR. Full data were available for 396 participants. Most SDQ nutrients and fruit and vegetable servings were lower than 24HR estimates (p < 0.05 except calcium, vitamin D, and saturated and trans fats. Spearman correlations between the SDQ and 24HR were modest and significant (p < 0.01, ranging from 0.19 (cholesterol to 0.45 (fruits and vegetables. Cross-classification into quartiles showed 33% of items were jointly classified into identical quartiles of the distribution, 73% into identical and contiguous quartiles, and only 7% were frankly misclassified. The SDQ is a reasonably accurate, rapid approach for ranking usual frequencies of selected nutrients and foods. Further testing is needed in a broader age range.

  10. A review and analysis of renewable energy curtailment schemes and Principles of Access: Transitioning towards business as usual

    International Nuclear Information System (INIS)

    Kane, Laura; Ault, Graham

    2014-01-01

    In the last decade, the EU has driven forward the development and connection of renewable power sources across Europe. This has changed the way in which distribution networks operate, moving from a passive system, to a more active system where generation and demand are located closer together with system states being more complex and variable. Increased penetration of renewable generation into distribution networks is presenting a number of challenges to Distribution Network Operators (DNOs) including the provision of network access in capacity constrained networks. The introduction of Active Network Management (ANM) is enabling an increase in renewable generation connections through enhanced network access in otherwise ‘full’ networks. This paper presents a way in which DNOs might move towards Business as Usual (BAU) arrangements for ANM schemes. It is necessary to determine the curtailment arrangements, or Principles of Access (PoA), and from this estimate generation access under ANM and the flow of services and money for different scenarios. In this paper, a comprehensive literature review, detailed case study evaluation on early ANM schemes, quantitative curtailment assessment for different PoA and a qualitative analysis of business models for different ANM PoA is presented in turn with conclusions drawn from these three approaches. - Highlights: • Literature review of Principles of Access. • Detailed case study analysis of Principles of Access in ANM projects. • Quantitative analysis of different Principles of Access. • Proposed business models for ANM as business as usual

  11. Influence of usual zinc intake and zinc in a meal on 65Zn retention and turnover in the rat

    International Nuclear Information System (INIS)

    Hunt, J.R.; Johnson, P.E.; Swan, P.B.

    1987-01-01

    The influences of zinc in a meal and usual zinc intake on zinc retention and turnover were investigated in 7-wk-old male rats fed diets containing 12-151 mg Zn/kg for 3 wk before and after consuming a 65 Zn-labeled meal containing ZnCl 2 . Retention corrected to zero time and turnover rate were determined by whole-body counting. Percent zinc retention was inversely proportional to the natural logarithm of the meal zinc, between 0.09 and 26 mumol. In comparison to lower doses, higher doses resulted in lower percent retention but greater amounts of zinc retained. Although the latter relationship was slightly curvilinear, there was no indication of a limited capacity for zinc retention with high doses. However, doses above 4 mumol resulted in higher turnover rates in rats accustomed to lower zinc intakes. Percent retention and the reciprocal of the turnover rate were proportional to the reciprocal of the dietary zinc concentration. The greatest differences in retention and turnover occurred between 12 and 26 mg Zn/kg diet. The zinc dose in a meal and the usual dietary zinc separately influenced percent zinc retention. These factors also interacted, such that greater dose effects were observed at lower zinc intakes and greater dietary zinc effects were observed at lower doses

  12. Residential Care

    Science.gov (United States)

    ... Kids For Teens For Parents & Teachers Resolving Family Conflicts The Holidays and Alzheimer's Glossary Virtual Library Online ... longer an option Costs Choosing a care setting Types of residential care A good long-term care ...

  13. Palliative Care

    Science.gov (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  14. Comprehensive Care

    Science.gov (United States)

    ... Comprehensive Care Share this page Facebook Twitter Email Comprehensive Care Understand the importance of comprehensive MS care ... In this article A complex disease requires a comprehensive approach Today multiple sclerosis (MS) is not a ...

  15. Conocimientos usuales de los pacientes diabéticos en los estudiantes de medicina del occidente de México Usual knowledge of medical students form Western Mexico on diabetic patients

    Directory of Open Access Journals (Sweden)

    Rafael Bustos Saldaña

    2007-12-01

    Full Text Available Objetivo: Identificar el conocimiento que presentan los estudiantes de Medicina acerca de los conceptos usuales de los pacientes diabéticos sobre su enfermedad. Material y métodos: Estudio descriptivo en 275 estudiantes de Medicina del Centro Universitario del Sur de la Universidad de Guadalajara. Se seleccionó la muestra en forma aleatoria a los alumnos inscritos en el calendario 2006 A, para aplicarles el instrumento Diabetes Knowledge Questionnaire (24. Se utilizó el programa de estadística EPI INFO 2000, se tomó una significancia estadística Objective: To identify the knowledge that presents Medicine students about the usual concepts of the diabetic patients on their disease. Material and Methods: Cross sectional study in 275 Medicine alumni of the University Center of the South of the University of Guadalajara. Sample was selected in randomized form in the students enrolled in calendar 2006 A, in order to apply them instrument Diabetes Knowledge Questionnaire (24. The statistic program was used EPI INFO 2000, a statistical significance was taken <0.05. Results: Students age: 20.03±1.9 years. The total average of guessed right answers was: 17.56± 3.24, students of 7º and 8º. cycle presented 19.53 ±2.15 and 19.75±1.92 right answers. As far as Basic knowledge of the disease 75,82% answered the reagents suitably, in glycemic control 70.7% and prevention measures and complications 71.9%. Conclusions: knowledge in Medicine students as far as the concepts that must have the diabetic patients on their disease increases in significant form as soon as it increases the semesters of study, the first scholastic cycles have the tendency to be similar to the population in regional diabetic patients.

  16. [Predictors of remission from major depressive disorder in secondary care].

    Science.gov (United States)

    Salvo, Lilian; Saldivia, Sandra; Parra, Carlos; Cifuentes, Manuel; Bustos, Claudio; Acevedo, Paola; Díaz, Marcela; Ormazabal, Mitza; Guerra, Ivonne; Navarrete, Nicol; Bravo, Verónica; Castro, Andrea

    2017-12-01

    Background The knowledge of predictive factors in depression should help to deal with the disease. Aim To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy.

  17. The impact of the survivorship care plan on health care use

    DEFF Research Database (Denmark)

    Jeppesen, Mette Moustgaard; Ezendam, Nicole P M; Pijnenborg, Johanna M A

    2018-01-01

    PURPOSE: The purpose of this paper was to assess the impact of survivorship care plan (SCP) provision and moderating factors on health care use following endometrial cancer treatment. METHODS: Women newly diagnosed with endometrial cancer were included in a pragmatic cluster randomized trial at 12...... of general practitioner, specialist, and additional health care was collected through questionnaires after diagnosis and at 6-, 12-, and 24-month follow-up and compared using linear multilevel regression analyses. RESULTS: Women who received an SCP had more cancer-related primary care visits compared...... to the usual care arm during the first year after diagnosis (β = 0.7, p women in the SCP group used more additional health care compared to women receiving usual care (24 vs. 11%, p = 0.04). Women with anxious symptoms (p = 0.03) and women who received radiotherapy (p = 0.01) had...

  18. Polyethylene glycol intestinal lavage in addition to usual antibiotic treatment for severe Clostridium difficile colitis: a randomised controlled pilot study.

    Science.gov (United States)

    McCreery, Greig; Jones, Philip M; Kidane, Biniam; DeMelo, Vanessa; Mele, Tina

    2017-07-31

    Clostridium difficile infections (CDI) are common, costly and potentially life threatening. Most CDI will respond to antibiotic therapy, but 3%-10% of all patients with CDI will progress to a severe, life-threatening course. Complete removal of the large bowel is indicated for severe CDI. However, the 30-day mortality following surgical intervention for severe CDI ranges from 20% to 70%. A less invasive approach using surgical faecal diversion and direct colonic lavage with polyethylene glycol (PEG) and vancomycin has demonstrated a relative mortality reduction of approximately 50%. As an alternative to these operative approaches, we propose to treat patients with bedside intestinal lavage with PEG and vancomycin instillation via nasojejunal tube, in addition to usual antibiotic management. Preliminary data collected by our research group are encouraging. We will conduct a 1-year, single-centre, pilot randomised controlled trial to study this new treatment strategy for patients with severe CDI and additional risk factors for fulminant or complicated infection. After informed consent, patients with severe-complicated CDI without immediate indication for surgery will be randomised to either usual antibiotic treatment or usual antibiotic treatment with the addition of 8 L of PEG lavage via nasojejunal tube. This pilot trial will evaluate our eligibility and enrolment rate, protocol compliance and adverse event rates and provide further data to inform a more robust sample size calculation and protocol modifications for a definitive multicentre trial design. Based on historical data, we anticipate enrolling approximately 24 patients during the 1-year pilot study period.As a pilot study, data will be reported in aggregate. Between-group differences will be assessed in a blinded fashion for evidence of harm, and to further refine our sample size calculation. This study protocol has been reviewed and approved by our local institutional review board. Results of the pilot

  19. Depression in elderly primary health care clinic attendees in Ilorin ...

    African Journals Online (AJOL)

    Depression in the elderly presenting at primary care settings is usually under- detected by primary care physicians. This study assessed the prevalence of depression and the utility of the Geriatric Depression Scale (Short Form) in detecting depression in elderly patients in primary care populations in Ilorin, Nigeria. This was ...

  20. Properties of charmed particle nonleptonic interactions following from Δ T=1/2 rule for usual mesons and baryons

    International Nuclear Information System (INIS)

    Arbuzov, B.A.; Cartasheva, V.G.; Tikhonin, F.F.

    1978-01-01

    A version of weak interaction has been considered in the frame of the model of 4-colour quarks with integer charges. The white part of the nonleptonic Lagrangian, responsible for the weak decay of usual particles, is constructed in such a way, that the ΔT=1/2 rule be fulfilled. This requirement fixed in a certain way the set of the parameters of full weak hadronic current. Parameters obtained in such a way give a complete description of the part of the Lagrangian with c-quark. The properties of the latter one reproduce to a certain extent those of the Lagrangian obtained in the GIM model, however the Lagrangian obtained in this work contains additional terms, that cannot be derived in the GIM model

  1. Preliminary study on arsenic concentration in groundwater in usual exploited aquifer in Ho Chi Minh City (pleistocene aquifer QIm)

    International Nuclear Information System (INIS)

    Phan Thanh Tong; Nguyen Kien Chinh; Tran Thi Bich Lien; Nguyen Van Suc; Le Danh Chuan; Huynh Le Khoa

    2004-01-01

    Recent days, As in groundwater is a hot spot in some countries in Asia (e.g India, Bangladesh, Myanmar, Thailand) that was revealed through Executive Meetings of RAS/8/084. In Vietnam, some reports on groundwater quality in Red River Delta and Mekong Delta (with few random groundwater samples selected to analyse randomly) brought an opinion that groundwater in some region in Vietnam contains a quantity of As is over WHO Limit to As concentration in drinking water. This project hat been carrying out in Ho Chi Minh City in order to survey and make a preliminary assessment on As content in groundwater in shallow aquifer which is usual exploited in one of important social-economic centers of Vietnam. (author)

  2. Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis

    DEFF Research Database (Denmark)

    Hjorthøj, C R; Fohlmann, A; Larsen, Anne-Mette

    2013-01-01

    BACKGROUND: Cannabis abuse in psychotic patients is associated with rehospitalizations, reduced adherence and increased symptom severity. Previous psychosocial interventions have been ineffective in cannabis use, possibly because of low sample sizes and short interventions. We investigated whether...... adding CapOpus to treatment as usual (TAU) reduces cannabis use in patients with cannabis use disorder and psychosis. Method A total of 103 patients with psychosis and cannabis use disorder were centrally randomized to 6 months of CapOpus plus TAU (n = 52) or TAU (n = 51). CapOpus consisted mainly...... of motivational interviewing and cognitive behaviour therapy (CBT). TAU was targeted primarily at the psychotic disorder. The primary outcome was self-reported days with cannabis use in the preceding month. RESULTS: Pre-randomization cannabis use frequency was 14.9 [95% confidence interval (CI) 12.7-17.1] days...

  3. The behaviour of trace elements and radionuclides in must of grapes during fermentation and usual wine technology

    International Nuclear Information System (INIS)

    Hellmuth, K.H.; Fischer, E.

    1985-01-01

    The elements Co(II), Sr(II), Cs(I), Tl(I) and Am(III) were added as their radionuclides to the must of white grapes of one vintage and from that wine was prepared using usual wine technology. The elimination of the elements during the fermentation and as a consequence of the subsequent treatments has been determined. The decrease of the metal contents with time follows approximately an exponential function in the cases of Co, Cs, Tl and Am, whereas the Sr-content remains nearly constant. In the total balance, the following residual values were found in the final wine: Co 8.6+-0.6%, Sr 41+-4%, Cs 0.13+-0.07 resp. 0.031+-0.008%, Tl 1.3+-0.2% and Am 1.0+-0.2% of the initial value. (orig./PW) [de

  4. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

    DEFF Research Database (Denmark)

    Kongsted, Alice; Montvilas, Erisela Qerama; Kasch, Helge

    2007-01-01

    practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12......-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general......Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion...

  5. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

    DEFF Research Database (Denmark)

    Kongsted, Alice; Montvilas, Erisela Qerama; Kasch, Helge

    2007-01-01

    Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion......-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general...... practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12...

  6. [Combined pulmonary fibrosis and emphysema (CPFE)--limitation of usual lung function test and challenge at practice].

    Science.gov (United States)

    Takai, Daiya

    2014-12-01

    Spirometry and the flow-volume curve test are commonly performed lung function tests. However, a unique clinical entity occasionally shows almost normal data in these tests, and is therefore missed on screening tests. The clinical entity of combined pulmonary emphysema and pulmdoary fibrosis was recognized and documented in the 90's in Japan, the USA, and Europe. Typical emphysema shows obstructive disorders, and pulmonary fibrosis shows restrictive disorders. Thus, the combination of both should lead to a combined disorder pattern in lung function tests, but this is not the case. In 2005, Cottin reported and redefined this combination of emphysema and fibrosis of the lung as "Combined Pulmonary Fibrosis and Emphysema" (CPFE). The patients are typically heavily smoking males who show an almost normal lung function. The upper lobe of these patients usually shows severe emphysema, which contributes to a static volume and a late phase in the forced volume test. On the other hand their lower lobe shows fibrotic change. The fibrotic portion contributes to early phase flow in the flow-volume curve. These mechanisms are a reason for the normal pattern appearance in lung function tests in CPFE patients. As a matter of course, these patients have damaged upper and lower lobes: their diffusing capacity of the lung shows a low performance, their saturation of blood hemoglobin decreases soon after light exercise, and their KL-6 (a blood marker of pulmonary fibrosis) usually shows a high value. They are considered a high risk group regarding complications of post-surgical treatment. Thus, when medical technologists identify suspicious cases, they should advise doctors to add diffusing capacity and KL-6 tests. (Review).

  7. Associations between usual school lunch attendance and eating habits and sedentary behaviour in French children and adolescents.

    Science.gov (United States)

    Dubuisson, C; Lioret, S; Dufour, A; Volatier, J L; Lafay, L; Turck, D

    2012-12-01

    Our objective was to investigate whether school lunch attendance was associated with overall eating habits and sedentary behaviour in a French sample of children and adolescents. Data for the study were taken from the second French cross-sectional dietary survey (INCA2-2006-07). In total, 1413 school children aged 3-17 years old were classified according to their school type and their usual school lunch attendance. Eating habits included meal regularity, dietary diversity, purchase in vending machine, snacking habits and frequency of eating in fast-foods. Two composite indices of eating habits were derived from multiple correspondence analyses. Sedentary behaviour was assessed by the average daily screen times for TV and computer. The association between school lunch attendance and each variable was tested. Multivariate association between school lunch attendance and the composite indices of eating habits and sedentary behaviours was studied. In all, 69.0% (CI(95%): 64.2-73.9) of secondary school children and 63.0% (CI(95%): 58.5-67.5) of pre- and elementary school children usually attended school lunch at least once a week. Pre- and elementary school children attending school lunches showed a higher dietary diversity score (P=0.02) and ate morning snacks more frequently (P=0.02). In secondary school children, attending school canteen was related to a lower rate of skipping breakfast (P=0.04) and main meals (P=0.01). In all school children, school lunch attendance was simultaneously associated with healthier overall eating habits and less sedentary behaviour. In France, children attending school canteens seem to have healthier eating habits and display less sedentary behaviour, independently of their socio-economic and demographic background.

  8. Absence of the predisposing factors and signs and symptoms usually associated with overreaching and overtraining in physical fitness centers

    Directory of Open Access Journals (Sweden)

    Carolina Ackel-D'Elia

    2010-01-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. METHOD: A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7 or signs and symptoms (8-13 was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching. A mean score was calculated ranging from 1 (completely absent to 5 (severe for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. RESULTS: The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60. CONCLUSION: According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60.

  9. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial

    Science.gov (United States)

    Wild, Beate; Friederich, Hans-Christoph; Gross, Gaby; Teufel, Martin; Herzog, Wolfgang; Giel, Katrin E; de Zwaan, Martina; Schauenburg, Henning; Schade-Brittinger, Carmen; Schäfer, Helmut; Zipfel, Stephan

    2009-01-01

    Background Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition