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Selected AbstractsFeasibility and validity of low-budget telephonic follow-up interviews in routine outcome monitoring of substance abuse treatmentADDICTION, Issue 7 2009Suzan C.C. Oudejans ABSTRACT Aims Routine outcome monitoring (ROM) is receiving growing attention. However, follow-up interviews are time-consuming and costly. This study examines the feasibility and validity of low-budget telephonic follow-up interviews for ROM in a substance abuse treatment centre (SATC). Design Observational study using data collected for routine outcome monitoring. Setting The study was performed in a SATC in an urban area in the Netherlands. Participants Feasibility and validity were assessed on data of 2325 patients. Measurements Data on pre-treatment socio-demographic and clinical characteristics were collected using electronic patient records (EPRs) and the European version of the Addiction Severity Index (EuropASI). Data on intensity of treatment were also collected through the EPRs. Telephonic follow-up interviews were conducted between 9 and 10 months after intake. Findings A 53% follow-up rate was achieved; 35% of the patients could not be contacted, 3% explicitly refused and in 8% other reasons accounted for non-participation. About 50% of the interviews took place in the intended time-frame. Costs were ,40 ($57) per completed interview. There were indications of selection bias, because patients with cocaine as their primary problem and patients with polysubstance abuse were under-represented in the follow-up sample; the presence of these disorders is associated with negative treatment outcome. Conclusions Implementing telephonic low-budget follow-up interviews for ROM is feasible, but selection bias threatens internal validity of data, limiting generalization to the total treatment population. Increased efforts to track patients for follow-up may improve generalization. [source] Venous needle dislodgement during hemodialysis: An unresolved risk of catastrophic hemorrhageHEMODIALYSIS INTERNATIONAL, Issue 1 2005S. Sandroni Venous line disconnection or needle dislodgement during hemodialysis with resultant hemorrhage is a potentially lethal event. The risk is compounded by the frequent failure of standard dialysis machines to detect the event, as blood flow through the venous needle typically creates enough back pressure to prevent venous pressure alarms even if the needle is completely out of the patient's AV access. Manufacturers are well aware of the risk and device literature contains specific warnings about it. The FDA publishes reports on its website about these events; so far this year there have been seven reported events with five deaths. Informal sources indicate that the actual (unreported) occurrence is much more frequent; we are aware of four additional events within our region alone. Efforts to reduce the risk include protocols requiring the access needles to always be visible, and use of enuresis detection devices. Anecdotal experience with these efforts suggests they are not highly effective. Protocols requiring documentation of more frequent needle site checks or alternate methods of securing the needles have not been formally evaluated. However, such efforts do not address the primary problem: there is a need for an engineered solution to this problem. Requirements for such a solution include: reliable detection of needle position and blood flow discrepancies, a useful alarm, and feedback to stop the blood pump. Persistence of this problem raises issues of regulatory oversight. [source] The Role of Benzodiazepines in the Treatment of InsomniaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2001Meta-Analysis of Benzodiazepine Use in the Treatment of Insomnia PURPOSE: To obtain a precise estimate of the efficacy and common adverse effects of benzodiazepines for the treatment of insomnia compared with those of placebo and other treatments. BACKGROUND: Insomnia, also referred to as disorder of initiating or maintaining sleep, is a common problem and its prevalence among older people is estimated to be 23% to 34%.1 The total direct cost in the United States for insomnia in 1995 was estimated to be $13.9 billion.2 The complaint of insomnia in older people is associated with chronic medical conditions; psychiatric problems, mainly depression, chronic pain, and poor perceived general condition;1,3,4 and use of sleep medications.5 Thus in most cases, insomnia is due to some other underlying problem and is not just a consequence of aging.6 Accordingly, the management of insomnia should focus on addressing the primary problem and not just short-term treatment of the insomnia. Benzodiazepines belong to the drug class of choice for the symptomatic treatment of primary insomnia.7 This abstract will appraise a meta-analysis that compared the effect of benzodiazepines for short-term treatment of primary insomnia with placebo or other treatment. DATA SOURCES: Data sources included articles listed in Medline from 1966 to December 1998 and the Cochrane Controlled Trials Registry. The medical subject heading (MeSH) search terms used were "benzodiazepine" (exploded) or "benzodiazepine tranquillizers" (exploded) or "clonazepam,""drug therapy,""randomized controlled trial" or "random allocation" or "all random,""human," and "English language." In addition, bibliographies of retrieved articles were scanned for additional articles and manufacturers of brand-name benzodiazepines were asked for reports of early trials not published in the literature. STUDY SELECTION CRITERIA: Reports of randomized controlled trials of benzodiazepine therapy for primary insomnia were considered for the meta-analysis if they compared a benzodiazepine with a placebo or an alternative active drug. DATA EXTRACTION: Data were abstracted from 45 randomized controlled trials representing 2,672 patients, 47% of whom were women. Fifteen studies included patients age 65 and older and four studies involved exclusively older patients. Twenty-five studies were based in the community and nine involved inpatients. The duration of the studies ranged from 1 day to 6 weeks, with a mean of 12.2 days and median of 7.5 days. The primary outcome measures analyzed were sleep latency and total sleep duration after a sleep study, subjects' estimates of sleep latency and sleep duration, and subjects' report of adverse effects. Interrater reliability was checked through duplicate, independent abstraction of the first 21 articles. Overall agreement was between 95% and 98% (kappa value of 0.90 and 0.95 accordingly) for classification of the studies and validity of therapy, and 76% (kappa value of 0.51) for study of harmful effects. A scale of 0 to 5 was used to rate the individual reports, taking into account the quality of randomization, blinding, follow-up, and control for baseline differences between groups. Tests for homogeneity were applied across the individual studies and, when studies were found to be heterogeneous, subgroup analysis according to a predefined group was performed. MAIN RESULTS: The drugs used in the meta-analysis included triazolam in 16 studies; flurazepam in 14 studies; temazepam in 13 studies; midazolam in five studies; nitrazepam in four studies; and estazolam, lorazepam, and diazepam in two studies each. Alternative drug therapies included zopiclone in 13 studies and diphenhydramine, glutethimide, and promethazine in one study each. Only one article reported on a nonpharmacological treatment (behavioral therapy). The mean age of patients was reported in 33 of the 45 studies and ranged between 29 and 82. SLEEP LATENCY: In four studies involving 159 subjects, there was sleep-record latency (time to fall asleep) data for analysis. The pooled difference indicated that the latency to sleep for patients receiving a benzodiazepine was 4.2 minutes (95% CI = (,0.7) (,9.2)) shorter than for those receiving placebo. Patient's estimates of sleep latency examined in eight studies showed a difference of 14.3 minutes (95% CI = 10.6,18.0) in favor of benzodiazepines over placebo. TOTAL SLEEP DURATION: Analysis of two studies involving 35 patients in which total sleep duration using sleep-record results was compared indicated that patients in the benzodiazepine groups slept for an average of 61.8 minutes (95% CI = 37.4,86.2) longer than those in the placebo groups. Patient's estimates of sleep duration from eight studies (566 points) showed total sleep duration to be 48.4 minutes (95% CI = 39.6,57.1) longer for patients taking benzodiazepines than for those on placebo. ADVERSE EFFECTS: Analysis of eight studies (889 subjects) showed that those in the benzodiazepine groups were more likely than those in the placebo groups to complain of daytime drowsiness (odds ratio (OR) 2.4, 95% confidence interval (CI) = 1.8,3.4). Analysis of four studies (326 subjects) also showed that subjects in the benzodiazepine groups were more likely to complain of dizziness or lightheadedness than the placebo groups. (OR 2.6, 95% CI = 0.7,10.3). Despite the increased reported side effects in the benzodiazepine groups, drop-out rates were similar in the benzodiazepine and placebo groups. For patient reported outcome, there was no strong correlation found for sleep latency data, (r = 0.4, 95% CI = (,0.3) (,0.9)) or for sleep duration (r = 0.2, 95% CI = ,0.8,0.4) between benzodiazepine dose and outcome. COMPARISON WITH OTHER DRUGS AND TREATMENTS: In three trials with 96 subjects, meta-analysis of the results comparing benzodiazepines with zopiclone, did not show significant difference in sleep latency in the benzodiazepine and placebo groups, but the benzodiazepine groups had increased total sleep duration (23.1 min. 95% CI = 5.6,40.6). In four trials with 252 subjects, the side effect profile did not show a statistically significant difference (OR 1.5, CI 0.8,2.9). There was only one study comparing the effect of behavioral therapy with triazolam. The result showed that triazolam was more effective than behavioral therapy in decreasing sleep latency, but its efficacy declined by the second week of treatment. Behavioral therapy remained effective throughout the 9-week follow-up period. There were four small trials that involved older patients exclusively, with three of the studies having less than 2 weeks of follow-up. The results were mixed regarding benefits and adverse effects were poorly reported. CONCLUSION: The result of the meta-analysis shows that the use of benzodiazepines results in a decrease in sleep latency and a significant increase in total sleep time as compared with placebo. There was also a report of significantly increased side effects, but this did not result in increased discontinuation rate. There was no dose-response relationship for beneficial effect seen with the use of benzodiazepines, although the data are scant. Zopiclone was the only alternative pharmacological therapy that could be studied with any precision. There was no significant difference in the outcome when benzodiazepines were compared with zopiclone. There was only one study that compared the effect of benzodiazepines with nonpharmacological therapy; thus available data are insufficient to comment. [source] Deficits in interval timing measured by the dual-task paradigm among children and adolescents with attention-deficit/hyperactivity disorderTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 3 2010Shoou-Lian Hwang Background:, The underlying mechanism of time perception deficit in long time intervals in attention-deficit/hyperactivity disorder (ADHD) is still unclear. This study used the time reproduction dual task to explore the role of the attentional resource in time perception deficits among children and adolescents with ADHD. Methods:, Participants included 168 children and adolescents with DSM-IV ADHD and 90 control children and adolescents without ADHD, aged 10 to 17 years, in Taipei. The DSM-IV diagnoses of ADHD and other psychiatric comorbid conditions were made by clinical assessments and confirmed by the psychiatric interviews of both parents and participants using the Chinese Kiddie Epidemiologic version of the Schedule for Affective Disorders and Schizophrenia. The participants were also assessed by using the Wechsler Intelligence Scale for Children-3rd edition (WISC-III), and time reproduction tasks (the single task and the simple and difficult versions of the dual tasks) at 5-second, 12-second, and 17-second intervals. The linear mixed model was used for data analysis. Results:, Children and adolescents with ADHD had less precise time reproduction than the controls in all three tasks except the 5-second interval of the single task. There were significant interactions between group and interval (12-second vs. 5-second, p = .030; 17-second vs. 5-second, p < .001), and between group and task (simple dual task vs. single task, p = .016; difficult dual task vs. single task, p < .001) after controlling for FSIQ, comorbidity, sex, age, use of methylphenidate, and the performance of the non-temporal tasks in dual tasks, if relevant. Conclusions:, Significantly increased estimation errors in ADHD with increased task difficulties suggest that impaired timing processing in children and adolescents with ADHD during long time intervals may be accounted for by the limited attentional capacity rather than a primary problem in timing per se. This finding does not apply to rapid time intervals, in which cerebellar circuitry is important. [source] Modelling the chloride signal at Plynlimon, Wales, using a modified dynamic TOPMODEL incorporating conservative chemical mixing (with uncertainty)HYDROLOGICAL PROCESSES, Issue 3 2007T. Page Abstract The application of a modified version of dynamic TOPMODEL for two subcatchments at Plynlimon, Wales is described. Conservative chemical mixing within mobile and immobile stores has been added to the hydrological model in an attempt to simulate observed stream chloride concentrations. The model was not fully able to simulate the observed behaviour, in particular the short- to medium-term dynamics. One of the primary problems highlighted by the study was the representation of dry deposition and cloud-droplet-deposited chloride, which formed a significant part of the long-term chloride mass budget. Equifinality of parameter sets inhibited the ability to determine the effective catchment mixing volumes and coefficients or the most likely partition between occult mass inputs and chloride mass inputs determined by catchment immobile-store antecedent conditions. Some success was achieved, in as much as some aspects of the dynamic behaviour of the signal were satisfactorily simulated, although spectral analysis showed that the model could not fully reproduce the 1/f power spectra of observed stream chloride concentrations with its implications of a wide distribution of residence times for water in the catchment. Copyright © 2006 John Wiley & Sons, Ltd. [source] Probing protein colloidal behavior in membrane-based separation processes using spectrofluorometric Rayleigh scattering dataBIOTECHNOLOGY PROGRESS, Issue 3 2010Rand Elshereef Abstract One of the primary problems in membrane-based protein separation is membrane fouling. In this study we explored the feasibility of employing Rayleigh light scattering data from fluorescence studies combined with chemometric techniques to determine whether a correlation could be established with membrane fouling phenomena. Membrane flux was measured in a dead-end UF filtration system and the effect of protein solution properties on the flux decline was systematically investigated. A variety of proteins were used as a test case in this study. In parallel, the colloidal behavior of the protein solutions was assessed by employing multiwavelength Rayleigh scattering measurements. To assess the usefulness of Rayleigh scattering measurements for probing the colloidal behavior of proteins, a protein solution of ,-lactoglobulin was used as a base-case scenario. The colloidal behavior of different ,-lactoglobulin solutions was inferred based on published data for this protein, under identical solution conditions, where techniques other than Rayleigh scattering had been used. Using this approach, good agreement was observed between scattering data and the colloidal behavior of this protein. To test the hypothesis that a high degree of aggregation will lead to increased membrane fouling, filtration data was used to find whether the Rayleigh scattering intensity correlated with permeate flux changes. It was found that for protein solutions which were stable and did not aggregate, fouling was reduced and these solutions exhibited reduced Rayleigh scattering. When the aggregation behavior of the solution was favored, significant flux declines occurred and were highly correlated with increased Rayleigh scattering. © 2010 American Institute of Chemical Engineers Biotechnol. Prog., 2010 [source] Promising practices in understanding and treating child neglectCHILD & FAMILY SOCIAL WORK, Issue 1 2003Marianne Berry ABSTRACT Child neglect is the most common type of child maltreatment in the United States. However, services provided to families who neglect often fail to address and treat the primary concerns associated with child neglect. The information provided in this paper identifies the primary problems contributing to child neglect, and some promising practices in child welfare casework that address these problems and show positive outcomes for the children and families who experience child neglect. Knowledge pertaining to assessment skills, treatment abilities, and model programmes is provided. [source] | ||||||||||