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Treatment Settings (treatment + setting)
Selected AbstractsThe manualization of a treatment programme for personality disorderCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2005Mary McMurran Background The advantages of manualized psychological treatments include: the promotion of evidence-based practice, the enhancement of treatment integrity, the facilitation of staff training, and the potential replicability of treatment. Argument The manualization of a multi-component, multidisciplinary treatment programme for male personality-disordered offenders is described. The background to this development is explained and the treatment setting is described briefly, followed by a description of the eight treatment manuals: (1) the treatment overview, (2) Psychoeducation focusing on personality disorder diagnosis and core beliefs, (3) Trust and Self-awareness group exercises, (4) Stop & Think! - a social problem-solving intervention, (5) Controlling Angry Aggression, (6) Controlling Substance Use, (7) Criminal Thinking/Belief Therapy, and (8) Skills for Living - a social skills manual. Conclusions In addition to the original aims of manualization, this exercise has clarified the treatment programme, included less highly trained staff in the delivery of therapy and permitted the evaluation of treatment modules, thus contributing to the incremental evaluation of the overall programme. These manuals may usefully be shared with other practitioners in the field. Copyright © 2005 Whurr Publishers Ltd. [source] Context-Oriented Model Development in Psychotherapy Planning (,COMEPP'): a useful adjunct to diagnosis and therapy of severe personality disordersACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2004M. Fischer-Kern Objective:, Pathogenous interpersonal (e.g. interfamilial) relationships and reference styles can compromise treatment efforts in severely disturbed (i.e. psychotic or borderline) patients. The integration of family- and individual-centred starting points may be useful in establishing interdisciplinary treatment concepts in these patients. Context-Oriented Model Development in Psychotherapy Planning (COMEPP) represents a diagnostic and therapy planning process, integrating both systemic and psychoanalytic conceptualizations. Method:, COMEPP is exemplified by the case of a young man with psychotic personality disorder who had previously been unresponsive to pharmacological and psychological treatment. Results:, After psycho-dynamical conflicts (i.e. primitive projective processes from the patient's mother to her son) had been elucidated during the COMEPP process, a sufficient treatment setting could be established. Conclusion:, COMEPP provides a psychotherapeutical approach to treatment planning on case-specific premises and may serve as an adjunct to concomitant pharmacological and psychological treatment strategies in so-called ,therapy refractory' patients. [source] Treatment of opioid dependence in adolescents and young adults with extended release naltrexone: preliminary case-series and feasibilityADDICTION, Issue 9 2010Marc J. Fishman ABSTRACT Background Opioid dependence is an increasing problem among adolescents and young adults, but in contrast to the standard in the adult population, adoption of pharmacotherapies has been slow. Extended-release naltrexone (XR-NTX) is a promising treatment that has been receiving increasing interest for adult opioid dependence. Clinical chart abstractions were performed on a convenience sample of 16 serial adolescent and young adult cases (mean age 18.5 years) treated for opioid dependence with XR-NTX who attended at least one out-patient clinical follow-up visit. Case descriptions Of these 16 cases, 10 of 16 (63%) were retained in treatment for at least 4 months and nine of 16 (56%) had a ,good' outcome defined as having substantially decreased opioid use, improvement in at least one psychosocial domain and no new problems due to substance use. Conclusions These descriptive results suggest that XR-NTX in the treatment of adolescents and young adults with opioid dependence is well tolerated over a period of 4 months and feasible in a community-based treatment setting, and associated with good outcomes in a preliminary, small non-controlled case-series. This probably reflects an overall trend towards greater adoption of medication treatments for this population. [source] Recent life problems and non-fatal overdose among heroin users entering treatmentADDICTION, Issue 2 2005Joanne Neale ABSTRACT Aims To investigate the role of recent life problems in non-fatal overdose among heroin users entering various drug treatment settings. Design Cross-sectional data from a longitudinal study investigating drug treatment effectiveness. Setting Five prison drug treatment services, three residential rehabilitation units, three residential detoxification units and 21 community drug treatment services located in rural, urban and inner-city areas of Scotland. Participants Of a total of 793 primary heroin users commencing drug treatment during 2001,02, 337 (42.5%) were prison drug service clients; 91 (11.5%) were residential rehabilitation clients; 97 (12.2%) were residential detoxification clients; and 268 (33.8%) were community drug treatment clients. Measurements Univariate and stepwise multivariate logistic regression analyses examined associations between overdosing in the 90 days prior to treatment entry and basic demographic characteristics, recent drug use and recent life problems. Findings Ninety-one study participants (11.5%) reported at least one overdose and 19 (2.4%) reported more than one overdose in the 90 days prior to treatment entry. A ,2 test revealed no significant difference in rates of recent overdosing between the four treatment settings (P = 0.650). Recent drug use and recent life problems,but not demographic characteristics,were associated independently with recent overdosing. However, recent life problems were not associated independently with recent overdosing among clients entering prison, clients entering residential rehabilitation or with multiple recent overdosing. Conclusions Associations between recent life problems and recent overdose were evident, but varied by treatment setting. Treatment providers should identify and address heroin users' life problems as part of a broad strategy of overdose prevention. [source] Treatment non-negotiables: why we need them and how to make them workEUROPEAN EATING DISORDERS REVIEW, Issue 4 2006Josie Geller Abstract In this paper, we define mandatory treatment components as ,treatment non-negotiables' and suggest that the manner in which non-negotiables are set and implemented has a significant impact on therapeutic alliance and outcome in the eating disorders. Common non-negotiable difficulties are reviewed and a philosophy is provided that can be applied to all stages of treatment: non-negotiables need to have a sound rationale, be consistently implemented, not take the client by surprise, and maximize client autonomy. We do not believe that a given non-negotiable is ,right' or ,wrong', but rather that treatment non-negotiables are optimally developed in response to the client population, treatment setting, clinician values and beliefs about change, and client and clinician input and experience. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Care provision for patients with eating disorders in Europe: what patients get what treatment where?EUROPEAN EATING DISORDERS REVIEW, Issue 3 2005Matthias Richard Abstract In this paper, we report on the similarities and differences between patients with eating disorders and the services provided to them across 80 centres participating in a European collaboration (COST Action B6). Differences in patient characteristics as well as differences in treatment regimen, especially length of treatment, are described. The relationship between patient characteristics, treatment setting and length of treatment is investigated by multilevel analysis. The findings show a rich diversity in service conditions and traditions across European countries. Patients with anorexia nervosa are mostly treated in inpatient settings, patients with bulimia nervosa are treated mostly as outpatients,with the exception of German-speaking countries. Day-patient settings were generally rare. Clinical characteristics of the patients,e.g. severity of symptoms or illness duration,contributed only little to the differences in treatment length (within as well as between centres), whereas organizational factors explained the largest proportion of between centre variability. The findings are discussed from a service research perspective. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Confirmatory factor analysis and recommendations for improvement of the Autonomy-Preference-Index (API)HEALTH EXPECTATIONS, Issue 3 2010Daniela Simon PhD Dipl Psych Abstract Objective, Validation of the German version of the Autonomy-Preference-Index (API), a measure of patients' preferences for decision making and information seeking. Methods, Stepwise confirmatory factor analysis was conducted on a sample of patients (n = 1592) treated in primary care for depression (n = 186), surgical and internal medicine inpatients (n = 811) and patients with minor trauma treated in an emergency department (n = 595). An initial test of the model was done on calculation and validation halves of the sample. Both local and global indexes-of-fit suggested modifications to the scale. The scale was modified and re-tested in the calculation sample and confirmed in the validation sample. Subgroup analyses for age, gender and type of treatment setting were also performed. Results, The confirmatory analysis led to a modified version of the API with better local and global indexes-of-fit for samples of German-speaking patients. Two items of the sub-scale, ,preference for decision-making', and one item of the sub-scale, ,preference for information seeking', showed very low reliability scores and were deleted. Thus, several global indexes-of-fit clearly improved significantly. The modified scale was confirmed on the validation sample with acceptable to good indices of fit. Results of subgroup analyses indicated that no adaptations were necessary. Discussion and conclusions, This first confirmatory analysis for a German-speaking population showed that the API was improved by the removal of several items. There were theoretically plausible explanations for this improvement suggesting that the modifications might also be appropriate in English and other language versions. [source] Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?HEALTH SERVICES RESEARCH, Issue 4 2008Sarah T. Hawley Objective. To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits. Data Sources/Data Collection. Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses (N=1,132 patients, 277 surgeons). Study Design. Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation. Principal Findings. Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts (p<.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient,physician communication was significantly (p<.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge. Conclusions. Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer. [source] Effectiveness and tolerability of paroxetine controlled release (CR) in the treatment of major depressive disorder: an open-label, prospective, multi-center trial in KoreaHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 6 2007Chi-Un Pae Abstract Objectives This study evaluated the effectiveness and tolerability of paroxetine controlled release (CR) for the treatment of Korean patients with major depressive disorder (MDD) in a naturalistic treatment setting. Methods One hundred and ninety patients with MDD were enrolled in this study. The Hamilton Depression Rating Scale-17 item (HAMD-17) and Clinical Global Impression-Severity (CGI-S) scores were measured at the baseline (day 0) and at weeks 1, 2, 4, and 8 (endpoint). The primary measure of effectiveness was a change in the mean HAMD-17 scores from the baseline to the endpoint. The secondary effectiveness measures included a decrease in the HAMD-17 scores of 50% or more at the endpoint compared with the baseline and a change in the mean CGI-S scores from the baseline to the endpoint. Remission was defined as a HAMD-17 score,,,7 at the endpoint. Results The HAMD-17 scores decreased by 56.5% (observed difference, OD,=,,13.3) (t,=,26.63, p,<,0.0001) from the baseline. The CGI-S scores also decreased by 50.0% (OD,=,,2.3) (t,=,24.47, p,<,0.0001). The response and remission rate at the endpoint was 64.2 and 48.4%, respectively. The adverse events were tolerable. No unexpected or serious side effects were observed. Conclusions Despite the methodological limitations, this study demonstrated that paroxetine CR is effective and tolerable for treating patients with MDD in an East Asian population. Copyright © 2007 John Wiley & Sons, Ltd. [source] The transitional object in dementia: clinical implicationsINTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES, Issue 2 2007Sheila LoboPrabhu Abstract The concept of the transitional object in human development was first proposed by Winnicott, and it has been extensively discussed in the child psychoanalytic literature. However, there are very few empirical studies on the transitional object in adult development. The transitional object has been discussed in relation to medical illness, medication, aggression, dreams, spirituality and religion, borderline personality disorder, anxiety disorder, fetishes, medication, and body image. There is very little literature on the transitional object in dementia. Dementia is a process of transition from a healthy, active state to a dependent state with progressive loss of memory, functional skills, and independence. Patients and families experience grief, loss, fear, anxiety, guilt, and anger. In this article, we address the role of the transitional object in dementia. We discuss the concepts of the transitional object and precursor object, and their possible role in interventions with patients and caregivers. We discuss various aspects of the therapeutic process and treatment setting, which may serve as transitional objects in various stages of dementia. The therapeutic relationship serves as the "holding environment" in which various transitions may be safely accomplished. Copyright © 2007 John Wiley & Sons, Ltd. [source] Pilot randomised controlled trial of community pharmacy administration of buprenorphine versus methadoneINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2006Isobel 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] Drug addicts in therapy,changes in life space in the course of one yearJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 5 2002Marcella Ravenna Abstract In a residential community treatment setting, moods and emotional states of drug addicts were explored over a 1-year period. The specific form of treatment of heroin addiction employed in the communities is based on the importance of interpersonal relationships for psychosocial transition. Twenty-nine participants reported current mood, emotions, attributions, and motive activation using a time-sampling diary for 2 weeks at the beginning of the treatment, and 6 and 12 months later. Results show an increase in positive emotions, and in subjective strength and freedom. Furthermore, participants report higher self-esteem and use less fatalistic attributions. This is interpreted as indicating successful transition processes in terms of higher autonomy, a more extended life space and increased levels of realism. Copyright © 2002 John Wiley & Sons, Ltd. [source] Addiction-Related Assessment Tools and Pain Management: Instruments for Screening, Treatment Planning, and Monitoring CompliancePAIN MEDICINE, Issue 2008Steven D. Passik PhD ABSTRACT Objective., To review and critique the various assessment tools currently available to pain clinicians for assessing opioid use and abuse in patients with chronic noncancer pain to allow pain clinicians to make informed selections for their practices. Methods., A literature search on PubMed was conducted in June 2006 using the search terms opioid plus screening or assessment with or without the additional term risk, and opioid-related disorders/prevention and control in order to identify clinical studies published in English over the previous 10 years. Additional studies were identified using the PubMed link feature and Google. When abstracts described or referred to a tool for opioid abuse screening, the corresponding publication was acquired and reviewed for relevance to the pain treatment setting. Results., Forty-three publications were selected for review from the abstracts identified, and 19 were rejected because they did not describe a specific tool or provide adequate information regarding the screening tool used. The remaining 24 publications described relevant screening tools for opioid abuse risk and were reviewed. Conclusions., A variety of self-administered and physician-administered tools differing in their psychometrics and intended uses have been developed, but not all have been validated for use in chronic pain patients seen in a clinical practice setting. Some tools assess abuse potential in patients being considered for opioid therapy, whereas other tools screen for the presence of substance abuse. By recognizing the psychometrics of each tool, clinicians can select the ones most appropriate for their patient population and screening needs. [source] Alcohol Use Disorders: Screening and DiagnosisTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 2003ABPP, Stephen A. Maisto Ph.D. The purpose of this article is to provide an overview of empirically supported, primarily self-report methods of screening and diagnosis related to alcohol use disorders (AUDs). The discussion of screening instruments focuses on the primary care setting, and the diagnosis instruments discussion centers on the alcohol (and other drug) treatment setting. The literature shows that the AUDIT and the CA GE are the most widely validated methods of screening for AUDs in primary care and may be applied readily in that context. Similarly, a number of instruments designed to derive DSM-IV (and ICD-10) AUD diagnoses, as well as constructs related to how AUDs are defined, are available and can meet a variety of clinical needs. Future research priorities include further development of brief methods to identify hazardous drinkers or individuals who have an AUD, as well as refinement of diagnosis instruments to increase their application across treatment settings and subpopulations. [source] From Adjuvant Therapy to Breast Cancer Prevention: BCPT and STARTHE BREAST JOURNAL, Issue 3 2001Barbara K. Dunn MD Abstract: The continued widespread prevalence of breast cancer supports placing a high priority on research aimed at its primary prevention, particularly among women who are at increased risk for developing this disease. The suggestion of potential agents for the primary chemoprevention of breast cancer evolved out of the treatment setting. Extensive experience with tamoxifen, a first-generation selective estrogen receptor modulator (SERM) showing efficacy, first, in the treatment of advanced breast cancer and, subsequently, as adjuvant therapy for early stage disease established the safety of this agent. Cumulative data from multiple adjuvant studies documented the efficacy of tamoxifen in reducing second primary breast cancers in the contralateral breast, supporting its potential as a chemopreventive agent for breast cancer. The safety and second primary data on tamoxifen, together with extensive information on its pharmacokinetics, metabolism, and antitumor effects, as well as its potentially beneficial effects on lipid metabolism and osteoporosis, led the National Surgical Adjuvant Breast and Bowel Project (NSABP) to select tamoxifen for testing in the first prospective randomized phase III trial of the efficacy of a chemopreventive agent for preventing breast cancer in women at increased risk of the disease. Accordingly, in 1992 the NSABP started the Breast Cancer Prevention Trial (P-1) in which 13,388 women 35 years of age who were at increased risk of breast cancer according to Gail model risk factors [family history, age, and personal history (i.e., age at first birth, age at menarche, previous breast biopsies)] were randomized to tamoxifen 20 mg/day or placebo for 5 years. Through 69 months of follow-up tamoxifen reduced the risk of invasive breast cancer, primarily estrogen receptor-positive tumors, by 49% (two-sided p < 0.00001). Tamoxifen reduced the risk of noninvasive breast cancer by 50% (two-sided p < 0.002). In addition, tamoxifen reduced fractures of the hip, radius, and spine, but it had no effect on the rate of ischemic heart disease. As previously shown, the rates of endometrial cancer and vascular events increased with tamoxifen. With the P-1 results establishing tamoxifen as the standard of care for the primary chemoprevention of breast cancer in high-risk women, concern over the side effects of tamoxifen has prompted a continuing search for an agent that displays a more desirable efficacy/toxicity profile. Raloxifene, a second-generation SERM approved for the prevention of osteoporosis in postmenopausal women, displays antiestrogenic properties in the breast and possibly the endometrium, and estrogenic effects in the bone and on the lipid profile, suggesting it as a candidate for comparison with the chemopreventive standard, tamoxifen. Raloxifene will be compared to tamoxifen in an equivalency trial, the Study of Tamoxifen and Raloxifene (STAR) NSABP P-2, which began in July 1999 at almost 500 centers in North America. The plan is to randomize 22,000 postmenopausal women 35 years of age at increased risk of breast cancer by Gail criteria to tamoxifen 20 mg/day or raloxifene 60 mg/day for 5 years. Study endpoints include invasive and noninvasive breast cancer, cardiovascular disease, endometrial cancer, bone fractures, and vascular events. [source] Joint attention training for children with autism using behavior modification proceduresTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 3 2003Christina Whalen Background: Deficits in joint attention are considered by many researchers to be an early predictor of childhood autism (e.g., Osterling & Dawson, 1994) and are considered to be pivotal to deficits in language, play, and social development in this population (Mundy, 1995). Although many researchers have noted the importance of joint attention deficits in the development of children with autism (e.g., Mundy, Sigman, & Kasari, 1994) and have called for intervention strategies (e.g., Mundy & Crowson, 1997), few studies have attempted to target joint attention. In this study, joint attention behaviors were taught to children with autism using a behavior modification procedure. Methods: A multiple-baseline design was implemented to evaluate intervention effects. The following target behaviors were included in the intervention: 1) Responding to showing, pointing, and gaze shifting of adult; 2) Coordinated gaze shifting (i.e., coordinated joint attention); and 3) Pointing (with the purpose of sharing, not requesting). Generalization to setting and parent, follow-up sessions, and social validation measures were also analyzed. Results: Joint attention behaviors were effectively trained and targeted behaviors generalized to other settings. In addition, positive changes were noted by naïve observers using social validation measures. Conclusions: Integrating joint attention training into existing interventions may be important for children with autism. In addition, training parents in these techniques may help to maintain joint attention skills outside of the treatment setting. [source] Using video modeling to teach a domestic skill with an embedded social skill to adults with severe mental retardationBEHAVIORAL INTERVENTIONS, Issue 4 2004Melissa A. Bidwell We assessed whether three adults with severe mental retardation would acquire a domestic skill (making coffee) with an embedded social skill (serving coffee to and sitting down beside a peer) via video modeling procedures. Training was conducted in a classroom in the participants' day treatment setting. The intervention consisted of (i) watching a video of an adult with a developmental disability making coffee and initiating a social interaction with a peer; and (ii) receiving verbal praise for each step of the task that was performed correctly. All three participants mastered the task and demonstrated generalization across settings, stimuli, and people. Two participants performed with 100% accuracy on maintenance probes conducted 1 month following mastery, and one participant did so following booster training. Copyright © 2004 John Wiley & Sons, Ltd. [source] Teaching a simple meal preparation skill to adults with moderate and severe mental retardation using video modelingBEHAVIORAL INTERVENTIONS, Issue 3 2003Ruth Anne Rehfeldt We evaluated whether adults with mental retardation in the moderate or severe range would acquire simple meal preparation skills via video modeling. Training was conducted in the kitchen of the participants' day treatment setting. The intervention consisted of (i) watching a video of an adult with a developmental disability making a peanut butter and jelly sandwich and (ii) receiving verbal praise for each step of the task that was performed correctly. All three participants mastered the task and demonstrated generalization across settings. All three participants also demonstrated maintenance of the skill one month following mastery. Copyright © 2003 John Wiley & Sons, Ltd. [source] Standardizing care in medical oncologyCANCER, Issue 23 2009Are Web-based systems the answer? Abstract BACKGROUND: Medical oncology is embracing information technology to standardize care and improve patient outcomes, with a range of Web-based systems used internationally. The authors' aim was to determine the factors affecting the uptake and use of a Web-based protocol system for medical oncology in the Australian setting. METHODS: The authors conducted 50 interviews and observed medical oncology physicians, nurses, and pharmacists in their treatment setting at 6 hospitals in different geographic locations. RESULTS: The Web-based system plays a major role in guiding oncology treatment across participating sites. However, its use varies according to hospital location, clinician roles, and experience. A range of issues impact on clinicians' attitudes toward and use of the Web-based system. Important factors are clinician,specific (eg, their need for autonomy and perceptions of lack of time) or environmental (eg, hospital policy on protocol use, endorsement of the system, and the availability of appropriate infrastructure, such as sufficient computers). The level of education received regarding the system was also found to be integral to its ongoing use. CONCLUSIONS: Although the provision of high-quality evidence-based resources, electronic or otherwise, is essential for standardizing care and improving patient outcomes, the authors' findings demonstrate that this alone does not ensure uptake. It is important to understand end-users, the environment in which they operate, and the basic infrastructure required to implement such a system. Implementation must also be accompanied by continuing education and endorsement to ensure both long-term sustainability and use of the system to its full potential. Cancer 2009. © 2009 American Cancer Society. [source] Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinomaCANCER, Issue 9 2003Evidence from a tertiary care cohort of chemotherapy-eligible patients Abstract BACKGROUND The appropriate use of adjuvant chemotherapy for elderly women with breast carcinoma remains controversial. Efficacy data in women age , 70 years are scarce, resulting in a lack of clear guidelines for patients in this age group. Although several studies have demonstrated decreasing use of chemotherapy with age, none specifically examined its use in an elderly cohort of patients who were deemed eligible for such therapy based on consensus guidelines, simultaneously examining the impact of comorbidity and previous history of malignant disease on these recommendations. METHODS The authors examined adjuvant chemotherapy use among chemotherapy-eligible patients age , 50 years who were evaluated in a tertiary care cancer center. Associations between patient age and 1) physician recommendation for adjuvant chemotherapy, 2) recommended treatment regimen, and 3) patient acceptance of the treatment plan recommended were examined, adjusting for the impact of aggressive tumor characteristics, medical comorbidity, previous history of malignant disease, and features of the treatment setting. RESULTS Of the 208 chemotherapy-eligible patients who were studied, 74% overall were recommended chemotherapy. Chemotherapy was recommended to 92% of women age 50,59 years compared with 77% of women age 60,69 years and 23% of women age , 70 years. Increasing age was associated strongly with a decreasing likelihood of receiving a recommendation in favor of chemotherapy. After adjusting for estrogen receptor status, previous history of malignant disease, comorbidity score, and prognostic group, the odds of receiving a recommendation in favor of chemotherapy fell by 22% per year or 91% per 10-year interval, and the rate of decline did not change significantly at age , 70 years. We found no age-related differences in either the drug regimens recommended or patient acceptance rates for adjuvant therapy. CONCLUSIONS Age was associated strongly and independently with physician recommendation for adjuvant chemotherapy among a group of older women who were eligible specifically for such therapy. Medical comorbidity and a history of previous malignant disease did not alter this correlation significantly, although the latter was a significant predictor of chemotherapy use. Further studies clearly are needed to determine the underlying reasons for this strong age effect and to explore strategies that will optimize the utilization of this potentially curative therapy in the elderly. Cancer 2003;97:2150,9. © 2003 American Cancer Society. DOI 10.1002/cncr.11338 [source] Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patientsACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010L. Baandrup Baandrup L, Allerup P, Lublin H, Nordentoft M, Peacock L, Glenthoj B. Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients. Objective:, To evaluate the effect of a multifaceted educational intervention on the frequency of antipsychotic co-prescribing in adult schizophrenia out-patients. Method:, Controlled quasi-experimental study performed in two Danish municipalities matched for baseline prevalence of antipsychotic polypharmacy, socioeconomic status and functional level of patients. The intervention was aimed at psychiatric healthcare providers and consisted of 1 day of didactic lectures, six 3-h educational outreach visits and an electronic reminder during drug prescribing. Results:, Between-group use of antipsychotic polypharmacy was compared at baseline (intervention group, N = 232/control group, N = 351) and after 1 year of intervention (intervention group, N = 216/control group, N = 386). The prevalence of antipsychotic polypharmacy at follow-up was not significantly different between treatment settings when adjusting for differences in case-mix (P = 0.07). Conclusion:, This multifaceted educational intervention failed to reduce the frequency of antipsychotic co-prescribing, but it suggested that future efforts to improve prescribing practice should address organizational barriers to implementation. [source] Clinical, Histologic, and Ultrastructural Changes after Nonablative Treatment with a 595-nm Flashlamp-Pumped Pulsed Dye Laser: Comparison of Varying SettingsDERMATOLOGIC SURGERY, Issue 7 2004David J. Goldberg MD Background. The flashlamp-pulsed dye laser has been used for nonablative dermal remodeling. Objective. We conducted a study analyzing the clinical, histologic, and electron microscopic findings after treatment with different flashlamp-pulsed dye laser settingss in the same subject. Results. Most subjects showed mild to moderate improvement after flashlamp-pulsed dye laser laser treatment. There was no statistical difference in the clinical, histologic, or electron microscopic findings with a variety of laser treatment settings. Conclusion. Nonablative dermal remodeling can be accomplished with not only a variety of different technologies, but also with the same laser using markedly different settings. [source] Staging anorexia nervosa: conceptualizing illness severityEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2008Sarah Maguire Abstract In recent years, there has been increasing attention to the conceptualization of anorexia nervosa (AN) and its diagnostic criteria. While varying levels of severity within the illness category of AN have long been appreciated, neither a precise definition of severity nor an empirical examination of severity in AN has been undertaken. The aim of this article is to review the current state of knowledge on illness severity and to propose a theoretical model for the definition and conceptualization of severity in AN. AN is associated with significant medical morbidity which is related to the ,severity' of presentation on such markers as body mass index, eating and purging behaviours. The development of a functional staging system, based on symptom severity, is indicated for reasons similar to those cited by the cancer lobby. Improving case management and making appropriate treatment recommendations have been the primary purpose of staging in other fields, and might also apply to AN. Such a standardized staging system could potentially ease communication between treatment settings, and increase the specificity and comparability of research findings in the field of AN. [source] Treatment process, alliance and outcome in brief versus extended treatments for marijuana dependenceADDICTION, Issue 10 2010Carly J. Gibbons ABSTRACT Aims The Marijuana Treatment Project, a large multi-site randomized clinical trial, compared a delayed treatment control condition with a brief (two-session) and extended (nine-session) multi-component treatment among 450 marijuana-dependent participants. In this report we present treatment process data, including the fidelity of treatment delivery in the three community-based treatment settings as well as the relationships between treatment process and outcome. Design Independent evaluations of clinician adherence and competence ratings were made based on 633 videotaped sessions from 163 participants. Relationships between clinician adherence and competence, ratings of the working alliance and marijuana treatment outcomes were evaluated. Findings Protocol treatments were implemented with strong fidelity to manual specifications and with few significant differences in adherence and competence ratings across sites. In the brief two-session treatment condition, only the working alliance was associated significantly with frequency of marijuana use, but in the extended treatment therapist ratings of working alliance predicted outcomes, as did the interaction of alliance and curvilinear adherence. Conclusions Behavioral treatments for marijuana use were delivered in community settings with good fidelity. Participant and therapist working alliance scores were associated significantly with improved marijuana use outcomes in a brief behavioral treatment for adults with marijuana dependence. In extended treatment the therapist ratings of working alliance were associated with more positive outcome. However, in that treatment there was also a significant interaction between alliance and curvilinear adherence. [source] Mortality risk up to 25 years after initiation of treatment among 420 Swedish women with alcohol addictionADDICTION, Issue 3 2009Brit Haver ABSTRACT Aims Women treated for alcohol addiction have mortality rates three to five times those of women from the general population (GP). However, these figures may be inflated because socially disadvantaged women with advanced drinking careers are over-represented in previous studies. Our aim was to study the long-term mortality of socially relatively well-functioning patients coming to their first treatment, compared to matched GP controls. Design The mortality rates and causes of death were compared between patients and their matched GP controls, using data from the Causes of Death Register throughout the follow-up period (0,25 years). Setting A specialized treatment programme for women only, called ,Early treatment for Women with Alcohol Addiction' (EWA) at the Karolinska Hospital, Stockholm, Sweden. Participants Subjects (n = 420) receiving their first treatment at the EWA programme, compared to a group of matched GP women (n = 2037). Findings The women patients had significantly higher mortality than matched GP controls throughout the whole follow-up period, with a relative risk of 2.4. However, the younger women had four times higher mortality than their matched controls. The peak of deaths occurred during the first 5 years, and alcohol-related causes of death were highly over-represented, as were uncertain suicides and accidents. Conclusions First-time-treated women with alcohol addiction have a substantially lower mortality than reported previously from clinical samples, except for the youngest group. Our figures were corrected for confounding factors such as socio-demographic status. We believe our results could apply to broader groups of heavy drinking women, inside or outside specialized treatment settings. [source] Recent life problems and non-fatal overdose among heroin users entering treatmentADDICTION, Issue 2 2005Joanne Neale ABSTRACT Aims To investigate the role of recent life problems in non-fatal overdose among heroin users entering various drug treatment settings. Design Cross-sectional data from a longitudinal study investigating drug treatment effectiveness. Setting Five prison drug treatment services, three residential rehabilitation units, three residential detoxification units and 21 community drug treatment services located in rural, urban and inner-city areas of Scotland. Participants Of a total of 793 primary heroin users commencing drug treatment during 2001,02, 337 (42.5%) were prison drug service clients; 91 (11.5%) were residential rehabilitation clients; 97 (12.2%) were residential detoxification clients; and 268 (33.8%) were community drug treatment clients. Measurements Univariate and stepwise multivariate logistic regression analyses examined associations between overdosing in the 90 days prior to treatment entry and basic demographic characteristics, recent drug use and recent life problems. Findings Ninety-one study participants (11.5%) reported at least one overdose and 19 (2.4%) reported more than one overdose in the 90 days prior to treatment entry. A ,2 test revealed no significant difference in rates of recent overdosing between the four treatment settings (P = 0.650). Recent drug use and recent life problems,but not demographic characteristics,were associated independently with recent overdosing. However, recent life problems were not associated independently with recent overdosing among clients entering prison, clients entering residential rehabilitation or with multiple recent overdosing. Conclusions Associations between recent life problems and recent overdose were evident, but varied by treatment setting. Treatment providers should identify and address heroin users' life problems as part of a broad strategy of overdose prevention. [source] The prevalence of eating disorders not otherwise specifiedINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 3 2007Paulo P.P. Machado PhD Abstract Objective: Eating Disorders Not Otherwise Specified (EDNOS) represent the most common eating disorder diagnosed in specialized treatment settings. The purpose of the current study is to assess the prevalence of EDNOS in a nationwide community sample. Method: Participants were 2,028 female students, aged 12,23, attending public schools in the 9th to 12th grades in Portugal. Participants completed the Eating Disorder Examination Questionnaire in Stage 1 of the study. In Stage 2, we selected all the participants who met any of these criteria: (1) BMI ,17.5, (2) scores ,4 on any of the four EDE-Q Subscales, (3) a total EDE-Q score ,4, or (4) the presence of dysfunctional eating behaviors. In Stage 2, eating disorder experts interviewed 901 participants using the Eating Disorder Examination. Results: The prevalence of all eating disorders was 3.06% among young females. Prevalence for anorexia nervosa was 0.39%, for bulimia nervosa 0.30%, EDNOS 2.37%. Conclusion: EDNOS is a very common eating disorder and accounts for three-quarters of all community cases with eating disorders. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] Differences in diagnostic subtypes among patients with late and early onset of a single depressive episodeINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2006Lars Vedel Kessing Abstract Objective It is unclear whether patients with late onset and patients with early onset present with different subtypes of depression. The aim of the study was to compare the prevalence of subtypes of ICD-10 single depressive episodes for patients with late onset (age >65 years) and patient with early onset (age,,,65 years) in a nationwide sample of all patients discharged from psychiatric in- or outpatient settings. Method All patients who got a diagnosis of a single depressive episode in a period from 1994,2002 at the end of the first outpatient treatment or at the first discharge from psychiatric hospitalisation ever in Denmark were identified in a nationwide register. Results In total, 18.192 patients were given a diagnosis of a single depressive episode at the first outpatient contact and 8.396 patients were given a diagnosis of a single depressive episode at the first psychiatric hospitalisation ever. Patients with late onset were more often women, more often presented with a severe depressive episode and more often with psychosis than patients with early onset, in both inpatient and outpatient treatment settings. No differences were found between patients with late and patients with early onset in the prevalence of depression with or without melancholic symptoms,in either of the treatment settings. Conclusions Patients with a late onset first depressive episode are more often women and are clinically characterised by more severe depressions and a higher prevalence of psychosis than patients with early onset. Copyright © 2006 John Wiley & Sons, Ltd. [source] Nursing the clinic vs. nursing the patient: nurses' experience of a day hospital chemotherapy serviceJOURNAL OF CLINICAL NURSING, Issue 9 2006Sonja Mcilfatrick PhD Aims and objectives., This study sought to explore the nurses' experience of a day hospital chemotherapy service in an acute general hospital in Northern Ireland and how this compared with their experience of working in an inpatient setting. Background., Despite the many changes taking place in cancer care delivery, little research has been conducted on nurses' experience of working in more acute cancer treatment settings. Research conducted to date has tended to focus on the role of nurses in wards, hospices and palliative care settings. Design., This Heideggerian hermeneutic phenomenological study explored nurses' lived experience of day hospital chemotherapy service. Method., Face-to-face focused in-depth interviews were conducted with the total population of nurses who worked in the day hospital at the time of data collection (n = 10). Data analysis involved a two-staged approach, the analysis of narratives and narrative analysis, based on the work of Polkinghorne (1995). Conclusions., The nurses' viewed their experience of the chemotherapy day hospital as having both positive and negative dimensions. The positive dimensions included an increased sense of autonomy and the challenge of developing new skills, while the negative dimension included a perceived decrease in their caring role: (i),The individual characteristics of the nurse were seen to have a key influence on caring experience; (ii),Role changes led to a perceived dichotomy between their actual and aspired role and their caring and clinical role. Relevance to clinical practice., There is a need to achieve a balance between delivering a clinical role (administering chemotherapy) while maintaining the centrality of the nurse,patient relationship. This can be likened to achieving a balance between ,nursing the clinic' alongside ,nursing the patient'. These findings have implications for the discourse on caring within other outpatient type clinics and discourse on cancer nursing as therapy and the culture of the cancer clinic. [source] Staff survey results and characteristics that predict assault and injury to personnel working in mental health facilitiesAGGRESSIVE BEHAVIOR, Issue 1 2003Julie Cunningham Abstract The purpose of this study was to complete a mental health staff opinion survey to identify patient and staff characteristics associated with staff assault and injury in psychiatric treatment settings and to develop a model of prediction for staff assault and injury utilizing these survey variables. The data consisted of opinion surveys sent to staff of 15 child, adolescent, and adult psychiatry inpatient units in the United States. Multivariate logistic regression was used to determine the level of assault and staff-reported injury prediction that could be obtained from the staff-completed opinion survey. Responses indicated a high prevalence of reported aggression, with 62.3% of staff endorsing verbal and physical aggression, property destruction, and self-injurious behavior as being prevalent at their site, whereas only 4.1% rated none of these as prevalent. Staff working with children and adolescents in settings with high rates of psychiatric diagnoses reported increased frequency of assault and injury compared with those working with adults. Younger, less experienced staff reported higher rates of assault and injury. Staff working with female patients reported similar rates of assault and injury to those working with males. A logistic regression analysis using staff-reported survey results of both staff and patient characteristics predicted assault correctly 73.7% of the time and injury 66.1% of the time. Resources for violence prevention and staff training programs in violence prevention are needed in child and adolescent psychiatry wards. Results are consistent with theories emphasizing the importance of negative emotions and affects, impulsivity, and frustration in goal-directed activities in human aggression. Aggr. Behav. 29:31,40, 2003. © 2003 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||