Treatment Interventions (treatment + intervention)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

The Impact of Treatment Intervention on Parenting Stress in Postpartum Depressed Mothers: A Prospective Study

FRCPC, Shaila Misri MD
The aim of this study was to evaluate whether treatment intervention for postpartum depression impacted maternal parenting stress levels. Twenty,three mothers referred for postpartum mood and anxiety disorder to an outpatient program were included in the study. Statistically and clinically significant decreases in levels of parenting stress were evident at the end of the treatment. Subjects' perceptions of their parenting characteristics were found to be a major contributor to stress levels. In addition to monitoring of depressive symptoms, routine assessment of maternal parenting qualities is recommended to ensure healthy child outcomes. [source]

Does occasional cannabis use impact anxiety and depression treatment outcomes?: results from a randomized effectiveness trial

Jonathan B. Bricker Ph.D.
Abstract This study investigated the extent to which occasional cannabis use moderated anxiety and depression outcomes in the Collaborative Care for Anxiety and Panic (CCAP) study, a combined cognitive-behavioral therapy (CBT) and pharmacotherapy randomized effectiveness trial. Participants were 232 adults from six university-based primary care outpatient clinics in three West Coast cities randomized to receive either the CCAP intervention or the usual care condition. Results showed significant (P<.01) evidence of an interaction between treatment group (CCAP vs. usual care) and cannabis use status (monthly vs. less than monthly) for depressive symptoms, but not for panic disorder or social phobia symptoms (all P>.05). Monthly cannabis users' depressive symptoms improved in the CCAP intervention just as much as those who used cannabis less than monthly, whereas monthly users receiving usual care had significantly more depressive symptoms than those using less than monthly. A combined CBT and medication treatment intervention may be a promising approach for the treatment of depression among occasional cannabis users. Depression and Anxiety 24:392,398, 2007. © 2006 Wiley-Liss, Inc. [source]

Management of patients with decompensated hepatitis B virus associated cirrhosis

Fabien Zoulim
Key Points 1Hepatitis B virus replication is associated with a severe outcome in patients with decompensated cirrhosis. 2Viral suppression induced by antivirals results in a clinical improvement that allows liver transplantation to be delayed or avoided. 3Early treatment intervention is mandatory in patients with decompensated cirrhosis because of the delay in the restoration of liver functions. 4Lamivudine is no longer the drug of choice because the initial enthusiasm has been tempered by the high rate of resistance development. 5Early add-on therapy with adefovir allows us to rescue lamivudine resistance, but its use may be limited by nephrotoxicity. 6Studies are ongoing with the newer generation of antivirals (telbivudine, tenofovir, entecavir, and emtricitabine) in monotherapy or in combination to determine the best strategy for achieving rapid and prolonged suppression of viral replication. These improved strategies should enhance treatment success enough to obtain clinical stabilization, to delay or prevent the need for transplantation, and to reduce the risk of hepatitis B virus recurrence on the graft. Liver Transpl 14:S1,S7, 2008. © 2008 AASLD. [source]

The Impact of Treatment Intervention on Parenting Stress in Postpartum Depressed Mothers: A Prospective Study

FRCPC, Shaila Misri MD
The aim of this study was to evaluate whether treatment intervention for postpartum depression impacted maternal parenting stress levels. Twenty,three mothers referred for postpartum mood and anxiety disorder to an outpatient program were included in the study. Statistically and clinically significant decreases in levels of parenting stress were evident at the end of the treatment. Subjects' perceptions of their parenting characteristics were found to be a major contributor to stress levels. In addition to monitoring of depressive symptoms, routine assessment of maternal parenting qualities is recommended to ensure healthy child outcomes. [source]

Practitioner Review: The effectiveness of systemic family therapy for children and adolescents

David Cottrell
Background: Systemic family therapy has become a widely used intervention in child and adolescent mental health services over the last twenty years. Methods: This paper reviews the development of systemic family therapy, briefly describes the theory and techniques associated with the most prominent contemporary strands of systemic practice, and examines the empirical justification for using systemic family therapies with children and adolescents. Results: There is a paucity of well-designed randomised controlled trials of systemic therapies with children and adolescents and those trials that do exist evaluate older structural and strategic therapies. Methodological limitations of existing research include the use of unrepresentative participants, small sample sizes and wide age ranges. There is a lack of credible no-treatment or alternative treatment controls, tests of clinical as opposed to statistical significance, and conceptually relevant outcome measures that examine underlying interactional mechanisms. The term `family therapy' encompasses a wide range of interventions and it is not always clear what treatment intervention has been delivered. Nevertheless, there is good evidence for the effectiveness of systemic family therapies in the treatment of conduct disorders, substance misuse and eating disorders, and some support for their use as second-line treatments in depression and chronic illness. Conclusions: Systemic family therapy is an effective intervention for children and adolescents but further well-designed outcome studies are needed using clearly specified, manualised forms of treatment and conceptually relevant outcome measures. [source]

The impact of pregnancy on breast cancer outcomes in women ,35 years,

CANCER, Issue 6 2009
Beth M. Beadle MD
Abstract BACKGROUND: Some evidence suggests that women with pregnancy-associated breast cancers (PABC) have a worse outcome compared with historical controls. However, young age is a worse prognostic factor independently, and women with PABC tend to be young. The purpose of the current study was to compare locoregional recurrence (LRR), distant metastases (DM), and overall survival (OS) in young patients with PABC and non-PABC. METHODS: Data for 668 breast cancers in 652 patients aged ,35 years were retrospectively reviewed. One hundred four breast cancers (15.6%) were pregnancy-associated; 51 cancers developed during pregnancy and 53 within 1 year after pregnancy. RESULTS: The median follow-up for all living patients was 114 months. Patients who developed PABC had more advanced T classification, N classification, and stage group (all P < .04) compared with patients with non-PABC. Patients with PABC had no statistically significant differences in 10-year rates of LRR (23.4% vs 19.2%; P = .47), DM (45.1% vs 38.9%; P = .40), or OS (64.6% vs 64.8%; P = .60) compared with patients with non-PABC. For those patients who developed breast cancer during pregnancy, any treatment intervention during pregnancy provided a trend toward improved OS compared with delaying evaluation and treatment until after delivery (78.7% vs 44.7%; P = .068). CONCLUSIONS: Young patients with PABC had no statistically significant differences in LRR, DM, or OS compared with those with non-PABC; however, pregnancy contributed to a delay in breast cancer diagnosis, evaluation, and treatment. Primary care and reproductive physicians should be aggressive in the workup of breast symptoms in the pregnant population to expedite diagnosis and allow multidisciplinary treatment. Cancer 2009. © 2009 American Cancer Society. [source]

Relationship of illness perceptions with depression among individuals diagnosed with lupus,

Errol J. Philip M.A
Abstract Background: The purpose of this study was to investigate the relationship of illness perceptions, as outlined in the Self-Regulatory Model of illness, with depression among individuals diagnosed with lupus. Methods: A mail-out questionnaire was completed by 154 members of the Australia Lupus Foundation and Lupus Foundation of New South Wales. Each questionnaire consisted of a Lupus Medical and Symptoms Questionnaire, the Illness Perceptions Questionnaire-Revised and the Cardiac Depression Scale. Results: Hierarchical regression analysis revealed that individuals who reported a perception of their illness as having negative life consequences, an unpredictable nature and themselves possessing little understanding of lupus, reported high levels of depression. Conclusions: This study indicated the existence of a high level of depressive symptoms among individuals diagnosed with lupus, and reinforces the need for screening procedures in chronic illness, and treatment interventions that target maladaptive illness perceptions. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]

Magistrates' Early Referral into Treatment (MERIT): preliminary findings of a 12-month court diversion trial for drug offenders

DAVID REILLY BSc(Psych Hons), MPsychol
Abstract The purpose of this paper is to present a description and preliminary findings of a 12-month trial of a Local Court diversion programme, called MERIT for Magistrates' Early Referral into Treatment. The aim of MERIT is to divert eligible drug offenders to treatment and rehabilitation services. A total of 172 offenders were assessed and 131 entered the programme. The sources of referral were court (58%), police (17%) and self (10%). Main problem drugs were heroin (57%), cannabis (21%) and amphetamines (11%). The majority (85%) had previous convictions and 50% had been in jail. At the end of the trial period one-third (33%) completed the programme and one-third (33%) remained in treatment. Main treatment interventions were case management and out-patient counselling, detoxification, residential rehabilitation and methadone maintenance. Police records showed that of the original 43 (33%) graduates only six had come to police notice, mainly for relatively minor offences. Early acceptance and preliminary results has led to an expansion of the MERIT programme across New South Wales. With the rapid expansion of drug courts and diversion programmes across Australia, descriptive studies are useful to provide beneficial data to assist policy makers and service providers to develop programmes. [source]

University of Michigan Addiction Research Center (UMARC): development, evolution, and direction

ADDICTION, Issue 6 2010
Robert A. Zucker
ABSTRACT A historical summary is provided of the evolution of the University of Michigan Addiction Research Center (UMARC) since its origins in 1988. Begun as an National Institutes of Health (NIH) research center within a Department of Psychiatry and focused solely upon alcohol and aging, early work emphasized treatment efficacy, differential outcome studies and characterization of the neurophysiological and behavioral manifestations of chronic alcoholism. Over the last 15 years, UMARC has extended its research focus along a number of dimensions: its developmental reach has been extended etiologically by studies of risk early in the life span, and by way of work on earlier screening and the development of early, brief treatment interventions. The addiction focus has expanded to include other drugs of abuse. Levels of analysis have also broadened, with work on the molecular genetics and brain neurophysiology underlying addictive processes, on one hand, and examination of the role of the social environment in long-term course of disorder on the other hand. Activities have been facilitated by several research training programs and by collaborative relationships with other universities around the United States and in Poland. Since 2002, a program for research infrastructure development and collaboration has been ongoing, initially with Poland and more recently with Ukraine, Latvia and Slovakia. A blueprint for the future includes expanded characterization of the neurobiology and genetics of addictive processes, the developmental environment, as well as programmatic work to address the public health implications of our ability to identify risk for disorder very early in life. [source]

A question of balance: prioritizing public health responses to harm from gambling

ADDICTION, Issue 5 2009
Peter J. Adams
ABSTRACT Aim To provide an overview on the nature and importance of public health approaches to the global expansion of commercial gambling. Method Three key areas of public health activity are examined: harm minimization, health promotion and the political determinants for change. Findings The rapid proliferation of gambling experienced in many countries is driven by the commercial development of new products orientated around continuous and rapid mass consumption. This is particularly the case with ongoing refinements to electronic gambling machines and the development of new gambling technologies using the internet and mobile telephones. So far responses to negative impacts have, on the whole, focused upon individualized treatment interventions. A public health approach to gambling offers a broad range of strategies to tackle the wider implications of gambling expansion: harm reduction provides evidence-based strategies for managing identifiable harm; health promotion focuses upon communities building their capacity, knowledge and resilience with regard to the attractions of gambling, and action on the political determinants sets out to increase the accountability and reduce the conflicts of interest that influence government resolve in managing their gambling environments. Conclusion In this new environment of mass consumption, efforts in developing treatment responses to problem gambling need to be balanced with, at least, equal efforts in developing public health responses. With the expansion of commercial gambling occurring globally, international agencies could play a critical role in supporting public health initiatives. [source]

A Dutch day treatment program for anorexia and bulimia nervosa in comparison with internationally described programs

M. W. Lammers
Abstract A Dutch day treatment program for patients with anorexia and bulimia nervosa is described and compared to intensive day treatment programs for patients with eating disorders outlined in international literature. The 5-day program is described in terms of its general characteristics, intended outcome and specific treatment interventions. Along these parameters it is compared to the programs found in a systematic literature search of day hospitalization programs for eating disorders. Global inspection shows a lot of similarities between all the programs. Looking more closely, also many important differences exist (concerning, e.g. treatment duration, intensity of treatment, theoretical orientation, goals of treatment and weight gain regime). Because of the differences, it is hard to compare outcome data between centres. Besides, on many of these dimensions, the literature does not yet tell us unambiguously what is best for our patients. Therefore, it is necessary to keep the dialogue between treatment centres going. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

REVIEW: Modeling stress and drug craving in the laboratory: implications for addiction treatment development

Rajita Sinha
ABSTRACT Addition is a chronic relapsing illness affected by multiple social, individual and biological factors that significantly impact course and recovery of the illness. Stress interacts with these factors and increases addiction vulnerability and relapse risk, thereby playing a significant role in the course of the illness. This paper reviews our efforts in developing and validating laboratory models of stress and drug cue-related provocation to assess stress responses and stress-related adaptation in addicted individuals compared with healthy controls. Empirical findings from human laboratory and brain imaging studies are presented to show the specific stress-related dysregulation that accompanies the drug-craving state in addicted individuals. In order to adequately validate our laboratory model, we have also carefully examined relapse susceptibility in the addicted individuals and these data are reviewed. The overarching goal of these efforts is to develop a valid laboratory model to identify the stress-related pathophysiology in addiction with specific regard to persistent craving and compulsive seeking. Finally, the significant implications of these findings for the development of novel treatment interventions that target stress processes and drug craving to improve addiction relapse outcomes are discussed. [source]

Toward a Biopsychosocial Model for 21st -Century Genetics

FAMILY PROCESS, Issue 1 2005
John S. Rolland M.D.
Advances in genomic research are increasingly identifying genetic components in major health and mental health disorders. This article presents a Family System Genetic Illness model to address the psychosocial challenges of genomic conditions for patients and their families, and to help organize this complex biopsychosocial landscape for clinical practice and research. This model clusters genomic disorders based on key characteristics that define types of disorders with similar patterns of psychosocial demands over time. Key disease variables include the likelihood of developing a disorder based on specific genetic mutations, overall clinical severity, timing of clinical onset in the life cycle, and whether effective treatment interventions exist to alter disease onset and/or progression. For disorders in which carrier, predictive, or presymptomatic testing is available, core nonsymptomatic time phases with salient developmental challenges are described pre- and post-testing, including a long-term adaptation phase. The FSGI model builds on Rolland's Family System Illness model, which identifies psychosocial types and phases of chronic disorders after clinical onset. The FSGI model is designed to be flexible and responsive to future discoveries in genomic research. Its utility is discussed for research, preventive screening, family assessment, treatment planning, and service delivery in a wide range of healthcare settings. [source]

Health-related quality of life improves in children and adolescents with inflammatory bowel disease after attending a camp sponsored by the Crohn's and colitis foundation of America

Melissa A. Shepanski MS
Abstract Purpose: To describe the reported health-related quality of life (HRQOL) in children and adolescents with inflammatory bowel disease (IBD) after attending an IBD summer camp. Methods: A prospective analysis of quality of life was completed at an overnight camp that was exclusively for patients with IBD, which was sponsored by the Crohn's and Colitis Foundation of America. The IMPACT-II questionnaire (Canada and United States) and the State-Trait Anxiety Inventory for Children were administered to the campers at the beginning and at the end of a 1-week camp to assess HRQOL and anxiety. The IMPACT-II questionnaire consists of 35 questions measuring 6 quality-of-life domains (i.e., bowel domain, systemic symptoms, emotional functioning, social functioning, body image, and treatment/interventions). The State-Trait Anxiety Inventory for Children consists of 2 different 20-item sets of questions. One set assesses state anxiety, and the other, trait anxiety. A repeated-measures multivariate analysis of variance was performed to determine the differences between scores attained before and after camp on the IMPACT-II questionnaire and in each of its domains. Paired sample t tests were performed on state and trait anxiety before and after camp. Results: A total of 125 individuals consented to participate, but 61 patients (50 girls and 11 boys; age range, 9 to 16 y) completed the IMPACT-II questionnaire in full. Of those 61 patients, 47 had Crohn's disease and 14 had ulcerative colitis. There was statistically significant improvement between the mean (±SD) precamp total score (172.95 ± 36.61) and the mean postcamp total score (178.71 ± 40.97; P = 0.035), bowel symptoms scores (P = 0.036), social functioning scores (P = 0.022), and treatment interventions scores (P = 0.012). No difference was found between anxiety scores before and after camp on either the state or trait anxiety inventories (n = 55; P > 0.05). Conclusions: Overall, HRQOL improved in children after attending IBD summer camp. This exploratory study suggests that contributing factors for these improvements may be an increase in social functioning, a better acceptance of IBD symptoms, and less distress regarding treatment interventions, suggesting that a camp that is specifically designed for children with IBD may normalize the chronic illness experience. However, future research using a multimodal measurement approach is warranted to support these conclusions. [source]

Monosymptomatic hypochondriacal psychosis presenting with recurrent oral mucosal ulcers and multiple skin lesions responding to olanzapine treatment

Ulviye Atilgano, lu MD
Monosymptomatic hypochondriacal psychosis (MHP) is a form of psychosis characterized by the delusional idea that there is a serious problem in the skin or other body parts. Because MHP patients believe that their complaint is dermatological, not psychiatric, they often admit to several other medical disciplines before coming to a psychiatry clinic. This leads to a series of time-consuming examinations and treatment interventions. In this case report, we emphasize the importance of diagnosing the illness correctly and referring the patient to a psychiatrist. The patient presented in this report has been treated with a new generation neuroleptic, olanzapine. This treatment has led to complete resolution of delusional symptoms. Therefore, we conclude that knowing that MHP is a psychiatric illness allows early establishment of diagnosis and successful treatment. [source]

Review of assessment and treatment of PTSD among elderly American armed forces veterans

Gina P. Owens
Abstract Background The number of elderly combat veterans is steadily increasing in the US and estimates project that a notable percentage of these veterans experience symptoms of posttraumatic stress disorder (PTSD). Limited data exist specifically related to prevalence, assessment, and treatment of PTSD among the elderly veteran population. Objective This review summarizes the available research related to difficulties in assessment with the elderly American Armed Forces veteran population. In addition, both psychotherapeutic and pharmacological treatment interventions for PTSD are discussed. Methods A literature search was conducted using PsycINFO, Medline, and the National Center for PTSD's PILOTS database. Results Evidence suggests that elderly veterans generally present more somatic symptoms of PTSD. Medical and psychological comorbodities, such as depression, substance abuse, or cognitive deficits can further complicate the assessment process. Cut-scores for existing instruments need to be further established with elderly veterans. Use of exposure therapies with the elderly has not been adequately researched and mixed results have been obtained for supportive therapy for treatment of PTSD. Controlled research investigating pharmacological interventions for PTSD with the elderly is also limited. Conclusion Evidence suggests that some psychotherapeutic and pharmacological interventions already utilized with younger individuals may be useful with the elderly veteran population. However, research indicates that modifications may be required for working with the elderly population and further research in the areas of assessment and treatment are necessary. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Inter-Rater Reliability of the Diagnoses of Psychosis and Depression in Individuals with Intellectual Disabilities

S. Einfeld
Background, There is a history of over-prescription of antipsychotics to individuals with intellectual disability (ID), while antidepressants may be under-prescribed. However, appropriate treatment is best supported when the diagnosis of psychosis or depression is valid and carries good predictive validity. The present authors report a study examining one aspect of validity, namely whether skilled clinicians can agree on whether an individual with an ID is psychotic or depressed. Materials and Methods, Pairs of clinicians assessed 52 individuals. Agreement was assessed using Cohen's kappa statistic and agreement proportion. Results, Overall agreement was high for both psychosis and depression. Whether the individual had mild ID or moderate/severe ID did not have a significant impact on agreement. Conclusions, Experienced clinicians achieved a high level of agreement as to whether a person with ID was psychotic or depressed similar to that found for those without ID. The findings provide some support for treatment interventions based on diagnosis. [source]

Development, implementation and evaluation of a new nurse-led continence service: a pilot study

Kate S. Williams BA
,,The Leicestershire Medical Research Council (MRC) Incontinence Study is a series of interrelated studies exploring the epidemiology of urinary symptoms, including incontinence, and evaluating service provision and treatment options for these symptoms. ,,This paper describes one aspect of the Leicestershire MRC Incontinence Study, namely the development, implementation and evaluation of a new nurse-led continence service. ,,When developing a new service it is important to determine its acceptability and suitability to the target population. ,,The new mode of service delivery was dependent on specially trained Continence Nurse Practitioners (CNP) delivering predefined evidence-based treatment interventions. ,,Objective and subjective outcome measures were used to evaluate the service. ,,The service was shown to be effective in reducing urinary symptoms and led to high levels of patient satisfaction. ,,This service is currently being evaluated in a randomized controlled trial. [source]

Periodontal disease progression and glycaemic control among Gullah African Americans with type-2 diabetes

Dipankar Bandyopadhyay
Bandyopadhyay D, Marlow NM, Fernandes JK, Leite RS: Periodontal disease progression and glycaemic control among Gullah African Americans with type-2 diabetes. J Clin Periodontol 2010; 37: 501,509. doi: 10.1111/j.1600-051X.2010.01564.x. Abstract Aim: To evaluate associations between glycaemic control and periodontitis progression among Gullah African Americans with type-2 diabetes mellitus (T2DM). Materials and Methods: From an ongoing clinical trial among T2DM Gullah, we extracted a cohort previously in a cross-sectional study (N=88). Time from baseline (previous study) to follow-up (trial enrollment, before treatment interventions) ranged 1.93,4.08 years [mean=2.99, standard deviation (SD)=0.36]. We evaluated tooth site-level periodontitis progression [clinical attachment loss (CAL) worsening of 2 mm, periodontal probing depth (PPD) increases of 2 mm and bleeding on probing (BOP) from none to present] by glycaemic control status (well-controlled=HbA1c<7%, poorly-controlled=HbA1c7%) using multivariable generalized estimating equations logistic regression, nesting tooth sites/person. Results: Poorly-controlled T2DM (68.18%) was more prevalent than well-controlled T2DM (31.82%). Proportions of tooth sites/person with CAL progression between baseline and follow-up ranged 0.00,0.59 (mean=0.12, SD=0.12), while PPD and BOP progression ranged 0.00,0.44 (mean=0.09, SD=0.11) and 0.00,0.96 (mean=0.24, SD=0.18), respectively. Site-level PPD at baseline was a significant effect modifier of associations between poorly-controlled T2DM and site-level CAL and PPD progression [adjusted odds ratios (OR) according to poorly-controlled T2DM among PPD at baseline=3, 5 and 7 mm, respectively: CAL progression=1.93, 2.64, and 3.62, PPD progression=1.98, 2.76, and 3.84; p<0.05 for all]. Odds of site-level BOP progression were increased (OR=1.24) for poorly-controlled T2DM, yet the results were not significant (p=0.32). Conclusions: These findings from a distinct, homogenous population further support the clinical relevance of identifying patients with poor glycaemic control and periodontitis, particularly among those with disparities for both diseases. [source]

Tertullian's motto and Callahan's method

Richard J. McNally
The purposes of this commentary are to provide a critique of Callahan's (this issue) article on Thought Field Therapy (TFT) and to discuss when our commitment to intellectual open-mindedness requires that we attend to nontraditional treatment interventions in clinical psychology. © 2001 John Wiley & Sons, Inc. J Clin Psychol 57: 1171,1174, 2001. [source]

A language programme to increase the verbal production of a child dually diagnosed with Down syndrome and autism

K. A. Kroeger
Abstract Background The incidence of children dually diagnosed with Down syndrome and autism is estimated to be as high as 11%. There is a paucity of research investigating linguistic treatment interventions for such children. This single-subject experiment examined a programme designed to increase the language production and verbal behaviour of a 9-year-old dually diagnosed boy who had been receiving a 15-h/week home-based applied behaviour analysis (ABA) programme. Methods Training principles were derived from previously empirically validated research in discrete trail learning and natural environment teaching, as well as modified incidental teaching procedures. The crux of the language programme involved withholding reinforcement until a spoken request was made. Results Language production noticeably increased for each target area after the introduction of the language programme and was maintained at a 9-month follow-up session. Conclusions A combined treatment approach incorporating direct instruction, natural environment teaching and incidental teaching can be effective in increasing and maintaining responsive and spontaneous speech in a child with Down syndrome diagnosed with autism. Replication studies are needed with such multiple dually diagnosed children to further evaluate the effectiveness and generalizability of this combined language programme. [source]

Venous thromboembolic disease: A single-centre case series study

Fiona Newall
Aim: The epidemiology of venous thromboembolism in children has likely changed since first being described a decade ago because of evolving management strategies and a greater awareness of predisposing factors for thrombosis in children. The Royal Children's Hospital commenced a 4-year prospective registry of venous thrombosis in 1999 to determine the current Australian epidemiology of venous thrombosis in infants and children. Methods: A prospective, single-centre registry was established to determine the prevalence, aetiology, diagnostic criteria, management and outcome of venous thromboembolism in an Australian tertiary paediatric centre. Results: The incidence of venous thrombosis was 8.0/10 000 hospital admissions. Fifty-eight per cent of infants and 49% of children were male. Seventy-seven per cent of venous thromboses in infants were associated with central venous cannulation compared with 47% in children. Doppler ultrasonography was the most frequently used diagnostic tool. Treatment strategies varied between age groups. The all-cause mortality rate for infants and children in this study was 8.4% (direct thrombus-related mortality 0%). Fifteen per cent of all patients demonstrated complete resolution of their venous thrombosis at discharge, with 48% demonstrating complete resolution at follow-up assessment. Fifteen per cent of patients experienced significant thrombosis-related morbidity at follow-up assessment. Conclusion: In this single-centre registry, venous thrombosis in infants and children occurred with greater frequency than has previously been reported and its epidemiology varied. Central venous catheterisation continues to be a common precipitant to venous thrombosis. Optimal diagnostic and treatment interventions for venous thromboembolism have not yet been determined for infants and children, despite the significant incidence of long-term sequelae. [source]

Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unit

Accessible summary ,,The views of patients and their relatives regarding the treatment are extremely important in mental health as well as in other medical disciplines. ,,In our study, consistent with the literature, the satisfaction levels of young people and their families regarding the service they got during their stay in the unit were determined to be high. ,,The questionnaire used in the survey was designed to allow for five domain-based subscales which were admission process, staff, environment/services, treatment interventions and treatment outcome. ,,The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that; the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. ,,The results of such studies help to improve the quality of treatment and the mental health service that children and adolescents and their families receive. Abstract The aim of this study is to demonstrate the feedback and the satisfaction levels of the adolescents and their parents who received treatment in the newly opened inpatient unit. The results of the questionnaire evaluating the quality of the mental health service provided by the inpatient unit were examined retrospectively. The participants were the adolescents and their parents who received treatment and were discharged between January 2006 and May 2007. They were asked to give feedback on their observations and perceptions about the treatment they received, starting from the admission assessment until the time they were discharged. The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. Information about the adolescents' and their parents' experience of the treatment they received is essential and valuable in terms of promoting the quality of service and better treatment outcomes of an inpatient unit. [source]

Undergraduate nursing students' perceptions of substance use and misuse: a Brazilian position

G. H. RASSOOL frsh msc ba rn rcnt rnt cert ed cert couns cert supervision & consultation iltm
Alcohol, cocaine and cannabis are the substances most commonly abused in Brazil. There is limited evidence on the perceptions of undergraduate nursing students towards substance misuse. Negative attitudes, in combination with the lack of appropriate knowledge and skills, may result in minimal care provided to substance misusers. The aims of the study are to examine the knowledge and attitudes of undergraduate nursing students towards substance misusers and consider the implications of these attitudes for nursing education. The Nurse Education in Alcohol and Drug Educational Faculty Survey (NEADA) questionnaire on knowledge and education, nursing interventions, attitudes and values was distributed to undergraduate nurses (n = 227) in the south and south-eastern part of Brazil. The findings showed that there is a lack of adequate education in drug and alcohol use and misuse, including competency skills, but the participants were positive about treatment interventions. A paradigm shift in nurse education curricula and further research studies on attitudes and values towards substance misuse should be on the educational agenda. These are challenges faced by nurses to meet the healthcare needs of substance misusers. [source]

Acute pancreatitis in dogs

Jennifer L. Holm DVM
Abstract Objective: To summarize current information regarding severity assessment, diagnostic imaging, and treatment of human and canine acute pancreatitis (AP). Human-based studies: In humans, scoring systems, advanced imaging methods, and serum markers are used to assess the severity of disease, which allows for optimization of patient management. The extent of pancreatic necrosis and the presence of infected pancreatic necrosis are the most important factors determining the development of multiple organ failure (MOF) and subsequent mortality. Considerable research efforts have focused on the development of inexpensive, easy, and reliable laboratory markers to assess disease severity as early as possible in the course of the disease. The use of prophylactic antibiotics, enteral nutrition, and surgery have been shown to be beneficial in certain patient populations. Veterinary-based studies: The majority of what is currently known about naturally occurring canine AP has been derived from retrospective evaluations. The identification and development of inexpensive and reliable detection kits of key laboratory markers in dogs with AP could dramatically improve our ability to prognosticate and identify patient populations likely to benefit from treatment interventions. Treatment remains largely supportive and future studies evaluating the efficacy of surgery, nutritional support and other treatment modalities are warranted. Data sources: Current human and veterinary literature. Conclusions: Pancreatitis can lead to a life-threatening severe systemic inflammatory condition, resulting in MOF and death in both humans and dogs. Given the similarities in the pathophysiology of AP in both humans and dogs, novel concepts used to assess severity and treat people with AP may be applicable to dogs. [source]

Effect of medical and surgical interventions on health-related quality of life in Parkinson's disease

Pablo Martinez-Martin MD
Abstract Motor-related parameters are the standard outcome parameters for treatment interventions. Nonetheless, subjective appraisals about the consequences of treatment on health-related quality of life (HRQoL) are meanwhile established and may uncover important aspects of interventions. We have reviewed the literature with a defined search strategy and collected 61 clinical trials, which have used HRQoL as a planned outcome parameter. The articles were rated similarly as for the Task Force report of the Movement Disorder Society on interventions for Parkinson's disease (PD), but the relevant outcome parameter was HRQoL. We found that unilateral pallidotomy, deep brain stimulation of the subthalamic nucleus, and rasagiline are efficacious to improve the HRQoL of PD patients. For many other interventions, the efficacy to improve HRQoL in the PD setting cannot be considered to be proven so far. HRQoL should be part of future trial designs and more research is necessary to understand the determinants of QoL in PD. © 2007 Movement Disorder Society [source]

Systematic literature review of treatment interventions for upper extremity hemiparesis following stroke

Marjorie L. Urton
Abstract The primary purpose of this review article is to critically analyse the literature from 1999 to 2005 regarding effective interventions for upper extremity hemiparesis following stroke. The researchers narrowed the scope of the review based on inclusion and exclusion criteria, which yielded 11 pertinent studies congruent with the selection criteria. Studies were categorized using Sackett's levels of evidence, level I being the highest degree of certainty and level V the lowest. Grades of recommendations were then developed, grade A being highly recommended, grade B discretionary and grade C not endorsed. Two studies were endorsed as level I , grade A, six were level II , grade B, and three were level III , grade C. Clinical recommendations inferred from the present evaluation are as follows: ,,Electrical stimulation can be used to improve upper limb outcomes in patients with moderate to severe upper limb dysfunction and is feasible for home-based interventions. ,,Therapy that utilizes goal-directed reaching behaviours promotes more typical reaching patterns than non-goal-directed interventions. ,,Reach-to-grasp movements show greater improvement when compensatory trunk movements are reduced. ,,As an addition to regular exercise therapy time, Arm BASIS training may enhance selective movements of the upper extremity (i.e. reaching). ,,When performed in conjunction with active neuromuscular stimulation, random and blocked practice may improve pre-motor, motor and total reaction times of the upper extremity. Copyright © 2006 John Wiley & Sons Ltd. [source]

The physiotherapy management of patients undergoing thoracic surgery: a survey of current practice in Australia and New Zealand

Julie Reeve
Abstract Background and Purpose.,Physiotherapy is considered an essential component of the management of patients after thoracotomy, yet the type of interventions utilized, and evidence for their efficacy, has not been established. The aim of the present study was to ascertain the current physiotherapy management of patients undergoing thoracotomy and the factors influencing practice among different providers.,Method.,A purpose-designed postal questionnaire was distributed to senior physiotherapists in all thoracic surgical units throughout Australia and New Zealand (n = 57).,Results.,A response rate of 81% was obtained (n = 46). Pre-operatively, 16 respondents (35%) reported assessing all thoracotomy patients. The majority of respondents (n = 44; 96%) indicated that all patients were seen by physiotherapists after surgery, with 29 respondents (63%) performing prophylactic physiotherapy interventions to prevent post-operative pulmonary complications. Respondents reported that physiotherapy treatment was usually commenced on day one post-operatively (n = 37; 80%) with the most commonly used treatment interventions being deep breathing exercises, the active cycle of breathing techniques, cough, forced expiration techniques and sustained maximal inspirations. Most respondents reported that patients first sat out of bed (n = 41; 89%), commenced shoulder range of movement (n = 23; 50%) and walking (n = 32; 70%) on day one post-operatively. The majority of respondents reported that they offered no post-operative pulmonary rehabilitation (n = 25; 54%), outpatient follow-up (n = 43; 94%) or post-thoracotomy pain management (n = 40; 87%). Respondents indicated that personal experience, literature recommendations and established practice were the factors which most influenced physiotherapy practice.,Conclusion.,Most patients after thoracotomy receive physiotherapy assessment and/or treatment in the immediate post-operative period, but only one-third were routinely seen pre-operatively and relatively few were reviewed following discharge from hospital. Further studies are required to guide physiotherapists in determining the efficacy of their practices for patients undergoing thoracotomy. Copyright © 2007 John Wiley & Sons, Ltd. [source]

School-based prevention and intervention programs for children with emotional disturbance: A review of treatment components and methodology

Linda A. Reddy
School practitioners and educators are frequently challenged by the diverse and pervasive academic, social, and behavioral needs of children at risk for and with emotional disturbance. The present article examines the outcome literature on school-based prevention and intervention programs by systematically reviewing the key treatment interventions and methodology used. A total of 29 investigations including 1,405 children and adolescents were reviewed and coded on 41 variables across three dimensions (i.e., sample characteristics, treatment components, and methodology). Single subject and group design studies were included. Behavioral and/or cognitive behavioral treatment approaches were primary used. Deficit-based assessment and treatment approaches (i.e., problem behaviors) were predominately used in the outcome literature with few investigations incorporating strength-based outcome approaches. Findings are discussed in relation to previous research. © 2008 Wiley Periodicals, Inc. [source]

Neurobiological Processes in Adolescent Addictive Disorders

Ty S. Schepis PhD
The purpose of this review is to summarize the neurobiological factors involved in the etiology of adolescent addiction and present evidence implicating various mechanisms in its development. Adolescents are at heightened risk for experimentation with substances, and early experimentation is associated with higher rates of SUD in adulthood. Both normative (e.g., immature frontal-limbic connections, immature frontal lobe development) and non-normative (e.g., lowered serotonergic function, abnormal hypothalamic-pituitary-adrenal axis function) neurobiological developmental factors can predispose adolescents to a heightened risk for SUD. In addition, a normative imbalance in the adolescent neurobiological motivational system may be caused by the relative underdevelopment of suppressive mechanisms when compared to stimulatory systems. These neurobiological liabilities may correspond to neurobehavioral impairments in decision-making, affiliation with deviant peers and externalizing behavior; these and other cognitive and behavioral traits converge with neurobiological factors to increase SUD risk. The progression to SUD acts as an amplifying feedback loop, where the development of SUD results in reciprocal impairments in neurobehavioral and neurobiological processes. A clearer understanding of adolescent neurobiology is a necessary step in the development of prevention and treatment interventions for adolescent SUD. [source]