A Pre-Post Comparison of a Multidimensional Treatment Program for Acutely Suicidal Borderline Patients

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
P. Ohlendorf ◽  
T. Di Clemente ◽  
D. Gaudry-Maire ◽  
Y. Burnand
Keyword(s):  
Catchment Area ◽  
Direct Costs ◽  
Borderline Personality ◽  
Psychiatric Services ◽  
Medical Emergency ◽  
Service Research ◽  
Borderline Patients ◽  
The Impact ◽  
Improved Outcome

Over the last few years, a new comprehensive program for acutely suicidal borderline patients has been developed in the Geneva area (careful description is provided in a distinct section of this workshop). The present work will report the results of a service research oriented study aimed at evaluating the impact of the implementation of such multidimensional intervention on a system of psychiatric services in a 500.000 inhabitant catchment area. Specifically, a pre-post design has been utilized to compare two distinct patient cohorts meeting criteria for borderline personality disorder who had bee referred to medical emergency room with suicidal attempt. Both cohorts had follow-up at 3-month and 1 year to assess treatment failure, repetition, hospitalization and direct costs. The results indicate that the program is feasible and may be associated with improved outcome and substantial costs savings among acutely suicidal borderline patients.

Recovery from Borderline Personality Disorder

2018 ◽  
pp. 117-128 ◽  
Author(s):  
Mary C. Zanarini
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Full Time ◽  
Important Goal ◽  
Symptomatic Recurrence ◽  
Borderline Patients ◽  
Vocational Functioning ◽  
Symptomatic Remission

As important as our findings concerning the high rates of symptomatic remission and low rates of symptomatic recurrence are, the rates of recovery are even more important. This is so because we defined “recovery” as concurrent symptomatic remission and good social and good full-time vocational functioning. After 10 years of prospective follow-up, 50% of borderline patients achieved this important goal. After 16 years of prospective follow-up, 60% of borderline patients achieved this key outcome. In general, recovery is more difficult to achieve and maintain than remission. Two vignettes are presented in this chapter. The first deals with a patient who remitted but never recovered, and the second deals with a patient who both remitted and recovered.

THE IMPACT OF AN EPILEPSY-CARE BUNDLE ON THE MANAGEMENT OF ACUTE SEIZURES IN A LARGE LONDON-BASED DISTRICT GENERAL HOSPITAL

2015 ◽  
Vol 86 (11) ◽  
pp. e4.107-e4
Author(s):  
Aravindhan Baheerathan ◽  
Kohilan Gananandan ◽  
Orlando Swayne
Keyword(s):  
District General Hospital ◽  
Business Case ◽  
Medical Emergency ◽  
Initial Assessment ◽  
Care Bundle ◽  
Staff Turnover ◽  
Acute Seizures ◽  
Neuro Imaging ◽  
The Impact

IntroductionSeizures account for 2–3% of presentations to the Accident & Emergency department. The National Audit of Seizure management in Hospitals (NASH) has demonstrated significant variances with regards to initial assessment and subsequent management. Standardised management protocols are crucial in optimising the care of this commonly encountered medical emergency.MethodsThe care of 30 patients admitted with seizures over a 1–month period was retrospectively reviewed. Following this a trust-wide seizure bundle was implemented and another 30 patients were reviewed. Data collection specifically assessed: ▸ Demographics of patients admitted, ▸ Immediate assessment & initial investigations, ▸ Consequent neuro-imaging & specialist investigations, ▸ Referral pathway.ResultsThe results showed poor uptake of the bundle and consequently management was broadly unchanged. The most significant results were:▸ 24% of cases did not have a senior review▸ 70% of cases were not discussed with neurology▸ 36% of cases did not have any follow up arrangedConclusionThe implementation of a seizure bundle can be challenging in the context of a unit that has a rapid staff turnover and is heavily staffed by locum physicians. Repeated staff education is required. This evidence is being used in a business case to employ an epilepsy nurse at Northwick Park. (Aravindhan Baheerathan and Kohilan Gananandan will both be presenting authors and contributed equally to this abstract).

scholarly journals Formal infectious diseases specialist consultation improves long-term outcome of methicillin-sensitive Staphylococcus aureus bacteremia

2019 ◽  
Author(s):  
E Forsblom ◽  
H Frilander ◽  
E Ruotsalainen ◽  
A Järvinen
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Staphylococcus Aureus Bacteremia ◽  
Long Term Follow Up ◽  
The Impact ◽  
Improved Outcome

Abstract Background Formal infectious diseases specialist (IDS) consultation has been shown to improve short-term outcome of Staphylococcus aureus bacteremia (SAB) but its effect on long-term outcome lacks evaluation. Methods Retrospective study of 367 methicillin-sensitive (MS) SAB patients followed for 10 years. The impact of formal IDS consultation on risk for new bacteremia and outcome during long-term follow-up were evaluated. Patients who died within 90 days were excluded to avoid interference from early deceased patients. Results 304 (83%) patients had formal IDS consultation whereas 63 (17%) received informal or no IDS consultation. Formal consultation, compared to informal or lack of consultation, associated to a reduced risk for a new bacteremia caused by any pathogen within 1-year (OR, 0.39; 95% CI, .18-.84; p=.014; 8% vs. 17%), and within 3-years (OR, 0.39; 95% CI, .19-.80; p=.010; 9% vs. 21%) whereas a trend towards a lower risk was observed within 10-years (OR, 0.56; 95% CI, .29-1.08; p=.079; 16% vs. 25%). Formal consultation, compared to informal or lack of consultation, improved outcome at 1-year (OR, 0.16; 95% CI, .06-.44; p<0.001; 3% vs. 14%), at 3-years (OR, 0.19; 95% CI, .09-.42; p<.001; 5% vs. 22%) and at 10-years (OR, 0.43; 95% CI, .24-.74; p=.002; 27% vs. 46%). Considering all prognostic parameters formal consultation improved outcome (HR, 0.42; 95% CI, .27-.65, p<.001) and lowered risk for any new bacteremia (OR, 0.45; 95% CI, .23-.88, p=.02) during 10-years follow-up. Conclusion MS-SAB management by formal IDS consultation, compared to informal or lack of IDS consultation, reduces risk for any new bacteremia episodes and improves long-term prognosis up to ten years.

Prevalence and Prognostic Impact of CEBPA mutations in Children with AML Treated with the AIEOP-LAM 2002/01 Protocol.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2643-2643
Author(s):  
Giovanni Cazzaniga ◽  
Riccardo Masetti ◽  
Giulia Ferrari ◽  
Tiziana Coliva ◽  
Carmelo Rizzari ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Group ◽  
Prognostic Impact ◽  
Granulocytic Differentiation ◽  
Free Survival ◽  
Cebpa Mutations ◽  
The Impact ◽  
Standard Risk ◽  
Improved Outcome

Abstract Abstract 2643 Poster Board II-619 C/EBP is a transcription factor that regulates terminal granulocytic differentiation. CEBPA mutations have been associated with improved outcome in both adult and pediatric patients with acute myeloid leukemia (AML). However, the impact in different treatment protocols, as well as the different outcome between single and double mutants, is still to be definitively established. We evaluated the prevalence and prognostic significance of CEBPA mutations in children with de novo non promyelocitic AML treated in Italy with the AIEOP-LAM 2002/01 pediatric protocol. Among 205 patients enrolled in the protocol between December 2002 and December 2007, 103 were successfully analyzed for CEBPA mutations by PCR amplification of TAD and bZIP domains of the gene, and through sequencing of positive cases after DHPLC analysis. Characteristics of analyzed and non analyzed patients were not statistically different. Two types of CEBPA mutations, N-terminal (TAD) truncating mutations and in-frame bZip domain mutations, were detected in 13/103 (12.6%) patients tested; 8 of them (61.5%) harboured both mutation types. Laboratory, clinical characteristics and outcomes for patients with CEBPA mutations were compared to those of patients with wild-type CEBPA. CEBPA mutations were significantly more common in older patients (8/13 vs 30/90 children were older than 10 years), in patients with FAB M1 (7/13 vs 4/90), and in patients with normal cytogenetics (13/13). None of the CEBPA mutated cases carried either FLT3 or NPM1 mutations. Only 1 mutated case was found in Standard Risk patients (defined as children carrying isolated CBF abnormality and achieving complete remission after 1 cycle of induction therapy), while the other 12 patients belonged to the High Risk group. Although the values did not reach statistical significance because of the low prevalence of CEBPA mutations, with a median follow up of 39 months (range 4–86) the event-free survival probability at 5 years was 76.9% vs. 59.6% for children with or without CEBPA mutations, respectively. The values for Disease-Free Survival were 83.3% vs. 65.4% and those for Overall Survival were 90.0%. 66.4%, respectively. No difference in terms of outcome was found between patient with a single and those with double mutants, neither between those with TAD- and bZIP- mutations. Therefore, patients in the AIEOP-LAM 2002/01 pediatric trial carrying CEBPA mutations seem to have a lower relapse rate and improved outcome, their overall survival approaching that of children belonging to the Standard Risk group (90% vs. 97%). If confirmed in a larger cohort of patients and with longer follow-up, these data suggest that CEBPA mutation analysis could be usefully employed to identify patients at lower risk of treatment failure and for allocating them into different classes of risk. Disclosures: No relevant conflicts of interest to declare.

Predictors of Slower Time-to-Cessation of Individual Therapy for Borderline Patients Over 16 Years of Prospective Follow-Up

2019 ◽  
Vol 33 (1) ◽  
pp. 135-144
Author(s):  
Dana B. Borkum ◽  
Frances R. Frankenburg ◽  
Garrett M. Fitzmaurice ◽  
Argyro Athanasiadi ◽  
Christina M. Temes ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Childhood Adversity ◽  
Borderline Personality ◽  
Individual Therapy ◽  
Childhood Neglect ◽  
Borderline Patients ◽  
History Of

The current study assesses time-to-cessation of individual therapy for patients with borderline personality disorder (BPD) and comparison subjects with other personality disorders (OPD) after 16 years of prospective follow-up. It also details the multivariate factors that predict this outcome for those with BPD. At baseline, 290 patients met criteria for BPD and 72 met criteria for OPD. Individuals with BPD had a significantly slower time-to-cessation of individual therapy than OPD comparison subjects. Seven baseline variables were found to be significant multivariate predictors of a slower time-to-cessation of individual therapy: older age, being white, severity of childhood neglect, history of a mood disorder, an IQ less than 90, poor vocational record prior to index admission, and higher level of trait neuroticism. The results of this study suggest that prediction of slower time-to-cessation of individual therapy is multifactorial in nature, involving factors related to demographics, childhood adversity, comorbidity, individual competence, and temperament.

Predictors of 18-month outcome for patients with borderline personality disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 1026-1026 ◽  
Author(s):  
D. Karaklic ◽  
J. Thuile ◽  
B. Granger ◽  
I. Secret ◽  
C. Bungener
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Life Events ◽  
Borderline Personality ◽  
Self Report ◽  
Global Functioning ◽  
Borderline Patients

IntroductionFor quite a long time, borderline personality disorder (BPD) has been viewed as a chronic disorder and borderline patients as extremely difficult to treat. However, those views are changing and there is an increasing recognition that the BPD has a far more benign course than previously thought, but predictors of its outcome remain poorly explored.Objective and aimsThe purpose of this study was to determine the most clinically relevant predictors of the outcome of BPD at the 18-month follow-up.MethodsBorderline patients (n = 75) were compared to patients with other personality disorders (OPD) (n = 40). All subjects were assessed at baseline and 6, 12, and 18 months with a series of semi structured interviews (personality disorders, global functioning, mental disorders, life events, …) and self-report measures (alexithymia and impulsivity). Logistic regression was used to estimate hazard ratios.ResultsAt the 18-month follow up, 57 BPD patients and 22 with OPD have been evaluated, 45% of borderline subjects and 50% of the OPD subjects achieved remission. Low impulsivity, low alexithymia, good global functioning, and older age at onset of symptoms were found to be significant predictors of good outcome of BPD. Our clinical data suggest that life events and the quality of current relationships are determinant in the outcome of BPD.Conclusions45% of patients with BPD are likely to improve in 18-months. Specific factors, such as impulsivity, alexithymia, life events and quality of current relationships, determine the short-term outcome of this disorder.

scholarly journals Impact of comorbidities and ablation strategy on outcome after pulmonary vein isolation with cryo-balloon in patients with non- paroxysmal atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Berkowitsch ◽  
J Hutter ◽  
S Zaltsberg ◽  
M Tomic ◽  
P Kahle ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Randomized Study ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Impact ◽  
Improved Outcome

Abstract Background Presence of several comorbidities in patients with atrial fibrillation is well known, but impact of them on outcome after pulmonary vein isolation with cryo-balloon is not enough investigated. First aim of the study was analysis of the impact of comorbidities on long term outcome after PVI with cryo-balloon new generation (CBA) and secondary goal was evaluation of the impact of additional posterior roof ablation (PRA) in these patients. Methods Patients with non-paroxysmal AF ablated with CBA in our institution since May 2012 and completed follow up &gt;3 months were enrolled in the study. The history of AF, cardiac comorbidities (CAD, Non ischemic-cardiomyopathy, heart insufficiency, right ventricular dysfunction) diabetes mellitus, and renal failure were assessed at admission, all patients received echocardiographic examination and blood test. After a single trans-septal access and PV angiography PVI was performed using a 28-mm CBA. Mapping of PV signals before, during, and after each cryo application was performed with a 3F lasso catheter. The procedural endpoint after PVI was defined as complete elimination of all fragmented signals at the PV antrum with verification of entrance and exit block. In some patients PRA was performed additionally to PVI at discretion of physician. The primary endpoint of this study was the first documented recurrence of atrial tachyarrhythmia (&gt;30 sec.), hospitalization due to cardio-vascular cause, re-do procedure or re-administration of anti-arrhythmic drugs. Results Among 560 patients 78 (13.9%) had no comorbidity and 299 (53.4%) were lasted with &gt;1 comorbidity. A total of 260 (46.4%) recurrences were obtained within median follow up of 28 (12–57) months. Female gender, long time from first diagnosis &gt;12 months and cardiac comorbidity were revealed to be independent predictors for long term recurrences whereas additional PRA performed in 176 pts independently improved outcome (61.9% vs 49.7%). Conclusion Cardiac comorbidities increased probability of post ablation recurrences, but performing of additional posterior roof ablation improved outcome in our cohort. These results should be confirmed in multi-center randomized study FUNDunding Acknowledgement Type of funding sources: None.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

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