Episodes of Care for First-Ever Psychiatric Patients a Long-Term Case-Register Evaluation in a Mainly Urban Area

1995 ◽  
Vol 167 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Michele Tansella ◽  
Rocco Micciolo ◽  
Annibale Biggeri ◽  
Giulia Bisoffi ◽  
Matteo Balestrieri
Keyword(s):  
Cox Regression ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Mental Illnesses ◽  
Rank Test ◽  
First Episode ◽  
Case Register ◽  
Episode Of Care ◽  
Episodes Of Care ◽  
Community Psychiatric Service

BackgroundPsychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of ‘survival analysis’ have rarely been used for assessing such data.MethodA longitudinal study was conducted over 10 years (1 January 1982 to 31 December 1991) on 1423 first-ever psychiatric patients, using the PCR of South Verona, Italy. The product-limit method, the log-rank test, the Cox regression model and the Poisson regression analysis were used to analyse episodes of care and relapses.ResultsThe duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one increased consistently from the second to the sixth episode. The only variable significantly associated with the length of the first episode of care was diagnosis (highest probability of having longer episodes for schizophrenic patients), while the length of the breaks following the first episode of care was associated with diagnosis, sex and occupational status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorders, for males, and for unemployed patients). The probability of opening a new episode of care decreased with time since last contact and increased with number of previous contacts.ConclusionsThe community psychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chronic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.

Psychiatric Out-Patients Seen Once Only in South Verona and Western Australia: A Comparative Case-Register Study

2005 ◽  
Vol 39 (5) ◽  
pp. 414-422 ◽  
Author(s):  
Alberto Rossi ◽  
Vera Morgan ◽  
Francesco Amaddeo ◽  
Marco Sandri ◽  
Michele Tansella ◽  
...  
Keyword(s):  
Mental Health ◽  
Western Australia ◽  
Service Providers ◽  
Initial Point ◽  
Community Mental Health Services ◽  
Case Register ◽  
Episode Of Care ◽  
Health Service Providers ◽  
Episodes Of Care ◽  
First Contact

Objective: This study examined variables associated with having a once-only contact with the out-patient department of two community mental health services in Italy and Australia. Method: Two 8-year cohorts of patients, who had a new episode of care with out-patient psychiatric departments in South Verona and in Western Australia, were followed-up for 3 months after the first contact, to identify those patients who had no further contact with services. Potential determinants of once-only contact were analysed. Results: Thirty percent of new episodes of care for persons who met the inclusion criteria of the study were once-only contacts with the service in South Verona. In Western Australia, the figure was 24%. Moreover, the proportion of once-only contact patients has increased over time in South Verona whereas, in Western Australia, it has remained stable. In Western Australia, once-only contact patients were younger whereas in South Verona they tended to be older. At both research sites, patients who had a once-only contact were more likely to be male and to have a less severe mental illness. Conclusions: The results of this study suggest that only clinical characteristics were significant determinants of this pattern of contact with services consistently at both sites: the less severe the patient's diagnosis, the more likely the patient is to have a once-only contact. This may well indicate good screening at the initial point of contact by both sets of mental health service providers. Prospective studies are necessary to clarify the problem of ‘onceonly contact’ and to organize a proper psychiatric care.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Caltagirone 1987–1990

1992 ◽  
Vol 1 (1) ◽  
pp. 45-60 ◽  
Author(s):  
Gaetano Interlandi ◽  
Maria Grazia Sotera
Keyword(s):  
Psychiatric Service ◽  
Similar Rate ◽  
Outpatient Clinics ◽  
Case Register ◽  
Diagnostic Categories ◽  
Community Psychiatric ◽  
Multiple Structures ◽  
Community Psychiatric Service ◽  
Made In

RiassuntoSono descritte, con la stessa metodologia impiegata in altre 4 aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-aerea, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Caltagirone. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (763/100000 residenti adulti) e un giorno (223/100000 residenti adulti) hanno valori inferiori ai RPC europei. I tassi di incidenza (281/100000 residenti adulti) indicano un afflusso di nuovi casi appartenenti a tutte le categorie diagnostiche. II RPC di Caltagirone monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale: residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 4,4 a 1. II tasso di lungoassistiti è di 122/100000 residenti adulti, con una tendenza ad un accumulo per quelli che vivono nel territorio, mentre vi è un calo di quelli che sono in Comunità. II costo del Dipartimento, che è andato riducendosi dal 1987 al 1990, è in buona parte da addebitare alle giornate di assistenza in Comunità.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Caltagirone are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the year prevalence (763'100000 adult inhabitants) and day prevalence (248'100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (248'100000 adult inhabitants) shows that new patients belong to all diagnostic categories. The PCR records data of the activities made in multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, care in outpatient clinics, domiciliary care, etc. The ratio between non-hospitalized and hospitalized users is 4.3 to 1. The rate of long-term patients is 122'100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the sheltered apartments is decreasing. The costs of the Service (which have decrease from 1987 to 1990) have to be attributed mainly to the costs of the treatment in sheltered apartments.

scholarly journals Pediatric Constraint-Induced Movement Therapy for a Young Child With Cerebral Palsy: Two Episodes of Care

2003 ◽  
Vol 83 (11) ◽  
pp. 1003-1013 ◽  
Author(s):  
Stephanie C DeLuca ◽  
Karen Echols ◽  
Sharon Landesman Ramey ◽  
Edward Taub
Keyword(s):  
Cerebral Palsy ◽  
Young Child ◽  
Weight Bearing ◽  
Fine Motor ◽  
First Episode ◽  
Constraint Induced Movement Therapy ◽  
Intensive Intervention ◽  
Episode Of Care ◽  
Episodes Of Care ◽  
Ci Therapy

Abstract Background and Purpose. This case report describes the use of “Pediatric Constraint-Induced Therapy (Pediatric CI Therapy)” given on 2 separate occasions for a young child with quadriparetic cerebral palsy. Case Description. The child was 15 months of age at the beginning of the first episode of care. She had previously received weekly physical therapy and occupational therapy for 11 months, but she had no functional use of her right upper extremity (UE), independently or in an assistive manner. She scored from 5 to 7 months below her chronological age on developmental assessments in gross motor, fine motor, and self-help skills. Intervention. Pediatric CI Therapy involved placement of a full-arm, bivalved cast on the child's less affected UE while providing 3 weeks of intensive intervention (6 hours a day) for the child's more affected UE (intervention 1). Therapy included activities that were goal oriented but broken down into progressively more challenging step-by-step tasks. Pediatric CI Therapy was administered again 5 months later to promote UE skills and independence (intervention 2). Outcomes. The child developed new behaviors throughout both interventions. During intervention 1, the child developed independent reach, grasp, release, weight bearing (positioned prone on elbows) of both UEs, gestures, self-feeding, sitting, and increased interactive play using both UEs. During intervention 2, she had increased independence and improved quality of UE movement, as supported by blinded clinical evaluations and parent ratings.

scholarly journals Cause-specific mortality in psychiatric patients after deinstitutionalisation

2001 ◽  
Vol 179 (5) ◽  
pp. 438-443 ◽  
Author(s):  
Vidje Hansen ◽  
Bjarne K. Jacobsen ◽  
Egil Arnesen
Keyword(s):  
Service System ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Cardiovascular Death ◽  
First Year ◽  
Case Register ◽  
Unnatural Death ◽  
Central Register ◽  
Specific Mortality ◽  
Standardised Mortality Ratios

BackgroundSince the late 1970s, the psychiatric service system in Norway has been changed gradually according to the principles of deinstitutionalisation.AimsTo document the mortality of psychiatric patients in a deinstitutionalised service system.MethodsThe case register of a psychiatric hospital covering the period 1980–1992 was linked to the Central Register of Deaths. Age-adjusted death rates and standardised mortality ratios (SMRs) were computed.ResultsPatients with organic psychiatric disorders had significantly higher mortality regardless of cause of death. SMRs ranged from 0.9 for death by cancer in women to 36.3 for suicide in men. For unnatural death, SMRs were highest in the first year after discharge. Compared to the periods 1950–1962 and 1963–1974, there has been an increase in SMRs for cardiovascular death and suicide in both genders.ConclusionsDeinstitutionalisation seems to have had as its cost a relative rise both in cardiovascular death and unnatural deaths for both genders, but most pronounced in men.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Portogruaro 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 101-116 ◽  
Author(s):  
Domenico De Salvia ◽  
Diego Rocco
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Incidence Rates ◽  
Prevalence Rates ◽  
Case Register ◽  
Community Psychiatric ◽  
Multiple Structures ◽  
One Year ◽  
Community Psychiatric Service

RiassuntoSono descritte, con la stessa metodologia impiegata in quattro altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Portogruaro. II monitoraggio della domanda su 4 anni evidenzia tassi di prevalenza un anno (1045/100000 residenti adulti), di prevalenza un giorno (332/100000 residenti adulti) e di incidenza (250/100000 residenti adulti) inferiori a quelli dei RPC europei. II RPC di Portogruaro monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale (residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, socioambientale, domiciliare, ecc), secondo il principio della continuità dell'assistenza fornita ai pazienti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è nel 1990 di 5,5 a 1. II tasso di lungoassistiti è di 161/100000 adulti. La spesa globale del Dipartimento è lievemente diminuita dal 1987 al 1990.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Portogruaro are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows one-year prevalence rates (1045/100000 adult inhabitants), one-day prevalence rates (332/100000 adult inhabitants) and incidence rates (250/100000 adult inhabitants) lower than those of other european PCRs. Portogruaro PCR records data of the activities made in a comprehensive psychiatric service, which has multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, in outpatient clinics, domiciliary, etc. The 1990 ratio between non-hospitalized and hospitalized users is 5.5 to 1. The rate of long-term patients is 161/100000 adult inhabitants. The costs of the Community Psychiatric Service slightly decreased during 1987-90 period.

scholarly journals Three-year outcome of first-episode psychoses in an established community psychiatric service

2000 ◽  
Vol 176 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Swaran P. Singh ◽  
Tim Croudace ◽  
Shazad Amin ◽  
Rosemary Kwiecinski ◽  
Ian Medley ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Psychiatric Service ◽  
First Episode ◽  
Inception Cohort ◽  
Severe Mental Disorders ◽  
Affective Psychoses ◽  
Community Psychiatric ◽  
Icd 10 ◽  
Community Psychiatric Service

BackgroundChanges in service provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis.AimsTo assess the three-year outcome of an inception cohort of first-episode psychoses treated in a modern, community-oriented service; to compare outcomes with an earlier cohort treated in hospital-based care; and to examine the predictive validity of ICD–10 diagnostic criteria.MethodThree-year follow-up (1995–1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980–1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort.ResultsOn most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance-related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability.ConclusionsIn a modern community service, 30–60% of patients with first-episode psychoses experience a good three-year outcome. The ICD–10 criteria have good predictive validity.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Verona-Sud 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 117-132 ◽  
Author(s):  
Matteo Balestrieri ◽  
Giuliano Meneghelli ◽  
Michele Tansella
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Incidence Rates ◽  
Prevalence Rates ◽  
Case Register ◽  
Multiple Structures ◽  
One Year ◽  
Community Psychiatric Service ◽  
Made In

RiassuntoSono descritte con la stessa metodologia impiegata in quattro altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Verona-Sud. II monitoraggio della domanda su 4 anni evidenzia tassi di prevalenza un anno (1010/100000 residenti adulti), prevalenza un giorno (306/100000 residenti adulti) e di incidenza (219/100000 residenti adulti) inferiori a quelli dei RPC europei. II RPC di Verona-Sud monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale (residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc), secondo il principio della continuità dell'assistenza fornita ai pazienti. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 2,5 a 1. II tasso di lungoassistiti e di 130/100000 adulti. La spesa globale del Dipartimento è aumentata di circa il 25%, con un incremento da parte di tutte le componenti dell'assistenza.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PcR) and catchment-area of the Community Psychiatric service of South-Verona are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows one-year prevalence rates (1010/100000 adult inhabitants), one-day prevalence rates (306/100000 adult inhabitants) and incidence rates (219/100000 adult inhabitants) lower than those of other European PCRs. South-Verona PCR records data of the activities made in a comprehensive psychiatric service, which has multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, in outpatient clinics, domiciliary, etc. The 1990 ratio between non-hospitalized and hospitalized users is 2.5 to 1. The rate of long-term patients is 130/100000 adult inhabitants. All the components of the treatment contributed to the 25% increment of the costs of the South-Verona Psychiatric Service.

Pathways to psychiatric care in South-Verona, Italy

1994 ◽  
Vol 24 (3) ◽  
pp. 641-649 ◽  
Author(s):  
M. Balestrieri ◽  
M. G. Bon ◽  
A. Rodriguez-Sacristan ◽  
M. Tansella
Keyword(s):  
Cultural Study ◽  
Psychiatric Care ◽  
Somatoform Disorders ◽  
Psychiatric Service ◽  
Latency Period ◽  
Cross Cultural ◽  
Cross Cultural Study ◽  
Episodes Of Care ◽  
Community Psychiatric Service ◽  
Care Problems

SynopsisThis paper compares the pathway to psychiatric care of patients contacting the South-Verona Community Psychiatric Service (CPS) with the pathways described in other countries, using the method of the WHO cross-cultural study of pathways in psychiatric care. One hundred and sixteen South-Verona residents starting new episodes of care were traced and included in the study. The first port of call for 92% of patients was a doctor. More than one-third arrived at the CPS directly, not filtered by other carers. One-third went first to the GP and then straight to the CPS. Both the median total interval since onset of symptoms and the median interval between onset of the problem and first seeking care was 8 weeks. Patients presenting first at the two major ports of call tend to have a quite similar latency period before seeking care. Problems presented are represented mostly by depression and anxiety. The diagnosis of affective disorders occurred in more than half of the sample, followed by neurotic and somatoform disorders and schizophrenia and related disorders. The intervals after seeing the first carer are short and quite homogeneous among all patients. More than three-quarters of the patients said that they received some form of treatment for their presenting problems prior to arrival at the CPS, mostly psychopharmacotherapy with sedatives/hypnotics. These results are discussed in the light of those obtained in the WHO cross-cultural study.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Legnano 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 85-99 ◽  
Author(s):  
Antonino Mastroeni ◽  
Maria Grazia Colombo
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Similar Rate ◽  
Case Register ◽  
Community Agencies ◽  
Community Psychiatric ◽  
The Mean ◽  
Community Psychiatric Service ◽  
The Cost

RiassuntoSono descritte, con la stessa metodologia impiegata in altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi dell'Unità Operativa di Psichiatria di Legnano. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (530/100000 residenti adulti) e un giorno (226/100000 residenti adulti) hanno valori inferiori ai RCP europei. I tassi di incidenza (152/100000 residenti adulti) sono diminuiti nel corso dei 4 anni considerati, mostrando la difficoltà dei servizi ad accogliere nuovi utenti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è, mediamente, di 3,8 a 1. II tasso dei lungoassistiti è di 195/100000 residenti adulti, con un accumulo di quelli che vivono nel territorio, ma non di quelli che sono in Comunita. II costo dei servizi psichiatrici di Legnano è diminuito nella componente ospedaliera e semiresidenziale, mentre è aumentato in quella territoriale.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure. Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Legnano are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the mean year prevalence (530/100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (152/100000 adult inhabitants) have diminished, showing a difficulty of the psychiatric services in accepting new patients. The ratio between non-hospidalized and hospidalized users is 3.8 to 1. The rate of long-term patients is 195/100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the community is increasing over the years, whereas the similar rate of patients living in the scheltered apartments is stable. The costs of the hospital-based and the semiresidential agencies decreased, while the cost of the community agencies increased.

scholarly journals Predictive impact of PVL assessments on clinical outcomes in patients undergoing TAVR

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Matsushita ◽  
B Marchandot ◽  
M Kibler ◽  
C Sato ◽  
J Heger ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cox Regression ◽  
Adenosine Diphosphate ◽  
Rank Test ◽  
Multicenter Studies ◽  
Cox Regression Analysis ◽  
Paravalvular Leakage ◽  
Transcatheter Aortic Valve ◽  
Log Rank Test ◽  
Cerebrovascular Events

Abstract Introduction Paravalvular leakage (PVL) following transcatheter aortic valve replacement (TAVR) is associated with greater mortality. In clinical practice, determining PVL severity after TAVR remains challenging and often requires multiparametric assessment. Purpose This study sought to evaluate the respective value of various modalities of PVL assessments, including transthoracic echocardiography (TTE), cine-angiography, aortic regurgitation index (ARI), and closure time with adenosine diphosphate (CT-ADP), in the prediction of adverse clinical outcomes. Methods We included 1044 patients from our prospective TAVR registry between February 2010 and May 2019. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization within 1-year. Established cutoff values of ARI (<25) and CT-ADP (>180 sec) were used to assess the presence of PVL after TAVR. Results Moderate to severe PVL occurred in 14.2% and 5.2% of patients as measured by TTE and angiography. The rate of patients with ARI <25 and CT-ADP >180 sec were 36.5% and 24.9%, respectively. Among the four modalities, PVL evaluated by angiography predicted poorer clinical outcomes (Log rank test; p=0.001), whereas TTE, ARI <25, and CT-ADP >180 sec were not associated with 1-year MACCE. By multivariate Cox regression analysis, moderate to severe PVL by angiography was an independent predictor of 1-year MACCE (hazard ratio: 1.96; 95% confidence interval: 1.22–3.00; p=0.007). Conclusions Paravalvular leakage measured by angiography was evidenced as the most meaningful modality in the prediction of adverse clinical outcomes. Future multicenter studies are warranted to ensure these findings in the current TAVR era. Figure 1 Funding Acknowledgement Type of funding source: None

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