”When You’re in the Hospital, You’re in a Sort of Bubble.”

Crisis ◽  
2014 ◽  
Vol 35 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Amanda Owen-Smith ◽  
Olive Bennewith ◽  
Jenny Donovan ◽  
Jonathan Evans ◽  
Keith Hawton ◽  
...  
Keyword(s):  
Lived Experience ◽  
Service Providers ◽  
Small Sample Size ◽  
Small Sample ◽  
Service Users ◽  
Number Of Factors ◽  
Increased Risk ◽  
Self Harm ◽  
The Uk ◽  
Depth Interviews

Background: Individuals are at a greatly increased risk of suicide and self-harm in the months following discharge from psychiatric hospital, yet little is known about the reasons for this. Aims: To investigate the lived experience of psychiatric discharge and explore service users’ experiences following discharge. Method: In-depth interviews were undertaken with recently discharged service users (n = 10) in the UK to explore attitudes to discharge and experiences since leaving hospital. Results: Informants had mixed attitudes to discharge, and those who had not felt adequately involved in discharge decisions, or disagreed with them, had experienced urges to self-harm since being discharged. Accounts revealed a number of factors that made the postdischarge period difficult; these included both the reemergence of stressors that existed prior to hospitalization and a number of stressors that were prompted or exacerbated by hospitalization. Conclusion: Although inferences that can be drawn from the study are limited by the small sample size, the results draw attention to a number of factors that could be investigated further to help explain the high risk of suicide and self-harm following psychiatric discharge. Findings emphasize the importance of adequate preparation for discharge and the maintenance of ongoing relationships with known service providers where possible.

An Exploration of Aftercare Services for Female Drug Users

2018 ◽  
Vol 30 (2) ◽  
Author(s):  
Talent Mhangwa ◽  
Madhu Kasiram ◽  
Sibonsile Zibane
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Drug Users ◽  
Service Providers ◽  
Service Users ◽  
Rehabilitation Centre ◽  
Aftercare Services ◽  
Data Source ◽  
Female Drug Users ◽  
Depth Interviews

The number of female drug users has been on the rise in South Africa, with statistics reflecting a rise in the number of women who attend treatment centres annually. This article presents empirical data from a broader qualitative study which aimed to explore perceptions concerning the effectiveness of aftercare programmes for female recovering drug users. The main data source was transcripts of in-depth interviews and focus groups with both service users and service providers from a designated rehabilitation centre in Gauteng, South Africa. Framed within a biopsychosocial-spiritual model, this article explores the perceptions and meanings which the female recovering drug users and the service providers attach to aftercare programmes. The findings of the research outlined the range of factors promoting recovery, alongside noteworthy suggestions for improvement in aftercare services. While acknowledging multiple influences on behaviour, this article highlights the significance of these findings in planning and implementing holistic aftercare programmes.

scholarly journals The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Peter Cox ◽  
Sonal Gupta ◽  
Sizheng Steven Zhao ◽  
David M. Hughes
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Random Effect ◽  
Small Sample ◽  
Future Research ◽  
Increased Risk

AbstractThe aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

scholarly journals Mediterranean Diet and Lifestyle Habits during Pregnancy: Is There an Association with Small for Gestational Age Infants? An Italian Single Centre Experience

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1941
Author(s):  
Rachele De Giuseppe ◽  
Manuela Bocchi ◽  
Silvia Maffoni ◽  
Elsa Del Bo ◽  
Federica Manzoni ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Mediterranean Diet ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Small Sample Size ◽  
Demographic Data ◽  
Small Sample ◽  
Activity Level ◽  
Lifestyle Habits ◽  
Increased Risk

Background. The small-for-gestational-age (SGA) in infants is related to an increased risk of developing Non-Communicable Diseases later in life. The Mediterranean diet (MD) is related to lower odds of being SGA. The study explored retrospectively the association between SGA, maternal MD adherence, lifestyle habits and other SGA risk factors during pregnancy. Methods. One hundred women (16–44 years) with a pregnancy at term were enrolled. Demographic data, parity, pre-gestational BMI, gestational weight gain, pregnancy-related diseases, and type of delivery were collected. The MD adherence (MEDI-LITE score ≥ 9), physical activity level, and smoking/alcohol consumption were registered. SGA neonates were diagnosed according to the neonatal growth curves. Results. Women were divided into “SGA group” vs. “non-SGA group”. The MD was adopted by 71% of women and its adherence was higher in the “non-SGA group” (p = 0.02). The prevalence of pregnancy-related diseases (gestational diabetes/pregnancy-induced hypertension) was higher in the “SGA group” (p = 0.01). The logistic regression showed that pregnancy-related diseases were the only independent risk factor for SGA. Conclusions. MD may indirectly reduce the risk of SGA since it prevents and exerts a positive effect on pregnancy-related diseases (e.g., gestational diabetes and hypertension). The small sample size of women in the SGA group of the study imposes a major limitation to the results and conclusions of this research, suggesting however that it is worthy of further investigation.

Combination of AST to ALT and neutrophils to lymphocytes ratios as predictors of locally advanced disease in patients with bladder cancer subjected to radical cystectomy: Results from a single-institutional series

2021 ◽  
pp. 039156032110351
Author(s):  
Alessandro Uleri ◽  
Rodolfo Hurle ◽  
Roberto Contieri ◽  
Pietro Diana ◽  
Nicolòmaria Buffi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Advanced Disease ◽  
Independent Predictor ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Small Sample ◽  
Locally Advanced Disease ◽  
Increased Risk

Background: Bladder cancer (BC) staging is challenging. There is an important need for available and affordable predictors to assess, in combination with imaging, the presence of locally-advanced disease. Objective: To determine the role of the De Ritis ratio (DRR) and neutrophils to lymphocytes ratio (NLR) in the prediction of locally-advanced disease defined as the presence of extravescical extension (pT ⩾ 3) and/or lymph node metastases (LNM) in patients with BC treated with radical cystectomy (RC). Methods: We retrospectively analyzed clinical and pathological data of 139 consecutive patients who underwent RC at our institution. Logistic regression models (LRMs) were fitted to test the above-mentioned outcomes. Results: A total of 139 consecutive patients underwent RC at our institution. Eighty-six (61.9%) patients had a locally-advanced disease. NLR (2.53 and 3.07; p = 0.005) and DRR (1 and 1.17; p = 0.01) were significantly higher in patients with locally-advanced disease as compared to organ-confined disease. In multivariable LRMs, an increasing DRR was an independent predictor of locally-advanced disease (OR = 3.91; 95% CI: 1.282–11.916; p = 0.017). Similarly, an increasing NLR was independently related to presence of locally-advanced disease (OR = 1.28; 95% CI: 1.027–1.591; p = 0.028). In univariate LRMs, patients with DRR > 1.21 had a higher risk of locally advanced disease (OR = 2.83; 95% CI: 1.312–6.128; p = 0.008). Similarly, in patients with NLR > 3.47 there was an increased risk of locally advanced disease (OR = 3.02; 95% CI: 1.374–6.651; p = 0.006). In multivariable LRMs, a DRR > 1.21 was an independent predictor of locally advanced disease (OR = 2.66; 95% CI: 1.12–6.35; p = 0.027). Similarly, an NLR > 3.47 was independently related to presence of locally advanced disease (OR = 2.24; 95% CI: 0.95–5.25; p = 0.065). No other covariates such as gender, BMI, neoadjuvant chemotherapy or diabetes reached statistical significance. The AUC of the multivariate LRM to assess the risk of locally advanced disease was 0.707 (95% CI: 0.623–0.795). Limitations include the retrospective nature of the study and the relatively small sample size.

Abstract 13215: Gender-affirming Hormones Are Associated With Increased Risk of QT Prolongation in Transgender Females

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniel Antwi Amoabeng ◽  
Ahmed Hanfy ◽  
Munadel Awad ◽  
Bryce D Beutler ◽  
Amneet Rai ◽  
...  
Keyword(s):  
Qt Interval ◽  
Small Sample Size ◽  
Qt Prolongation ◽  
Small Sample ◽  
Rank Test ◽  
Qt Interval Prolongation ◽  
Northern Nevada ◽  
Increased Risk ◽  
Before And After ◽  
Signed Rank Test

Introduction: Women have a longer QT interval than men. This sex-specific difference is attributed to hormones associated with the biological female sex. Male-to-female transgender individuals often take antiandrogens such as spironolactone or goserelin in addition to estrogens to suppress testosterone effects while increasing feminine features. Effects of gender-affirming hormone therapy (GHT) on the QT interval in these individuals remains to be elucidated. Hypothesis: We assessed the hypothesis that the use of GHT is associated with an increased risk for QT interval prolongation in transgender females. Methods: We identified 46 transgender females through a search of the electronic medical records of a Veterans Administration hospital in Northern Nevada. Patients with a diagnosis of congenital long QT syndrome were excluded. Of these, 13 patients had ECGs before and after initiation of GHT and were included. We adapted the Tisdale score using the auto-calculated corrected QT interval (QTc) to estimate the risk of QT prolongation. Age, QTc, and Tisdale scores before and after GHT initiation were compared using the Wilcoxon signed-rank test. All tests were performed as two-tailed at a 5% level of significance. Results: All 13 study patients were taking estrogens. Of these, 3 (23.1%) were taking goserelin and 9 (69.2%) were taking spironolactone. Mean ± SEM age at ECG acquisition was 45.0 ± 4.4 and 47.7 ± 4.7 years before and after the initiation of GHT respectively. Mean ± SEM QTc after initiation of GHT was significantly higher compared to the baseline (467.5 ± 12.8 ms vs. 428.2 ± 7.1 ms) (Figure 1A). The average baseline Tisdale score was significantly smaller on follow-up (1-point vs. 3 points) (Figure 1B). Conclusions: GHT appears to be associated with increased QTc in transgender women. This needs to be interpreted with caution owing to the very small sample size in this study. Further studies to investigate the strength of this association, if it exists, are warranted.

scholarly journals Survival of patients with melanoma metastatic brain metastases in the era of novel systemic therapies in Cardiff, Wales

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv13-iv13
Author(s):  
Joseph Pasquale ◽  
Joanita Ocen ◽  
James Powell ◽  
Satish Kumar
Keyword(s):  
Targeted Therapy ◽  
Brain Metastases ◽  
Small Sample Size ◽  
Brain Lesion ◽  
Small Sample ◽  
Simultaneous Treatment ◽  
Local Progression ◽  
Significant Difference ◽  
Retrospective Nature ◽  
The Uk

Abstract The incidence of malignant melanoma (MM) is increasing in the UK; it’s projected to rise by 7% by 2035. MM has high predisposition to developing brain metastases (BM) with 50–60% of patients being affected. Stereotactic radiosurgery (SRS) and surgery, key interventions in managing patients with BM, have been shown to improve survival outcomes of patients. Patients’ prognosis and survival has also significantly improved with the advent of novel therapies in the last few years. It was noted that the Cardiff Neuro-Oncology multidisciplinary team were receiving increasing amount of referrals for consideration of surgery or SRS in patients with MM. 106 MDT referrals were retrospectively reviewed. 31 patients had surgery, 20 patients had SRS and the remaining 54 patients had WBRT. There was no significant difference in the patient distribution. The majority of patients had 1 brain lesion in both groups (in similar proportions). The 12 month survival for the surgical cohort was 65% for immunotherapy group, 55%- targeted therapy and 30%- no therapy. For the SRS group the 12 month survival for immunotherapy was 45%, targeted therapy- 40% and 20%- no therapy. The median OS for surgery versus SRS was 8 and 7 months respectively. The results suggest that simultaneous treatment with surgery or SRS in conjunction with SACT does improve survival. Interpretation of results will have to be taken with caution due to the retrospective nature and the small sample size. Going forward, we will delve deeper and review local progression rates and SACT timing/sequencing in our practice.

scholarly journals Facilitating User Involvement in Activation Programmes: When Carers and Clerks Meet Pawns and Queens

2014 ◽  
Vol 44 (2) ◽  
pp. 235-254 ◽  
Author(s):  
ANNE BRITT DJUVE ◽  
HANNE C. KAVLI
Keyword(s):  
Human Factor ◽  
Service Providers ◽  
Qualitative Interviews ◽  
User Involvement ◽  
Individual Characteristics ◽  
Service Users ◽  
Ideal Types ◽  
Number Of Factors ◽  
User Influence ◽  
The Individual

AbstractUser involvement has become an explicit goal within social service provision. Even so, the term remains ambiguous, and its implementation troublesome. Implementation theory lists a number of factors influencing bureaucratic behaviour; in this paper we investigate the ‘human factor’. Our ambition is to provide a framework for analysis of user influence in activation programmes that includes the individual characteristics of both service users and service providers. Building on theoretical insights from the literature on activation and agency, we develop a framework that distinguishes between two ideal types of service users: Pawns and Queens, and two types of service providers: care-oriented Carers and rule-oriented Clerks. This framework is then applied to identify key challenges for the interaction between users and caseworkers in two challenging situations: when service users express little or no agency and when they express agency that is incompatible with the overall goals of the programme. We find that Carers show pronounced reluctance to overrule the choices made by service users even when they have conflicting views – and tend to postpone decisions when they interact with Pawns. Clerks tend to overrule the decisions of Queens when they have conflicting views, and to make decisions on behalf of Pawns. The analysis draws on data collected from 126 qualitative interviews with service providers and participants in the Norwegian Introductory Programme for immigrants and a survey of 320 caseworkers.

scholarly journals Diagnostic Dissent: Experiences of Perceived Misdiagnosis and Stigma in Persons Diagnosed With Schizophrenia

2018 ◽  
Vol 59 (1) ◽  
pp. 69-98 ◽  
Author(s):  
Faith A. Forgione
Keyword(s):  
Mental Illness ◽  
Life History ◽  
Lived Experience ◽  
Psychiatric Diagnosis ◽  
Psychiatric Hospitals ◽  
Service Users ◽  
Psychiatric Theory ◽  
Study Participants ◽  
Depth Interviews ◽  
Insight Into

It is not uncommon for individuals to disagree with their psychiatric diagnosis. The experience of perceived misdiagnosis can be challenging for service users, as mainstream psychiatric theory often views this disagreement as an indication of “poor insight” into their putative illness. Some researchers have suggested that labeling a service user as lacking insight can be detrimental to the service user’s recovery. Regardless of whether a person agrees with his or her diagnosis, persons labeled with “mental illness” sometimes internalize the discrimination and stigma that they encounter. However, few studies have examined the lived experience of disagreeing with a diagnosis. The present study investigated the first-person experiences of three individuals who believed that they were misdiagnosed with a psychotic disorder. As part of a larger study, participants completed in-depth interviews about their life history and experiences in psychiatric hospitals. Data were analyzed using phenomenological methods. Participants felt that their clinicians assigned an erroneous and stigmatizing label that did not match their self-experience. Diagnostic dissent, a form of perceived misdiagnosis, was a way for individuals to assert their self-experience against perceived invalidation and stigmatizing labels.

scholarly journals “Coke on Tick”: exploring the cocaine market in the UK through the lens of financial management

2017 ◽  
Vol 24 (2) ◽  
pp. 181-199 ◽  
Author(s):  
Alexandra Hall ◽  
Georgios A. Antonopoulos
Keyword(s):  
Financial Management ◽  
Capital Investment ◽  
Relevant Literature ◽  
Organised Crime ◽  
Content Type ◽  
Number Of Factors ◽  
The Uk ◽  
Depth Interviews ◽  
Different Sources ◽  
Integral Feature

Purpose This paper aims to offer detailed preliminary data and analysis that focuses specifically on the structures and financial aspects of the UK cocaine market. Design/methodology/approach This paper is based on in-depth interviews with – among others – four active criminal entrepreneurs involved in powder cocaine supply in the UK. Furthermore, along with a review of relevant literature and open sources, in-depth interviews were undertaken with a range of experts with knowledge of the cocaine market. These experts include law enforcement agents and independent academics/researchers who have researched the cocaine market in the UK and internationally. Findings The cocaine market is a fragmented business dependent on networks of individual entrepreneurs and groups. At the core of collaborations often lie family, ethnic or kinship relationships and relationships forged within legal businesses and in prison. Capital investment practices in this market are flexible, “messy” and mutating, and money comes from a range of different sources. Credit is an integral feature of the cocaine business in the UK. The financial management of the cocaine trade is a result of (and reflects) a number of factors, such as the fragmented and decentralised nature of the trade. Originality/value Empirical research into financial aspects of organised crime manifestations is important for the assumptions that are part of public debate to be tested. In addition, understanding the broader range of financial aspects of organised crime is an important component of the process of crimes for gain and can contribute to both better investigation and better prevention.

Discrepancy of blast percentage between the bone marrow aspirate and biopsy and its impact on survival outcomes in patients with myelodysplastic syndromes excess blast (MDS-EB).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 7053-7053
Author(s):  
Meera Yogarajah ◽  
Phuong L. Nguyen ◽  
Rong He ◽  
Hassan Alkhateeb ◽  
Mithun Vinod Shah ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Scoring System ◽  
Small Sample Size ◽  
Scoring Systems ◽  
Standard Of Care ◽  
Small Sample ◽  
International Prognostic Scoring System ◽  
Increased Risk ◽  
Significant Difference ◽  
Impact On Survival

7053 Background: The revised International Prognostic Scoring System (IPSS-R) aids in prognosticating MDS. The percentage (%) of blasts in the bone marrow is one of the major determinants of the scoring system. The aspirate blast % is utilized as the standard of care, but there could be discrepancies in the blast % reported by the aspirate and the biopsy. We aim to study the possible use of bone marrow biopsy blasts in MDS-EB in calculating IPSS-R. Methods: The MDS database was reviewed for cases of MDS-EB after due IRB approval. We calculated IPSS-R scores based on the aspirate blast % (IPSS-RAsp) and biopsy blast % (IPSS-RBx). The biopsy blast % was reported morphologically or by the CD34 stain. Whenever a range was reported the highest value was utilized as the blast %. Suboptimal aspirates were excluded from the study. The overall survival (OS) was determined by IPSS-RAsp, IPSS-RBx and IPSS-R highest blast (IPSS-RHi). OS estimates were calculated by Kaplan-Meier curves and log-rank testing using JMP v.13. Uno’s concordance statistic was used to compare all 3 risk scoring systems. Results: Of 1322 patients, 431 (33%) cases were identified with MDS-EB; out of which 173 cases had both blasts reported in the biopsy and the aspirate. Out of 173 cases, 35 (20%) had MDS-EB1, and 61 (35%) had MDS EB-2 based on both biopsy and aspirate (concordant cases). Seventy seven (45%) patients changed from EB-1 to EB2 or vice versa based on the biopsy blast (44/77 (57%) cases were upstaged). The OS outcomes based on the IPSS-RBx biopsy showed a clear and meaningful separation with median OS decreasing with increased risk but IPSS-RAsp and IPSS-RHi did not (Table). We compared the 3 models for observed OS differences using the Uno model and there was no statistically significant difference. Conclusions: IPSS-RBx (but not IPSS-RAsp and IPSS-RHi) identified prognostic groups for OS with median OS decreasing with increased risk. The small sample size may have led to an insignificant effect on model power by Uno model. This finding needs to be validated by other centers. [Table: see text]

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