Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Clients

  • adult client
  • care client
  • corporate client
  • health client
  • home care client
  • individual client
  • older client
  • other client
  • treatment client

  • Terms modified by Clients

  • client autonomy
  • client care
  • client characteristic
  • client company
  • client experience
  • client factor
  • client firm
  • client group
  • client groups
  • client need
  • client organization
  • client outcome
  • client perception
  • client perspective
  • client population
  • client pressure
  • client problem
  • client progress
  • client protein
  • client relationship
  • client relationships
  • client satisfaction

  • Selected Abstracts


    ADDICTION, Issue 2 2008
    No abstract is available for this article. [source]


    Jennifer L. Hodgson
    Knowledge of how one should manage suicidal, homicidal, child maltreatment, and domestic violence situations is paramount in the training of marriage and family therapists (MFTs). Simulated patient modules were created to help clinical faculty address these crisis situations in a protected learning environment. The modules were implemented by the MFT faculty in collaboration with the Office of Clinical Skills Assessment and Education at East Carolina University's Brody School of Medicine. Qualitative data over the course of 2 years revealed six thematic domains regarding therapists' performance, therapists' emotions, the simulation experiences, and lessons learned. Educational, clinical, and research recommendations include tools to implement simulation exercises into marriage and family therapy programs as well as suggestions to assess for teaching effectiveness. [source]


    Suzanne Bartle-Haring
    Using Bowen Family Systems Theory as a theoretical underpinning, in this study, we investigated the hypothesis that clients with higher levels of differentiation would improve more quickly in therapy than clients with lower levels of differentiation. Hierarchical Linear Modeling was used to analyze the data over nine sessions of therapy in a sample from an on-campus training clinic. The results suggest that there was variation in the initial levels of psychological symptoms and that differentiation was a significant predictor of this variance. The results also suggest that although psychological symptoms decreased over the nine sessions of therapy, there was very little variance in this change. These results are discussed in relation to Bowen Theory. The difficulties of doing this type of research and the lessons learned from this project are also discussed. [source]


    Angela Hetherington
    ABSTRACT This paper reviews recent literature pertaining to therapists who sexually exploit their clients. It examines some of the common characteristics that have been identified in therapists who abuse, and the psychosexual factors in their background. It goes on to discuss the dynamics which may prevail in the event of therapist abuse. Research suggests that therapists who exploit their role will only do so if they are in some way dysfunctional (Russell 1993). Similarly, therapists who abuse are found to have severe problems with their own sexual identities and experience a considerable amount of sexual anxiety and guilt in their personal relationships (Strean 1993b). It is suggested that their own unresolved conflicts take precedence over those of their clients and unconsciously they harbour a deep antipathy towards the practice of psychotherapy (Strean 1993a). [source]

    Impact of mixed-parallelism on parallel implementations of the Strassen and Winograd matrix multiplication algorithms

    F. Desprez
    Abstract In this paper we study the impact of the simultaneous exploitation of data- and task-parallelism, so called mixed-parallelism, on the Strassen and Winograd matrix multiplication algorithms. This work takes place in the context of Grid computing and, in particular, in the Client,Agent(s),Server(s) model, where data can already be distributed on the platform. For each of those algorithms, we propose two mixed-parallel implementations. The former follows the phases of the original algorithms while the latter has been designed as the result of a list scheduling algorithm. We give a theoretical comparison, in terms of memory usage and execution time, between our algorithms and classical data-parallel implementations. This analysis is corroborated by experiments. Finally, we give some hints about heterogeneous and recursive versions of our algorithms. Copyright © 2004 John Wiley & Sons, Ltd. [source]

    Serving two organizations: Exploring the employment relationship of contracted employees

    Jacqueline A-M Coyle-Shapiro
    Although growth has occurred in contract employment arrangements both in the public and private sectors, scant research has been conducted on the organizations and employees affected by these arrangements. This study examines the employment relationship of long-term contracted employees using a social exchange framework. Specifically, we examine the effects of employee perceptions of organizational support from contracting and client organizations on their (a) affective commitment to each organization and (b) service-oriented citizenship behavior. We also examine whether felt obligation toward each organization mediates this relationship. Our sample consists of 99 long-term contracted employees working for four contracting organizations that provide services to the public on behalf of a municipal government. Results indicate that the antecedents of affective commitment are similar for the client and contracting organization. Employee perceptions of client organizational supportiveness were positively related to felt obligation and commitment to the client organization. Client felt obligation mediated the effects of client perceived organizational support (POS) on the participation dimension of citizenship behavior. Our study provides additional support for the generalizability of social exchange processes to nontraditional employment relationships. Implications for managing long-term contracted employees are discussed. © 2006 Wiley Periodicals, Inc. [source]

    The Reliability, Validity and Practical Utility of Measuring Supports using the I-CAN Instrument: Part II

    Vivienne C. Riches
    Background, There is an urgent need for developing reliable, valid and practical instruments that assess and classify the support needed by persons with disability to function in their chosen living, working and social environments. I-CAN is an instrument that addresses the frequency and level of support needed (not individual skills or deficits) for each individual with a disability. Method, Studies were conducted to assess the test,retest reliability and inter-rater reliability. Concurrent validity was investigated by exploring the relationship between the I-CAN domain scales and the Inventory for Client and Agency Planning (ICAP) (Bruininks et al. 1986) and the Quality of Life Questionnaire (QOL-Q) (Schalock & Keith 1993). Predictive validity studies were undertaken using day- and night-time support hours. Regression analyses were run using these measures with I-CAN domain scales. Two independent studies were also conducted to ascertain the practical utility of the instrument. Results, The I-CAN instrument demonstrated excellent inter-rater and test,retest reliability in the Activities and Participation domains. Low-to-moderate test,retest results in Physical Health, Mental Emotional Health and Behaviour domains were tracked to actual change in support needs in these areas. Validity proved acceptable. The relationships between I-CAN domain scales and adaptive behaviour were mixed but in the expected direction. Low-to-moderate correlation coefficients were evident between the I-CAN scales and the QOL-Q Total, but greater support needed in certain domains was associated with less empowerment and independence, and less community integration and social belonging. Attempts to explain current support hours against the I-CAN scales were disappointing and suggest that a number of other factors apart from individual support need to play a significant role. There was general satisfaction with the assessment process from stakeholders and participant groups. Conclusions, I-CAN is a reliable, valid and user-friendly instrument for assessing the support needs of people with disabilities. It uses a process that involves the persons with disability, their family and friends and staff as appropriate. It is also apparent that the current provision of paid support hours by agencies is a complex phenomenon that is not based solely on individual support needs. Further research is warranted on the influence of the environment and the perceptions of need for support based on negotiable and non-negotiable support needs. [source]

    An Evaluation of Client Satisfaction With Training Programs and Technical Assistance Provided by Florida's Coordinated School Health Program Office

    Robert M. Weiler
    ABSTRACT: Client or customer satisfaction surveys assess the perceived quality of programs, products, services, and employee performance. Such assessments prove beneficial for evaluation and planning purposes. This survey examined the satisfaction of clients using the programs, services, and technical assistance provided through the Coordinated School Health Program Office (CSHPO) in the Florida Department of Education. Using the 42-item Client Satisfaction Survey, data were collected in summer 1999 from 300 of 574 clients (52.3%) who attended training sessions or sought technical assistance from CSHPO during 1996,1999. More than two-thirds (67.2%) of clients rated the training programs as "very good" or "excellent" at increasing their understanding about the concept of a coordinated school health program. Overall, 69.7% of clients rated the training programs they attended as "very good" or "excellent." Resource materials and staff effectiveness rated positively as well. Findings confirmed client satisfaction with CSHPO's training programs, technical assistance, and staff. Information obtained through the client satisfaction survey can be used by CSHPO to assist in future program planning and resource allocations. [source]

    Evaluating the use of plasma hematocrit samples to detect ketones utilizing urine dipstick colorimetric methodology in diabetic dogs and cats

    Mark A. Brady DVM
    Abstract Objective: To determine whether plasma from a heparinized hematocrit tube placed on a urine dipstick would accurately reflect (positive or negative) urine ketone results in diabetic dogs and cats. Design: Prospective study, 37 dogs and 43 cats, with a known history of diabetes or hyperglycemia, glucosuria, and symptoms of undiagnosed diabetes mellitus were tested. Setting: Veterinary Referral Hospital. Animals: Client owned dogs and cats. Interventions: None. Measurement and main results: Heparinized plasma and urine ketone results were recorded using urine reagent strips. Plasma dipstick results were compared to urine dipstick results as the standard. Results were recorded based on the color chart provided by the manufacturer. Two individuals were responsible for verifying the results of the colorimetric test. Test efficiency was 97% (sensitivity = 96%, specificity = 100%) for the canine population, 93% (sensitivity = 100%, specificity = 83%) for the feline population, and 95% (sensitivity = 98%, specificity = 91%) for the total population. Four of 80 animals were found to have discordant results (1 dog and 3 cats). Conclusion: Plasma from heparinized hematocrit tubes is clinically useful for detecting the presence or absence of ketonuria, and therefore ketosis, in diabetic dogs and cats using urine dipstick colorimetric methodology. [source]

    Evaluation of Abdominal Fluid: Peripheral Blood Creatinine and Potassium Ratios for Diagnosis of Uroperitoneum in Dogs

    Chad Schmiedt DVM, DACVS
    Objective:To determine the clinical efficacy of abdominal fluid to peripheral blood ratios of creatinine and potassium concentrations to diagnose uroperitoneum in dogs. Design:Records of 13 dogs with confirmed uroabdomen were retrospectively analyzed. Prospective evaluation of 8 dogs with nonrenal ascites provided data for a control population. Setting:Veterinary Medical Teaching Hospital. Animals:Client owned dogs. Interventions:None Measurements and Main Results:Abdominal fluid potassium (mEq/L) and creatinine concentrations (mg/dl) were recorded. Peripheral blood potassium and creatinine concentrations were also recorded. Ratios were calculated based on these values. An abdominal fluid creatinine concentration to peripheral blood creatinine concentration ratio of > 2:1 was predictive of uroabdomen in dogs (specificity 100%, sensitivity 86%). An abdominal fluid potassium concentration to peripheral blood potassium concentration of > 1.4:1 is also predictive of uroabdomen in dogs (specificity 100%, sensitivity 100%). All dogs with uroabdomen had an abdominal fluid creatinine concentration that was at least 4 times normal peripheral blood levels. Conclusion:Abdominal fluid to peripheral blood potassium and creatinine ratios provide a means to diagnose uroperitoneum in dogs without elevated peripheral blood creatinine. [source]

    Client experiences in work rehabilitation in Sweden: a one-year follow-up study

    Eva Wallstedt-Paulsson
    Abstract This study, carried out in a work rehabilitation unit in Sweden, investigated how clients perceived their work experiences after a one-year follow up. A semi-structured interview was administered to 14 former clients and a content analysis was applied. Seven categories were derived from the results: ,Expectations of the rehabilitation process'; ,Social relationships'; ,Client influences on the rehabilitation process'; ,Occupations engaged in during the rehabilitation programme'; ,Perceived outcome'; ,Current occupations'; and ,Future aspirations'. The dominating expectations were to find a job, with an overall desire for change. The social relationships with the staff and other clients were of great importance. The positive outcome of the rehabilitation was described as feeling better or having new skills. The perceived negative outcome was that the rehabilitation programme had not turned out as the client expected. The clients reported varying daily occupations after the rehabilitation experience and a majority were contented and optimistic about their future. The main conclusions of the study are that when planning a work rehabilitation programme, efforts have to be made to examine clients' interests and skills, and to develop a dialogue between clients and staff. Further research is needed to evaluate the work rehabilitation experience from the clients' perspective. Copyright © 2007 John Wiley & Sons. Ltd. [source]

    A Decision Support System Specification for Cost Escalation in Heavy Engineering Industry

    Nashwan N. Dawood
    The heavy civil engineering industry (railways, sewage-treatment, chemical and pharmaceutical facilities, oil and gas facilities, etc.) is one of the major contributors to the British economy and generally involves a high level of investment. Clients in this industry are demanding accurate cost estimates, proper analysis of out-turn cost and cost escalation, and a high quality risk analysis throughout the construction processes. Current practices in the industry have suggested that there is a lack of structured methodologies and systematic cost escalation approaches to achieve an appropriate cost analysis at the outset of projects and throughout the construction processes. In this context the prime objective of this research work is to develop a structured cost escalation methodology for improving estimating management and control in the heavy engineering industry construction processes. The methodology is composed of a forecasting model to predict cost indices of major items in industry and a risk knowledge-base model for identifying and quantifying causes of cost escalations. This paper reviews and discusses a knowledge-based model for applying a cost escalation factor. The cost escalation factor is made up of market variation, a risk element, and a component for bias. A knowledge elicitation strategy was employed to obtain the required knowledge for the model. The strategy included questionnaires, interviews, and workshops, and deliverables came in the form of influences and their effect on project cost escalation. From these deliverables, a decision support system and specifications for applying cost escalation to base estimates are presented. [source]

    Tunable scheduling in a GridRPC framework

    A. Amar
    Abstract Among existing grid middleware approaches, one simple, powerful, and flexible approach consists of using servers available in different administrative domains through the classic client,server or remote procedure call paradigm. Network Enabled Servers (NES) implement this model, also called GridRPC. Clients submit computation requests to a scheduler, whose goal is to find a server available on the grid using some performance metric. The aim of this paper is to give an overview of a NES middleware developed in the GRAAL team called distributed interactive engineering toolbox (DIET) and to describe recent developments around plug-in schedulers, workflow management, and tools. DIET is a hierarchical set of components used for the development of applications based on computational servers on the grid. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    Audit Committee, Board Characteristics, and Auditor Switch Decisions by Andersen's Clients,

    Ken Y. Chen
    First page of article [source]

    Drug misuse and acquisitive crime among clients recruited to the National Treatment Outcome Research Study (NTORS)

    Duncan Stewart
    Background Criminal activity among drug-misusing populations can result in considerable costs. This paper examines the relationship between acquisitive criminal behaviour and drug use among a cohort of 1075 clients recruited to the National Treatment Outcome Research Study (NTORS). Method Clients were recruited from 54 drug misuse treatment programmes in England. A structured interview was administered by clinical staff. The majority of clients were opiate-dependent poly-drug users. Results 27 000 acquisitive criminal offences were reported by the cohort in the three months prior to starting treatment, of which shoplifting was the most common offence. There was marked variation in the amount of acquisitive crime reported; just 10% of the sample were responsible for three-quarters of the crimes committed. Two other groups were identified: low-rate offenders, and those who did not commit an acquisitive crime. Multivariate analyses revealed that frequency of illicit drug use was associated with increased levels of criminal behaviour. Compared with the no-crime group, the high-rate offenders were 11 times more likely to be regular users of heroin, and three times more likely to have used cocaine regularly. Discussion These findings suggest that the most dependent and problematic drug misusers present treatment services with the greatest challenge in terms of reducing levels of criminality. Copyright © 2000 Whurr Publishers Ltd. [source]

    Patients' help-seeking behaviours for health problems associated with methadone and buprenorphine treatment

    Abstract Introduction and Aims. Clients in opioid substitution therapy often have considerable unmet health-care needs. The current study aimed to explore health problems related to opioid substitution therapy among clients on methadone and buprenorphine treatment. Design and Methods. A self-complete, cross-sectional survey conducted among 508 patients receiving methadone and buprenorphine treatment at community pharmacies in New South Wales (NSW), Australia. Results. The most common problems for which participants had ever sought help were dental (29.9%), constipation (25.0%) and headache (24.0%). The most common problems for which participants would currently like help were dental (41.1%), sweating (26.4%) and reduced sexual enjoyment (24.2%). There were no significant differences between those currently on methadone and those currently on buprenorphine for any of the health problems explored, nor differences for gender or treatment duration. Participants on methadone doses 100 mg or above were significantly more likely to want help currently for sedation. Discussion and Conclusions. The considerable unmet health care needs among participants in this study suggest that treatment providers should consider improving the detection and response to common health problems related to opioid substitution therapy. [source]

    Process evaluation of an out-patient detoxification service

    Abstract This paper describes the process evaluation of an out-patient detoxification service (ODS) established by Drug Health Services (DHS) to increase the supervised withdrawal options for substance users in a Sydney metropolitan Area Health Service. The ODS aimed to provide a safe and effective supervised withdrawal to substance users who were at low risk of severe withdrawal, engage those with severe dependence in further treatment and increase the involvement of general practitioners (GPs) in the medical care of ODS clients. During its first 10 months of operation, the ODS received 199 inquiries, assessed 82 individuals and admitted 76 clients for detoxification. Withdrawal treatment proceeded without complications and within the expected time frames. Fifty-four clients completed withdrawal, 10 ceased treatment, 10 remained in treatment without completing withdrawal and two were transferred elsewhere. Clients who injected substances (mainly heroin) daily at admission, compared to others, were less likely to complete withdrawal and more likely to use a range of non-prescribed substances during withdrawal. One-fifth of clients went on to further treatment with DHS, attending at least once. Overall, the ODS met its goals, providing a safe and effective supervised withdrawal to local residents, especially women, young people and those withdrawing from benzodiazepines who had significant substance dependence, impairment and previous alcohol and other drug (AOD) treatment. Non-injecting substance users benefited most from the ODS in terms of withdrawal completion and ongoing treatment. The level of GP involvement in the conjoint care of ODS clients remained constant over time. The development and expansion of the ODS are discussed. [source]

    Early intervention with difficult to engage, ,high-risk' youth: evaluating an intensive outreach approach in youth mental health

    Carsten Schley
    Abstract Background: Although intensive outreach (IO) models such as assertive community treatment and intensive case management have a strong evidence base in adult psychiatry, their effectiveness in the early intervention sector is unknown. Aim: To explore client characteristics and treatment effects in a group of difficult to engage, ,high-risk' young people, seen by the Intensive Mobile Youth Outreach Service (IMYOS, ORYGEN Youth Heath) in Western Metropolitan Melbourne. Methods: The clinical files of 47 clients were audited, targeting demographic and treatment outcome data prior to and during IMYOS involvement. Results: Clients typically presented with traumatic childhoods, disrupted education, repeated treatment dropout, poor mental health and ,high-risk' behaviours. Results showed a significant reduction in risk to self and others between referral and discharge, and significantly lower admissions rates and inpatient days compared with the 9 months prior to referral. Conclusions: IO might be an effective early intervention strategy to minimize risk of harm and decrease hospitalization in young people. However, conclusions are provisional as there was no control group included in this study. Further study is required, perhaps with a waiting list control. [source]

    Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study

    ADDICTION, Issue 1 2008
    Michael Gossop
    ABSTRACT Aims This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence. It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes. Methods Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4,5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers. Findings Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels. Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up. Abstinence from stimulants increased at follow-up but (except at 1-year follow-up) no additional benefit was found for NA/AA attendance. There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points. More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders. Conclusions NA/AA can support and supplement residential addiction treatment as an aftercare resource. In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups. [source]

    Eating disturbance and severe personality disorder: outcome of specialist treatment for severe personality disorder

    Fiona Warren
    Abstract Objective To assess the outcome for patients receiving specialist democratic therapeutic community treatment for personality disorder (PD) when they also have eating disturbance. Method Prospective, naturalistic study. Personality psychopathology and disturbed eating attitudes of 135 male and female referrals to tertiary treatment for PD were assessed at referral. Seventy-five referrals were admitted for treatment and 60 were not. Participants were reassessed at 1-year follow-up. Results There was a significant effect of treatment on dieting but not other aspects of eating disturbance. However, patients with eating disturbance were not more likely than those without to terminate treatment early or to have poorer outcome in terms of their personality pathology. Severity of baseline personality pathology did not predict treatment response. Conclusion Clients with comorbidity should be considered for treatment of the personality disorder prior to treatment for the eating disorder. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

    Ontogenesis in Narrative Therapy: A Linguistic-Semiotic Examination of Client Change

    FAMILY PROCESS, Issue 1 2004
    Peter Muntigl Ph.D.
    In this article I investigate how the narrative therapy process facilitates client change. The kind of change that I focus on is linguistic-semiotic; that is, how clients develop their meaning potential through language. What I will demonstrate is how an examination of the linguistic-semiotic level provides new insights into narrative therapy's role in endowing clients with the semiotic materials to make new meanings. An examination of six conjoint sessions involving a narrative therapist with one couple revealed that client change or ontogenesis is composed of three semiotic phases. In the first phase of ontogenesis clients display a beginning semiotic repertoire by formulating "extreme case" descriptions of self and other's behaviors. In the second phase clients are scaffolded by therapist's questions and reformulations into construing events as problems and problems as the agents of negative behaviors. In the final phase clients display a development in their semiotic potential. Clients are able to eliminate problems and construe themselves as agents without prior therapist scaffolding. Therefore, in the latter stages of the narrative process clients are able to deploy meanings that have been generated throughout therapy, in order to produce narratives of self agency and self control. [source]

    Multiple Realities: A Relational Narrative Approach in Therapy With Black,White Mixed-Race Clients

    FAMILY RELATIONS, Issue 2 2003
    Kerry Ann Rockquemore
    Notions of a racial identity for persons with one Black and one White parent have assumed the existence of only a singular identity (first Black and later biracial). Emerging empirical research on racial identity formation among members of this group reveals that multiple identity options are possible. In terms of overall health, the level of social invalidation one encounters with respect to racial self-identification is more important than the specific racial identity selected. Here a relational narrative approach to therapy with Black,White mixed-race clients who experience systematic invalidation of their chosen racial identity is presented through a detailed case illustration. [source]

    Evidence from the United States on the Effect of Auditor Involvement in Assessing Internal Control over Financial Reporting

    Jean C. Bedard
    Securities regulators around the world are considering the costs and benefits of alternative policies for providing information to financial markets on corporate internal control. These policy options differ on the level of auditor involvement, among other dimensions. We examine the association of relative auditor involvement and auditor characteristics with Section 302 internal control disclosures made by US ,non-accelerated filers' from 2003 to 2005. We find more material weaknesses disclosed in the fourth quarter, when there is relatively more auditor involvement, relative to the first three quarters. Clients of larger audit firms have higher disclosure rates (although they are probably less risky due to more stringent client acceptance standards), but this difference is due to fourth quarter disclosures. Audit firms with Section 404 experience also have greater material weakness disclosure, implying process improvement associated with knowledge sharing across engagements. Collectively, our results shed light on ways to increase the effectiveness of internal control regulation. [source]

    Costs of community-based public mental health services for older adults: variations related to age and diagnosis

    Todd Gilmer
    Abstract Background Several studies have examined service use among older adults although, to our knowledge, none has examined costs from a systems perspective. This study examined use and costs of mental health services among older adults in San Diego County in order to determine how expenditures and modes of service varied by age cohort and psychiatric diagnosis. Methods Utilization data from San Diego County Adult and Older Adult Mental Health Services (AOAMHS) were used to identify older adults (age,,,60) receiving services in the community during fiscal year 2003,2004. Cost data were derived from detailed examination of cost reports, and Medicaid fee schedules. Trends in demographic and clinical characteristics by six age cohorts were described. Multivariate models were used to estimate the relationships between costs, age, and clinical diagnosis while controlling for other demographic and clinical characteristics. Components of costs were also examined. Results Total expenditures declined from age cohorts 60,64 through ages 85 and over. Expenditures were similar, and greatest, for clients with schizophrenia and bipolar disorder, while outlays were lower for those with major depression, other psychotic disorder, other depression, anxiety, substance use disorder, and cognitive disorders. Clients diagnosed with cognitive disorder had high use of emergency services and little connection to outpatient services. Conclusions Expenditures were related to age and clinical diagnosis. Future efforts should investigate older adults' pathways to care, and should determine whether older adults presenting in emergency services would benefit from a specialized case management program providing linkages to community based resources. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    Pilot randomised controlled trial of community pharmacy administration of buprenorphine versus methadone

    Isobel M Cameron research fellow
    Objectives The established regime for opiate substitute prescribing for drug misusers is daily methadone administered under supervision in community pharmacies. Buprenorphine has recently been introduced as an alternative. However there is a lack of evidence of the effectiveness of buprenorphine maintenance therapy (BMT) in the UK treatment setting. This study aimed to assess methods for a randomised controlled trial (RCT) and the feasibility of pharmacy-based supervised self-administration (SSA) of buprenorphine compared to methadone. Setting Specialist substance misuse service, general practices and community pharmacies in Aberdeen, Scotland. Method The design was a pilot RCT. Opiate-dependent drug misusers, newly referred for maintenance treatment were randomised to receive BMT or methadone maintenance therapy (MMT). Clients and pharmacists were interviewed at baseline and at the end of a 12-week intervention period. Clients completed the quality of life measure EQ-5D. Pharmacy activities were timed. Key findings Twenty-one opiate-dependent clients were recruited (BMT = 11, MMT = 10). Recruitment levels improved as the trial progressed. Clients' treatment preferences were evident. Withdrawals occurred early with BMT. Clients found SSA of buprenorphine acceptable, but found daily administration more manageable than three times weekly. Pharmacists found the dispensing of buprenorphine to be an acceptable role, but felt less certain of ensuring against diversion with buprenorphine than they were with methadone. Pharmacy activities associated with buprenorphine took longer than those associated with methadone (mean = 7 min 25 s versus mean = 3 min 27 s, respectively). Conclusion Recruitment to a trial comparing MMT to BMT for opiate-dependent clients within a UK treatment setting is feasible. Clients and pharmacists found buprenorphine acceptable. [source]

    Effects of Multiple Clients on the Reliability of Audit Reports

    ABSTRACT This paper demonstrates the existence of two different kinds of externalities induced by an auditor servicing multiple clients at the same time. First, we show that the capital market price for a client can increase in the number of qualified reports that his auditor issues to his other clients, thus producing a stock price externality. Second, when the audit firm has limited wealth, an additional client can actually decrease the audit quality and increase the average likelihood of audit failure relative to a single-client setting because of reporting externalities. Our analysis also demonstrates how requiring a more effective audit oversight mechanism can actually produce unintended consequences such as an increased likelihood of audit failures. [source]

    Effectiveness of Falls Clinics: An Evaluation of Outcomes and Client Adherence to Recommended Interventions

    Keith D. Hill PhD
    OBJECTIVES: To evaluate outcomes associated with falls clinic programs. DESIGN: Longitudinal. SETTING: Thirteen outpatient falls clinics in Victoria, Australia. PARTICIPANTS: Four hundred fifty-four people referred for clinic assessment (mean age±standard deviation 77.9±8.8; 73% female). INTERVENTION: After assessment, multifactorial interventions were organized to address identified risk factors. MEASUREMENTS: A Minimum Data Set was developed and used across all clinics to derive common data on falls, falls injuries, and secondary measures associated with falls risk, including balance, falls efficacy, gait, leg strength, function, and activity. All measures were repeated 6 months later. RESULTS: Clients had a high risk of falls, with 78% having had falls in the preceding 6 months (63% multiple fallers, 10% experiencing fractures from the falls). An average of 7.6±2.8 falls risk factors were identified per client. The clinic team organized an average of 5.7±2.3 new or additional interventions per client. Sixty-one percent of eligible clients returned for the 6-month assessment. At this time, there was more than a 50% reduction in falls, multiple falls, and fall injuries (P,.004) and small but significant improvements evident on secondary measures of balance, leg strength, gait speed, and confidence outcomes (P<.006). Average adherence to recommendations was 74.3%. Factors associated with higher adherence included being male, younger than 65, living with others, and having a caregiver (P<.05). CONCLUSION: This large multicenter study identified high falls risk of older people referred to falls clinics, the multifactorial nature of their presenting problems and provides preliminary evidence of positive outcomes after falls clinic management. [source]

    Optimism and Pessimism in Matching Clients to Alcoholism Treatments,

    Mark D. Litt
    First page of article [source]

    Your vanishing vendors: Lessons from bank M&As

    James S. Sagner
    What should corporate clients of banks do during the current period of bank consolidations? The author of this article,a treasury consultant,says that lessons from bank mergers and acquisitions (M&As) can be used by firms whose other vendors are also undergoing mergers. That includes vendors who provide information processing, financial transactions, accounting, tax preparation, and other services. Clients are facing the very real prospect of their long-term vendor relationships vanishing,to be replaced by unknown firms from another part of the globe. © 2010 Wiley Periodicals, Inc. [source]

    Ectoparasites: are they the proximate cause of cleaning interactions?

    I. M. Côté
    We tested the importance of ectoparasites in cleaning symbioses by comparing the activity of Caribbean cleaning gobies (Elacatinus evelynae) and of their clients during three daily periods (early morning, midday and late afternoon) in which ectoparasite availability varied naturally. Emergence from the benthos of gnathiid isopod larvae, the main target of cleaning goby predation, was higher at night, when cleaners are inactive, than during the day. Overall ectoparasite loads also tended to be higher on clients in the morning. This coincided with higher rates of visits to cleaning stations by client fish in the morning than at midday, but high rates of client visits were also recorded in the late afternoon. Clients were more likely to adopt stereotypical incitation poses, which increase the likelihood of being cleaned, in the morning than later in the day. Inspection bouts by cleaning gobies were longest in the morning. Cleaner and client behaviours therefore change predictably in response to natural diurnal variation in ectoparasite availability. These results add to a growing number of studies supporting the idea that cleaning symbioses are mutualisms dependent on ectoparasite removal. [source]