Outcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison

Objective: In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. Methods: We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care (‘PARCS consumers’) with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period (‘inpatient-only consumers’). We used routinely collected data to compare them on a range of outcomes. Results: Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. Conclusion: Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.

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Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd20.4.121 ◽

2011 ◽

Vol 20 (4) ◽

pp. 121-123

Author(s):

Jeri A. Logemann

Keyword(s):

Decision Making ◽

Patient Care ◽

Clinical Outcomes ◽

Clinical Judgment ◽

Clinical Decision Making ◽

Evidence Based Practice ◽

Clinical Decision ◽

Evidence Based ◽

Clinical Method ◽

Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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Book Review of Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit

New England Journal of Medicine ◽

10.1056/nejm199406093302327 ◽

1994 ◽

Vol 330 (23) ◽

pp. 1695-1695

Keyword(s):

Inpatient Unit ◽

Short Term

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Decline in Marriage Associated with the COVID-19 Pandemic in the United States

Socius Sociological Research for a Dynamic World ◽

10.1177/2378023120980328 ◽

2020 ◽

Vol 6 ◽

pp. 237802312098032

Author(s):

Brandon G. Wagner ◽

Kate H. Choi ◽

Philip N. Cohen

Keyword(s):

United States ◽

The United States ◽

Cumulative Number ◽

Short Term ◽

Know How ◽

The Social ◽

Reporting Delays ◽

Social Upheaval ◽

Near Future ◽

Do So

In the social upheaval arising from the coronavirus disease 2019 (COVID-19) pandemic, we do not yet know how union formation, particularly marriage, has been affected. Using administration records—marriage certificates and applications—gathered from settings representing a variety of COVID-19 experiences in the United States, the authors compare counts of recorded marriages in 2020 against those from the same period in 2019. There is a dramatic decrease in year-to-date cumulative marriages in 2020 compared with 2019 in each case. Similar patterns are observed for the Seattle metropolitan area when analyzing the cumulative number of marriage applications, a leading indicator of marriages in the near future. Year-to-date declines in marriage are unlikely to be due solely to closure of government agencies that administer marriage certification or reporting delays. Together, these findings suggest that marriage has declined during the COVID-19 outbreak and may continue to do so, at least in the short term.

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Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial

The American Journal of Sports Medicine ◽

10.1177/0363546520988741 ◽

2021 ◽

Vol 49 (4) ◽

pp. 982-993

Author(s):

Anne-Sofie Agergaard ◽

Rene B. Svensson ◽

Nikolaj M. Malmgaard-Clausen ◽

Christian Couppé ◽

Mikkel H. Hjortshoej ◽

...

Keyword(s):

Clinical Trial ◽

Clinical Outcome ◽

Randomized Clinical Trial ◽

Clinical Outcomes ◽

Rating Scale ◽

Power Doppler ◽

Patellar Tendinopathy ◽

Short Term ◽

Level Of Evidence

Background: Loading interventions have become a predominant treatment strategy for tendinopathy, and positive clinical outcomes and tendon tissue responses may depend on the exercise dose and load magnitude. Purpose/Hypothesis: The purpose was to investigate if the load magnitude influenced the effect of a 12-week loading intervention for patellar tendinopathy in the short term (12 weeks) and long term (52 weeks). We hypothesized that a greater load magnitude of 90% of 1 repetition maximum (RM) would yield a more positive clinical outcome, tendon structure, and tendon function compared with a lower load magnitude of 55% of 1 RM when the total exercise volume was kept equal in both groups. Study Design: Randomized clinical trial; Level of evidence, 1. Methods: A total of 44 adult participants with chronic patellar tendinopathy were included and randomized to undergo moderate slow resistance (MSR group; 55% of 1 RM) or heavy slow resistance (HSR group; 90% of 1 RM). Function and symptoms (Victorian Institute of Sport Assessment–Patella questionnaire [VISA-P]), tendon pain during activity (numeric rating scale [NRS]), and ultrasound findings (tendon vascularization and swelling) were assessed before the intervention, at 6 and 12 weeks during the intervention, and at 52 weeks from baseline. Tendon function (functional tests) and tendon structure (ultrasound and magnetic resonance imaging) were investigated before and after the intervention period. Results: The HSR and MSR interventions both yielded significant clinical improvements in the VISA-P score (mean ± SEM) (HSR: 0 weeks, 58.8 ± 4.3; 12 weeks, 70.5 ± 4.4; 52 weeks, 79.7 ± 4.6) (MSR: 0 weeks, 59.9 ± 2.5; 12 weeks, 72.5 ± 2.9; 52 weeks, 82.6 ± 2.5), NRS score for running, NRS score for squats, NRS score for preferred sport, single-leg decline squat, and patient satisfaction after 12 weeks, and these were maintained after 52 weeks. HSR loading was not superior to MSR loading for any of the measured clinical outcomes. Similarly, there were no differences in functional (strength and jumping ability) or structural (tendon thickness, power Doppler area, and cross-sectional area) improvements between the groups undergoing HSR and MSR loading. Conclusion: There was no superior effect of exercising with a high load magnitude (HSR) compared with a moderate load magnitude (MSR) for the clinical outcome, tendon structure, or tendon function in the treatment of patellar tendinopathy in the short term. Both HSR and MSR showed equally good, continued improvements in outcomes in the long term but did not reach normal values for healthy tendons. Registration: NCT03096067 (ClinicalTrials.gov identifier)

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Temporal Changes in Pollen Grain Concentration Predict Short-Term Clinical Outcomes in Acute Coronary Syndromes

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.06.045 ◽

2021 ◽

Vol 30 ◽

pp. S112

Author(s):

O. Al-mukhtar ◽

S. Vogrin ◽

S. Noaman ◽

E. Lampugnani ◽

D. Dinh ◽

...

Keyword(s):

Clinical Outcomes ◽

Acute Coronary Syndromes ◽

Temporal Changes ◽

Pollen Grain ◽

Short Term ◽

Coronary Syndromes

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SHORT-TERM CLINICAL OUTCOMES OF TRANSCATHETER TRICUSPID VALVE REPAIR WITH THE 3RD GENERATION MITRACLIP XTR SYSTEM

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02561-4 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1202

Author(s):

Tobias Friedrich Ruf ◽

Rebecca Hahn ◽

Andres Beiras-Fernandez ◽

Felix Kreidel ◽

Michaela Hell ◽

...

Keyword(s):

Clinical Outcomes ◽

Tricuspid Valve ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Short Term

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An evaluation of service user experience, clinical outcomes and service use associated with urgent care services that utilise telephone-based digital triage: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-021-01576-x ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Vanashree Sexton ◽

Jeremy Dale ◽

Helen Atherton

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Clinical Outcomes ◽

User Experience ◽

Service User ◽

Service Use ◽

Urgent Care ◽

Narrative Synthesis ◽

Service User Experience ◽

Synthesis Approach

Abstract Background Telephone-based digital triage is widely used by services that provide urgent care. This involves a call handler or clinician using a digital triage tool to generate algorithm-based care advice, based on a patient’s symptoms. Advice typically takes the form of signposting within defined levels of urgency to specific services or self-care advice. Despite wide adoption, there is limited evaluation of its impact on service user experience, service use and clinical outcomes; no previous systematic reviews have focussed on services that utilise digital triage, and its impact on these outcome areas within urgent care. This review aims to address this need, particularly now that telephone-based digital triage is well established in healthcare delivery. Methods Studies assessing the impact of telephone-based digital triage on service user experience, health care service use and clinical outcomes will be identified through searches conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. Search terms using words relating to digital triage and urgent care settings (excluding in-hours general practice) will be used. The review will include all original study types including qualitative, quantitative and mixed methods studies; studies published in the last 20 years and studies published in English. Quality assessment of studies will be conducted using the Mixed Methods Appraisal Tool (MMAT); a narrative synthesis approach will be used to analyse and summarise findings. Discussion This is the first systematic review to evaluate service user experience, service use and clinical outcomes related to the use of telephone-based digital triage in urgent care settings. It will evaluate evidence from studies of wide-ranging designs. The narrative synthesis approach will enable the integration of findings to provide new insights on service delivery. Models of urgent care continue to evolve rapidly, with the emergence of self-triage tools and national help lines. Findings from this review will be presented in a practical format that can feed into the design of digital triage tools, future service design and healthcare policy. Systematic review registration This systematic review is registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO 2020 CRD42020178500).

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Service Use, Drop-Out Rate and Clinical Outcomes: A Comparison Between High and Low Intensity Treatments in an IAPT Service

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465813000544 ◽

2014 ◽

Vol 42 (6) ◽

pp. 747-759 ◽

Cited By ~ 16

Author(s):

Stella W. Y. Chan ◽

Malcolm Adams

Keyword(s):

Clinical Outcomes ◽

High Intensity ◽

Recovery Rate ◽

Service Use ◽

Evaluation Study ◽

Drop Out ◽

Stepped Care ◽

Depression And Anxiety ◽

Low Intensity ◽

Drop Out Rate

Background: The IAPT services provide high and low intensity psychological treatments for adults suffering from depression and anxiety disorders using a stepped care model. The latest national evaluation study reported an average recovery rate of 42%. However, this figure varied widely between services, with better outcomes associated with higher “step-up” rates between low and high intensity treatments. Aims: This study aimed to compare the two intensity groups in an IAPT service in Suffolk. Method: This study adopted a between groups design. A sample of 100 service users was randomly selected from the data collected from an IAPT service in Suffolk between May 2008 and February 2011. The treatment outcomes, drop-out rate, and other characteristics were compared between those who received high and low intensity treatments. Results: The high intensity group received, on average, more sessions and contact time. They received more CBT sessions and less guided self-help. There were no group differences in terms of the drop-out and appointment cancellation rates. Analyses on clinical outcomes suggested no group difference but demonstrated an overall recovery rate of 52.6% and significant reduction in both depression and anxiety symptoms. Conclusions: Despite methodological limitations, this study concludes that the service as a whole achieved above-average clinical outcomes. Further research building upon the current study in unpacking the relative strengths and weaknesses for the high and low intensity treatments would be beneficial for service delivery.

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Revolving door syndrome: A new meaning for an old concept?

European Psychiatry ◽

10.1016/s0924-9338(11)72819-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1114-1114

Author(s):

P. Garrido ◽

C. Saraiva

Keyword(s):

Health Care ◽

Hospital Admissions ◽

Strong Predictor ◽

Statistical Significance ◽

Revolving Door ◽

Full Time ◽

University Hospitals ◽

Short Term ◽

Care Services ◽

Psychiatric Units

Introduction“Revolving Door Syndrome” is usually defined as a cyclical pattern of short-term readmissions to the psychiatric units of health care centers, by young adults with chronic psychiatric disorders. Concerning the actual politics in health care sistems, with sucessive budget cuts and reduction of full-time hospital beds, the authors' aim has been to identify the patients that enter into a vicious circle of being admitted to hospital, discharged, and admitted again, as well as the underlying psychosocial reasons.ObjectivesThe purpose of this study was to identify factors associated with short-term readmissions to psychiatric acute care services, with statistical significance, and clinical interest, within a portuguese sample.Material and methodsRetrospective cohort study, in which the medical records of patients admitted to Coimbra University Hospitals two or more times (with short-term readmissions) between January and December of 2009, were analysed for socio-demographic characteristics, psychiatric diagnostic, presence of comorbidities, number of hospital admissions within that year, psychofarmacological treatments and presence of social and familiar support.Results and conclusionsThe authors found that lack of social and familiar support is a strong predictor for “Revolving Door Syndrome”, as well as the presence of a chronic psychiatric disorder.

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