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Treatment Unit (treatment + unit)
Selected AbstractsA Delphi survey of the views of adult male patients with personality disorders on psychoeducation and social problem-solving therapyCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 5 2007Mary McMurran Background,Psychoeducation and social problem-solving therapy are treatment components that work well in tandem for offenders with personality disorders, hence it is worthwhile to maintain and improve their effectiveness. Aim,The aim was to seek patients' views of these therapies to contribute to their development. Method,A Delphi survey was conducted with all 12 male inpatients of a personality disorder hospital treatment unit. Results,Round 1 produced 30 statements for psychoeducation and 59 for social problem-solving therapy to be rated in Round 2. There was consensus at a level of 70% for all items. Both psychoeducation and social problem-solving therapies were viewed as useful by these patients. The men also suggested improvements in psychoeducation, including minimizing the delay between assessment and feedback, provision of reference material, preparation for the work and support afterwards. Areas identified for improvement in social problem-solving therapy included more frequent review of progress, greater consistency of delivery, eliciting problems more effectively, providing reference material, supporting patients in group work, and the development of an advanced therapy. Discussion,A Delphi approach to evaluation of therapies with the people receiving them is not only feasible but seems to offer a practical way of making useful clinical adjustments to the work. Further research with larger samples might usefully focus on whether such an approach enhances treatment compliance. Copyright © 2007 John Wiley & Sons, Ltd. [source] Mortality among mentally disordered offenders: a community based follow-up studyCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2005Tabita Björk Background Follow-up information about outcome for hospitalized mentally disordered offenders (MDO) is necessary for evaluation and improvement in quality of forensic psychiatric care. Aim A study was undertaken to estimate the standard mortality rate (SMR) of a population based sample of people sentenced to forensic psychiatric care. Method All MDOs in Örebro County, Sweden, discharged from a forensic psychiatric treatment unit between 1992 and 1999 were identified (n = 46). The variables were gender, age, offence, diagnosis and duration of admission. Case linkage was made with the National Cause-of-Death register. Median follow-up time was 53 months (0,93). Results The sample yielded a significantly elevated SMR 13.4 (95% CI 4.35,31.3) times higher than that in the general population, mostly due to suicide. Conclusions The cohort size is small but representative, and it provides data from an additional country for the growing international pool confirming the high risk of premature, generally self-inflicted death among MDOs. Resettlement and rehabilitation services for them may need to take as much account of mortality risk as that of reoffending. Copyright © 2005 Whurr Publishers Ltd. [source] Trauma in the family: groupwork on family awareness for men in high security hospitalCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2000Estelle Moore BSc MSc PhD C.Psychol Introduction It is typically considered important in clinical practice to generate an understanding of the relationships and consequences of interaction patterns within the families of patients with serious interpersonal difficulties and histories of violent offending. Method Eight men on a dedicated treatment unit for patients with personality disturbance within a maximum security hospital participated in structured groupwork which focused on family awareness. Results Two measures of outcome were employed: their recollections of family life were assessed before and after the intervention, and their general progress in rehabilitation was followed up 12 months later. Summary scores of the participants' recall of feelings associated with familial figures indicate that the group reported changes in their feelings over the eight-month period. For the duration of the group, and during the subsequent year, the group members remained on the same ward; two had been transferred to medium security at follow-up. Discussion The inherent bias and the small numbers in the group prevent generalization. However, it seems that patients who participated in group work are likely to remain on the ward studied or be moved to lower security. The recollection and sharing experiences of family life may have reduced the patients' sense of isolation. Copyright © 2000 Whurr Publishers Ltd. [source] Let eating disorder patients decide: Providing choice may reduce early drop-out from inpatient treatmentEUROPEAN EATING DISORDERS REVIEW, Issue 3 2009Walter Vandereycken Abstract Premature drop-out from treatment is a highly prevalent phenomenon among eating disorder (ED) patients. In a specialized inpatient treatment unit a major change was made in the admission strategy in 2001, giving a maximum of personal choice to the patients. A quasi-experimental research was carried out comparing 87 patients treated till 2000 (,old' strategy) with 87 patients treated from 2001 on (,new' strategy). The results indicate that the provision of choice at the beginning of treatment significantly reduced drop-out during the first weeks of inpatient treatment. No differences between both strategies on later drop-out and weight change (in anorexia nervosa patients) during inpatient treatment were found. The results are discussed in the light of the importance placed on dynamics of personal choice, autonomy and volition within the framework of the self-determination theory (SDT). Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] People with learning disabilities admitted to an assessment and treatment unit: impact on challenging behaviours and mental health problemsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 7 2008E. SLEVIN This study describes the evaluation of an assessment and treatment unit for people with learning disabilities. Results showed the main reasons for admission for the 48 people admitted to the unit were because of challenging behaviours and mental health problems. Valid and reliable scales were used to measure the behaviours and mental health problems of those admitted across three-time periods: pre-admission, during admission and post-admission. The analysis found significant reductions in challenging behaviours and mental health problems following admission to the unit. The unit was staffed by a multidisciplinary team with nurses making up the largest group of staff. A number of issues of concern are discussed including access to mental health services for people with learning disabilities, the need for robust community services and areas that require further research. In conclusion, the study found evidence supporting the value of the unit and how it may lessen distress in learning disabled people who are behaviourally disturbed. It is suggested that nurses played a key role in the unit but they need to make the support and caring they provide more visible. Nurses need to harness and make explicit the caring they provide for people with learning disabilities. [source] Optimizing the frequency of outpatient short-contact dithranol treatment used in combination with broadband ultraviolet B for psoriasis: a randomized, within-patient controlled trialBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2003S.R. Mcbride Summary Background Recent concerns over the side-effects of psoralen plus ultraviolet (UV) A, immunosuppressive and cytotoxic treatments have led to increased interest in dithranol for treatment of psoriasis. Few studies have investigated how frequently dithranol should be applied. Dithranol-induced inflammation is maximal at 48,72 h, suggesting that daily application of dithranol may not be optimal. Objectives To investigate the effectiveness of five times weekly application of short-contact dithranol (SCD) compared with three times weekly application in a dedicated hospital outpatient treatment unit. Methods A randomized, within-patient, controlled study was performed. Patients had SCD applied five times weekly to one half of the body, and three times weekly to the other side. Whole-body UVB irradiation was given 5 days a week. Patients were assessed weekly for 8 weeks. Principal outcome measures were percentage reduction in modified Psoriasis Area and Severity Index (mPASI) at the end of study and time to 50% improvement in mPASI score. Results Twenty-nine patients were recruited; four were excluded from analysis. Mean percentage reduction in mPASI score at the end of study for five times weekly application was 57·3% (95% confidence interval, CI 39·6,75·0%) and for three times weekly application was 55·4% (95% CI 37·8,73·1%; P = 0·34). Mean time to 50% improvement in mPASI for five times weekly treatment was 4·1 weeks and for three times weekly treatment was 4·0 weeks (P = 0·50). There was no difference in the frequency or severity of burning episodes for each side. Conclusions This study suggests that three times weekly application of SCD may be as effective as five times weekly when used in conjunction with UVB administered five times weekly. Large studies of whole-body comparisons are warranted to assess further the optimal frequency of SCD and UVB therapy for psoriasis. [source] Were the changes to Sweden's maintenance treatment policy 2000,06 related to changes in opiate-related mortality and morbidity?ADDICTION, Issue 9 2010Anders Romelsjö ABSTRACT Aims To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006. Design We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden. Setting Sweden. Participants Patients in maintenance treatment. Measurements Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations. Findings The surveys showed a marked change to a less restrictive policy, with increased use of ,take-away doses' and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20,30% reduction in opiate-related mortality and inpatient care between 2000,2002 and 2004,2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998,2006, statistically significant declines occurred only in Stockholm County. Conclusions The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues. [source] Quality assurance of specialised treatment of eating disorders using large-scale internet-based collection systems: Methods, results and lessons learned from designing the Stepwise databaseEUROPEAN EATING DISORDERS REVIEW, Issue 4 2010Andreas Birgegård Abstract Computer-based quality assurance of specialist eating disorder (ED) care is a possible way of meeting demands for evaluating the real-life effectiveness of treatment, in a large-scale, cost-effective and highly structured way. The Internet-based Stepwise system combines clinical utility for patients and practitioners, and provides research-quality naturalistic data. Stepwise was designed to capture relevant variables concerning EDs and general psychiatric status, and the database can be used for both clinical and research purposes. The system comprises semi-structured diagnostic interviews, clinical ratings and self-ratings, automated follow-up schedules, as well as administrative functions to facilitate registration compliance. As of June 2009, the system is in use at 20 treatment units and comprises 2776 patients. Diagnostic distribution (including subcategories of eating disorder not otherwise specified) and clinical characteristics are presented, as well as data on registration compliance. Obstacles and keys to successful implementation of the Stepwise system are discussed, including possible gains and on-going challenges inherent in large-scale, Internet-based quality assurance. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Accessibility of Addiction Treatment: Results from a National Survey of Outpatient Substance Abuse Treatment OrganizationsHEALTH SERVICES RESEARCH, Issue 3 2003Peter D. Friedmann Objectives This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment. Methods Program directors and clinical supervisors from a nationally representative panel of outpatient substance abuse treatment units in the United States were surveyed in 1990, 1995, and 2000. Accessibility was measured from clinical supervisors' reports of whether the treatment organization provided "treatment on demand" (an average wait time of 48 hours or less for treatment entry), and of whether the program turned away any patients. Results In multivariable logistic models, provision of "treatment on demand" increased two-fold from 1990 to 2000 (OR, 1.95; 95 percent CI, 1.5 to 2.6), while reports of turning patients away decreased nonsignificantly. Private for-profit units were twice as likely to provide "treatment on demand" (OR, 2.2; 95 percent CI, 1.3 to 3.6), but seven times more likely to turn patients away (OR, 7.4; 95 percent CI, 3.2 to 17.5) than public programs. Conversely, units that served more indigent populations were less likely to provide "treatment on demand" or to turn patients away. Methadone maintenance programs were also less likely to offer "treatment on demand" (OR, .65; 95 percent CI, .42 to .99), but more likely to turn patients away (OR, 2.4; 95 percent CI, 1.4 to 4.3). Conclusions Although the provision of timely addiction treatment appears to have increased throughout the 1990s, accessibility problems persist in programs that care for indigent patients and in methadone maintenance programs. [source] A study of the effect of isothiazolones on the performance and characteristics of a laboratory-scale rotating biological contactorJOURNAL OF APPLIED MICROBIOLOGY, Issue 1 2001L. Laopaiboon Aims: To study the effect of the isothiazolone biocide (Kathon WT) on the performance of laboratory-scale rotating biological contactors (RBCs) and their component biofilms. Methods and Results: Biofilms were established on the RBCs and then exposed to 0·7,15 p.p.m. isothiazolones. Young, 1-week-old, biofilms were found to attain treatment efficiency equal to that of mature, 2-month-old, biofilms. Isothiazolone concentrations at 3 p.p.m. and above caused a progressive decline in treatment efficiency and 15 p.p.m. isothiazolones inhibited all microbial activity and resulted in the death of the biofilms. Bio-oxidation and the biodegradation of isothiazolones within the biofilms ontinued unhindered at concentrations which caused the total inhibition of planktonic bacteria. Conclusions: There was at least a 10-fold difference in susceptibility of planktonic and biofilm bacteria to isothiazolones. The chemical oxygen demand (COD) test was shown to be a reliable tool for investigating the efficiency of wastewater treatment units when the influent contains isothiazolones, while the biochemical oxygen demand (BOD) was unreliable due to the inhibition of bio-oxidation by the biocide. Significance and Impact of the Study: The results show that RBCs can be used to treat effluents containing isothiazolones at concentrations up to 1·5 p.p.m. [source] A property-based optimization of direct recycle networks and wastewater treatment processesAICHE JOURNAL, Issue 9 2009José María Ponce-Ortega Abstract This article presents a mathematical programming approach to optimize direct recycle-reuse networks together with wastewater treatment processes in order to satisfy a given set of environmental regulations. A disjunctive programming formulation is developed to optimize the recycle/reuse of process streams to units and the performance of wastewater treatment units. In addition to composition-based constraints, the formulation also incorporates in-plant property constraints as well as properties impacting the environment toxicity, ThOD, pH, color, and odor. The MINLP model is used to minimize the total annual cost of the system, which includes the cost for the fresh sources, the piping cost for the process integration and the waste stream treatment cost. An example problem is used to show the application of the proposed model. The results show that the simultaneous optimization of a recycle network and waste treatment process yields significant savings with respect to a commonly-used sequential optimization strategy. © 2009 American Institute of Chemical Engineers AIChE J, 2009 [source] Phototherapy and PUVA photochemotherapy in childrenPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 2 2004S. A. Holme The use of phototherapy and photochemotherapy in children has been limited due to concerns over their long-term carcinogenic potential. Furthermore, the method of administration is disconcerting to some children, particularly as phototherapy treatment units are seldom rendered ,child-friendly'. Despite these reservations, ultra-violet therapies can be useful treatment options for children with selected dermatological conditions provided they are used under carefully controlled conditions. [source] Sampling Techniques Influence Understory Plant Trajectories After Restoration: An Example from Ponderosa Pine RestorationRESTORATION ECOLOGY, Issue 4 2003Julie E. Korb Abstract Although there is no one correct technique for sampling vegetation, the sampling design chosen may greatly influence the conclusions researchers can draw from restoration treatments. Considerations when designing vegetation sampling protocol include determining what sampling attributes to measure, the size and shape of the sampling plot, the number of replicates and their location within the study area, and the frequency of sampling. We installed 20 point-intercept transects (50-m long), 8 belt transects (10 × 50 m), 10 adapted Daubenmire transects (four 0.5 × 2-m plots), and 4 modified-Whittaker plots (20 × 50 m with smaller nested plots) in treatment and control units to measure understory herbaceous response in a forest restoration experiment that tested different treatments. Point-intercept transects on average recorded at least twice as much plant cover as did adapted Daubenmire transects and modified-Whittaker plots taken at the same location for all control and treatment units. Point-intercept transects and adapted Daubenmire plots on average captured fewer rare and exotic species in the control and treatment units in comparison with the belt transects and modified-Whittaker plots. Modified-Whittaker plots captured the highest species richness in all units. Early successional understory response to restoration treatments was likely masked by the response of the herbaceous community to yearly climatic variation (dry vs. wet years). Species richness and abundance were higher in wet years than dry years for all control and treatment units. Our results illustrate that sampling techniques can greatly influence perceptions of understory plant trajectories and therefore the interpretation of whether restoration goals have been achieved. In addition, our results suggest that restoration monitoring needs to be conducted for a sufficient length of time so that restoration treatment responses can be detected. [source] | ||||||||||||||||