A Multisite Randomized Block Experiment on the Seamless System of Care Model for Drug-Involved Probationers

2016 ◽  
Vol 47 (1) ◽  
pp. 50-73 ◽  
Author(s):  
Alese Wooditch ◽  
Lincoln B. Sloas ◽  
Faye S. Taxman
Keyword(s):  
Treatment Initiation ◽  
System Of Care ◽  
Community Treatment ◽  
Risk Level ◽  
Care Group ◽  
Control Group ◽  
Care Model ◽  
Probation Office ◽  
Abuse Treatment ◽  
Block Experiment

This multisite randomized block experiment examines the efficacy of the seamless system of care for probationers (an integrated probation model combined with substance abuse treatment intervention onsite at a probation office). The sample consists of 251 drug-involved probationers randomized into probation with referral to community treatment or the seamless system of care. Key outcomes are examined over a 1-year period by recidivism risk level. When compared with probationers in the control group, the findings are that those in the seamless system of care group had fewer drug use days overall, less alcohol consumption, improved treatment initiation and adherence, but a higher number of days incarcerated. Low-risk seamless system participants had the most favorable outcomes compared with other study conditions. This study demonstrates the importance of tailoring interventions to the risk level of the probationer, and that the seamless system works better for lower risk offenders with substance use disorders.

scholarly journals Primary dementia care based on the individual needs of the patient: study protocol of the cluster randomized controlled trial, DemStepCare

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isabella Bablok ◽  
◽  
Harald Binder ◽  
Dominikus Stelzer ◽  
Klaus Kaier ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Dementia Care ◽  
Cluster Randomized Controlled Trial ◽  
Control Group ◽  
Care Model ◽  
Randomized Controlled ◽  
Individual Needs ◽  
Cluster Randomized ◽  
The Individual

Abstract Background Most people with dementia (PwD) are cared for at home, with general practitioners (GPs) playing a key part in the treatment. However, primary dementia care suffers from a number of shortcomings: Often, diagnoses are made too late and therapies by GPs do not follow the guidelines. In cases of acute crises, PwD are too often admitted to hospital with adverse effects on the further course of the disease. The aim of this study is to implement and evaluate a new GP-based, complex dementia care model, DemStepCare. DemStepCare aims to ensure demand-oriented, stepped care for PwD and their caregivers. Methods/design In a cluster randomized controlled trial, the care of PwD receiving a complex intervention, where the GP is supported by a multi-professional team, is compared to (slightly expanded) usual care. GPs are clustered by GP practice, with 120 GP practices participating in total. GP practices are randomized to an intervention or a control group. 800 PwD are to be included per group. Recruitment takes place in Rhineland-Palatinate, Germany. In addition, a second control group with at least 800 PwD will be formed using aggregated routine data from German health insurance companies. The intervention comprises the training of GPs, case management including repeated risk assessment of the patients’ care situation, the demand-oriented service of an outpatient clinic, an electronic case record, external medication analyses and a link to regional support services. The primary aims of the intervention are to positively influence the quality of life for PwD, to reduce the caregivers’ burden, and to reduce the days spent in hospital. Secondary endpoints address medication adequacy and GPs’ attitudes and sensitivity towards dementia, among others. Discussion The GP-based dementia care model DemStepCare is intended to combine a number of promising interventions to provide a complex, stepped intervention that follows the individual needs of PwD and their caregivers. Its effectiveness and feasibility will be assessed in a formative and a summative evaluation. Trial registration German Register of Clinical Trials (Deutsches Register Klinischer Studien, DRKS), DRKS00023560. Registered 13 November 2020 - Retrospectively registered. HTML&TRIAL_ID=DRKS00023560.

Effect of breast milk oral care in infants who underwent surgical correction of ventricular septal defect

2021 ◽  
pp. 1-4
Author(s):  
Xian-Rong Yu ◽  
Yu-Qing Lei ◽  
Jian-Feng Liu ◽  
Zeng-Chun Wang ◽  
Hua Cao ◽  
...  
Keyword(s):  
Breast Milk ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Oral Care ◽  
Intervention Group ◽  
Physiological Saline ◽  
Surgical Correction ◽  
Controlled Study ◽  
Care Group ◽  
Control Group

Abstract Objective: This study explored the clinical effect of employing breast milk oral care for infants who underwent surgical correction of ventricular septal defect. Methods: A prospective randomised controlled study was conducted in a provincial hospital between January, 2020 and July, 2020 in China. Patients were randomly divided into an intervention group (breast milk oral care, n = 28) and a control group (physiological saline oral care, n = 28). The intervention group was given oral nursing using breast milk for infants in the early post-operative period, and the control group was given oral nursing using physiological saline. Related clinical data were recorded and analysed. Results: There were no significant differences in age, gender, weight, operation time, cardiopulmonary bypass time, or aortic cross-clamping time between the two groups. Compared with the physiological saline oral care group, the mechanical ventilation duration, the length of ICU stay in the breast milk oral care group were significantly shorter. The time of start feeding and total enteral nutrition were significantly earlier in the intervention group than those in the control group. The incidence of post-operative pneumonia in the breast milk oral care group was 3.6%, which was significantly lower than that of the physiological saline oral care group. Conclusion: The use of breast milk for oral care in infants who underwent surgical correction of VSD can reduce the incidence of post-operative pneumonia and promote the recovery of gastrointestinal function.

scholarly journals Astragalus Polysaccharide Injection (PG2) Normalizes the Neutrophil-to-Lymphocyte Ratio in Patients with Advanced Lung Cancer Receiving Immunotherapy

2021 ◽  
Vol 20 ◽  
pp. 153473542199525
Author(s):  
Shih Ming Tsao ◽  
Tz Chin Wu ◽  
JiZhen Chen ◽  
Feichi Chang ◽  
Thomos Tsao
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Survival Data ◽  
Treatment Initiation ◽  
Checkpoint Inhibitors ◽  
Neutrophil To Lymphocyte Ratio ◽  
Advanced Lung Cancer ◽  
Control Group ◽  
Lymphocyte Ratio ◽  
Astragalus Polysaccharide

Objectives: The neutrophil-to-lymphocyte ratio (NLR) is a prognostic marker in patients with cancer receiving immunotherapy. Recent studies have shown that a high NLR was associated with a poor response and decreased survival. However, there is no intervention to reverse abnormally high NLR and improve clinical outcomes. Astragalus polysaccharide injection (PG2) is an immunomodulatory therapy for cancer-related fatigue. This study aimed to examine whether PG2 might normalize the NLR and affect the overall survival of patients with lung cancer treated with immunotherapy. Materials and Methods: We retrospectively examined the medical records of patients with lung cancer treated with immune checkpoint inhibitors (ICIs) between October 1, 2015 and November 30, 2019. All patients received ICI combination chemotherapies, and some similarly received PG2 (Control vs PG2). The NLR was assessed before treatment and 6 weeks after ICI initiation, and the survival data was collected at least 4 years after treatment initiation for the first enrolled patient. Results: Fifty-three patients were included. Six weeks after ICI initiation, 91.3% of the patients in the PG2 group exhibited a predefined “Decrease or no change” in the NLR, which was 28% higher than that in the Control group (63.3%) ( P = .028). The NLR significantly decreased by 31.60% from baseline in the PG2 group ( P = .012), whereas it increased by 5.80% in the Control group ( P = .572). Six weeks after ICI treatment initiation, both groups had a median NLR of 3.73, and the overall survival was also similar (PG2 vs Control, 26.1 months vs 25.4 months, respectively); however, the PG2 group had a higher median baseline NLR than the Control group (PG2 vs Control, 4.51 vs 2.81, respectively). Conclusion: This study demonstrated that PG2 could normalize the NLR in patients with lung cancer receiving ICI combination treatments.

scholarly journals Randomised controlled study of two counselling models at the Swedish alcohol helpline: Effectiveness and sustainability outcomes at 12-month follow-up

2021 ◽  
pp. 145507252110078
Author(s):  
Thi-Thuy-Dung Nguyen ◽  
Eleonor Säfsten ◽  
Filip Andersson ◽  
Maria Rosaria Galanti
Keyword(s):  
Alcohol Use ◽  
Usual Care ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Risk Level ◽  
Care Group ◽  
Structured Intervention ◽  
Randomised Controlled ◽  
Level Reduction

Aim: This two-arm parallel randomised controlled trial explored the effectiveness of a brief counselling model compared with the usual multi-session counselling at an alcohol telephone helpline. Methods: A total of 320 callers who contacted the Swedish Alcohol Helpline (SAH) because of hazardous or harmful alcohol use were randomised to either brief structured intervention (self-help booklet plus one proactive call) or usual care (multi-session telephone counselling). The primary outcome was a downward shift in risk level at 12-month follow-up compared with baseline, based on self-reports. Sustained risk level reduction throughout the whole follow-up was also assessed as secondary outcome. Results: Both interventions were significantly associated with a shift to a lower level of risky alcohol use (75% among participants in the brief structured intervention, and 70% in the usual care group) after 12 months. There was no difference between the two interventions in the proportions changing alcohol use or sustaining risk level reduction. Conclusion: In the context of telephone helplines, minimal and extended interventions appear to be equally effective in promoting long-term change in alcohol use.

scholarly journals Economic evaluation of outpatients with type 2 diabetes mellitus assisted by a pharmaceutical care service

2011 ◽  
Vol 55 (9) ◽  
pp. 686-691 ◽  
Author(s):  
Anna Paula de Sá Borges ◽  
Camilo Molino Guidoni ◽  
Osvaldo de Freitas ◽  
Leonardo Régis Leira Pereira
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Pharmaceutical Care ◽  
Care Service ◽  
Emergency Department Visits ◽  
Care Group ◽  
Control Group ◽  
Pharmaceutical Care Service

OBJECTIVE: To analyze the costs related to visits and drug prescription in outpatients with type 2 diabetes mellitus assisted by a pharmaceutical care service. SUBJECTS AND METHODS: A prospective and experimental study was carried out. Seventy one patients were divided into two groups: control and pharmaceutical care. Patients in the pharmaceutical care group were followed up monthly by a single clinical pharmacist. RESULTS: The pharmaceutical care group had a statistically significant reduction in costs of metformin and emergency department visits, and increased costs with their family physicians. On the other hand, the control group had a statistically significant increase of 21.3% in the general costs of treatment and visits. CONCLUSION: The pharmaceutical care group maintained the same costs related to drugs and visits, while the control group showed a significant increase in general costs.

Compulsory Psychiatric Treatment in the Community

1991 ◽  
Vol 158 (6) ◽  
pp. 792-799 ◽  
Author(s):  
Tom Sensky ◽  
Timothy Hughes ◽  
Steven Hirsch
Keyword(s):  
Psychiatric Treatment ◽  
Treatment Compliance ◽  
Community Treatment ◽  
Control Group ◽  
The Past ◽  
History Of ◽  
Treatment Use ◽  
Reduced Time ◽  
Treatment Order ◽  
Community Treatment Order

Following in-patient psychiatric treatment under Section 3 of the Mental Health Act, some patients have in the past remained on Section after discharge, and subsequently the Section has been renewed while the patient remained ‘on leave’. People treated thus with ‘extended leave’ probably resemble closely those who would be placed on a community treatment order if this were available. A group of these extended-leave patients was compared with a control group, matched for age, sex and diagnosis, selected by consultant psychiatrists as not requiring treatment using a community treatment order. The two groups showed very few differences, but the extended-leave patients more commonly had a history of recent dangerousness and non-compliance with psychiatric treatment. Use of extended leave improved treatment compliance, reduced time spent in hospital, and reduced levels of dangerousness.

Effects of aerobic plus explosive power exercises on bone remodeling and bone mineral density in young men

2017 ◽  
Vol 43 (1) ◽  
pp. 40-48
Author(s):  
Veysi Çay ◽  
Gurbuz Buyukyazi ◽  
Cevval Ulman ◽  
Fatma Taneli ◽  
Yeliz Doğru ◽  
...  
Keyword(s):  
Maximal Oxygen Consumption ◽  
Exercise Program ◽  
Exercise Group ◽  
Risk Level ◽  
Control Group ◽  
Maximal Heart Rate ◽  
Mineral Density ◽  
Explosive Power ◽  
Before And After ◽  
And Control

AbstractObjectives:This study aims to examine effects of aerobic jogging and explosive power exercises on body composition, maximal oxygen consumption (MaxVOMaterials and methods:Thirty seven healthy males were divided into exercise group (EG, n=19) and control group (CG, n=18). EG completed 10 weeks of outdoor aerobic (jogging at 60–70% maximal heart rate reserve starting from 20 min steadily increasing up to 28 min) and explosive power exercises (in 2–3 sets, with maximum repetitions lasting 15 s), 3 times per week. All measurements were taken before and after the exercise program. BMD was measured via dual energy X-ray absorptiometry (DEXA).Results:Body mass index (p<0.001) significantly decreased; MaxVOConclusion:Performing our outdoor exercise program in spring months might have an important role in the significant increase (9 vs. 22 ng/mL) in mean vitamin D level, which reached above the fracture risk level of 20 ng/mL.

scholarly journals New Challenges Regarding the Intervention of Musculoskeletal Risk in Truck Service Garages

2021 ◽  
Vol 14 (1) ◽  
pp. 181
Author(s):  
Coral Oliver Hernández ◽  
Shimeng Li ◽  
María José Aguado Benedí ◽  
Inmaculada Mateo Rodríguez
Keyword(s):  
Musculoskeletal Disorders ◽  
Initial Assessment ◽  
Risk Level ◽  
Control Group ◽  
Entire Body ◽  
Course Of Action ◽  
Postural Load ◽  
Rapid Entire Body Assessment ◽  
Experimental Group ◽  
Postural Training

Background: The automotive industry is heavily affected by sick leaves caused by the handling of loads and using postures that produce musculoskeletal disorders. Research is needed to analyse their causes and find possible solutions to eliminate or mitigate these risks. Objective: Our objective was to analyse the level of musculoskeletal risk in the different work tasks performed by truck and bus mechanics. Our intention is also to analyse whether postural training and feedback can help reduce risk. Methods: The rapid entire body assessment (REBA) was used to assess the postures performed by 35 mechanics from eight branches throughout Spain. The participants were subsequently divided randomly into two groups (experimental group and control group). The experimental group (EG) was given training and feedback on their postures and the control group (CG) was not offered any type of intervention. A few months after the initial assessment, their postural load in the usual tasks was re-evaluated. Results: An overall average REBA Score: 10.49 ± 1.33. The main risk was found in the trunk and arms with sustained above-the-head postures. EG’s second results are significantly improved compared to the first (p = 0.026 *). Conclusions: These jobs have a high-risk level of musculoskeletal disorders. The course of action presented with postural training and feedback has shown satisfactory results. Nevertheless, given the size of the sample, further research will be needed to delve deeper into this possibility as a future line of intervention.

Abstract 225: A Depression Quality Program and Cardiovascular Disease: Assessing the Impact on Care

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Linda Gordon ◽  
Amanda Malecky ◽  
Andrew Althouse ◽  
Nicole Ansani
Keyword(s):  
Usual Care ◽  
Goal Attainment ◽  
Intervention Group ◽  
Phone Call ◽  
Categorical Variables ◽  
Care Group ◽  
Control Group ◽  
Surrogate Outcome ◽  
The Impact

Background: Data demonstrate an adverse association between depression and coronary artery disease prognosis. Therefore, a depression screening program was initiated in the catheterization (cath) lab. The goals were to improve HEDIS depression compliance rates and determine the impact on clinical outcomes. Methods: Adult patients in an inpatient cath lab from 3 cardiology practices were screened for enrollment in a randomized controlled trial. All cath lab patients received a PHQ-9 depression screener. Those who screened positive for depression (score ≥ 10) were randomized to intervention or usual care. The usual care group received a follow-up phone call to re-administer the PHQ-9 at 6-8 weeks and within 210 days of discharge. The intervention group was administered the PHQ-9 and received intensive education at baseline, 6-8 weeks, and within 210 days of discharge. Education included targeted depression information with a mental health care provider and comprehensive disease management education with a cardiovascular nurse practitioner. Outcomes included: differences in HEDIS depression goal attainment; depression response/remission rates; and cardiovascular goals. Differences between groups were tested using chi-squared tests (categorical variables) and t-tests (continuous variables). Results: Baseline characteristics were similar between control (N=43) and intervention (N=40) groups, with the exception of significantly fewer African American patients in the control group (N=2, 4.7%) vs intervention (N=9, 22.5%). Changes in HEDIS goal attainment show that patients in the intervention group were slightly more likely to be referred to a provider to address depression (95.0% vs 86.0%, p=0.314), or receive meds for depression (65.0% vs 51.2%, p=0.219), but these differences are not statistically significant. More patients in the intervention group refused meds for depression compared to control (15.0% vs. 2.3%, p=0.041); have received blood work (65.0% vs 41.9%, p=0.030); and have received follow-up within 210 days (82.5% vs 46.5%, p<0.001). Treatment adjustment rate was higher in the intervention group compared to control (85.0% vs. 65.1%, p=0.037). Hospital readmission rate was similar between groups (p=0.896) and there was no difference in depression remission or response rates (p=0.426). Further, no differences were seen in cardiovascular surrogate outcome parameters, including cholesterol, A1c, CRP, or BNP between groups; except SGOT was significantly different between groups (-5.0 intervention vs 2.0 control p=0.045). Conclusions: These data demonstrate improvements in attaining a surrogate outcome measure of quality (HEDIS goals); however, this does not appear to translate to a significant clinical impact. Quality measures may need to be continuously reassessed to ensure efficiency and effectiveness of care.

The Pediatric Experience of an Experimental Prepaid Group Practice in a Medical School Setting

PEDIATRICS ◽  
1974 ◽  
Vol 53 (3) ◽  
pp. 319-325
Author(s):  
Lawrence Kahn ◽  
Gerald T. Perkoff
Keyword(s):  
Medical School ◽  
Medical Care ◽  
Hospital Admissions ◽  
School Setting ◽  
Controlled Study ◽  
Care Group ◽  
Care Utilization ◽  
Control Group ◽  
Group Practice ◽  
Fee For Service

The Medical Care Group (MCG) of Washington University is an experimental prepaid group practice which operates as an integral part of a medical school. When the practice was begun, study (MCG) and control group (CG) families were enrolled and selected prospectively by random drawing. Medical care utilization by families in the prepaid group practice (MCG) then was compared with that of families cared for in the traditional fee-for-service system (CG). The data presented here represent pediatric utilization for the first 25 months' experience. There were 592 pediatric person years of experience (PY) in MCG and 697 PY in CG. MCG enrollees made almost twice as many ambulatory visits as did CG, 3.45 versus 1.79 visits/PY. There were fewer hospital admissions and the average duration of stay was shorter for MCG than for CG. Thus, MCG used 53.4% fewer hospital days 10.8 per 100 PY compared to 23.2 for CG (p = &lt; 0.01). This reduction resulted more from reduced nonsurgical than surgical utilization. These data substantiate, in a prospectively controlled study of pediatric enrollees, the reduced hospital and increased ambulatory care utilization expected in a prepaid group practice and support the feasibility of conducting such a practice as an integral part of a medical school setting.

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