Supervised community treatment: 2-year follow-up study in Suffolk

2012 ◽  
Vol 36 (8) ◽  
pp. 298-302 ◽  
Author(s):  
Stephen Dye ◽  
Srinivas Dannaram ◽  
Benjamin Loynes ◽  
Rebecca Dickenson
Keyword(s):  
Significant Proportion ◽  
Community Treatment ◽  
Data Collection Tool ◽  
Community Treatment Orders ◽  
Specific Data ◽  
History Of ◽  
Services Implementation ◽  
Clinical Measurements ◽  
To Receive

Aims and methodTo describe the use of community treatment orders (CTOs) and outcomes for patients placed under CTOs within the first 8 months of use in Suffolk. We performed retrospective and prospective examination of health records to collect sociodemographic and clinical measurements with a specific data-collection tool.ResultsAll of the patients studied had a major psychotic mental illness. A significant proportion of the patients had a history of alcohol or substance misuse and contact with judicial services. Implementation of a CTO was associated with an increase in engagement, a decrease in the number of admissions, and increased time spent outside hospital.Clinical implicationsThis small localised study indicates that supervised community treatment can have benefits for some patients. The challenge now is to examine the practice of supervised community treatment and to receive meaningful feedback from people who are subject to such treatment.

Compulsory Psychiatric Treatment in the Community

1991 ◽  
Vol 158 (6) ◽  
pp. 799-804 ◽  
Author(s):  
Tom Sensky ◽  
Timothy Hughes ◽  
Steven Hirsch
Keyword(s):  
Psychiatric Treatment ◽  
Total Sample ◽  
Community Treatment ◽  
Specific Data ◽  
Psychiatric Admissions ◽  
History Of ◽  
Criminal Charges ◽  
Treatment Order ◽  
Community Treatment Order

Several English consultant psychiatrists were asked to identify which patients currently under their care they would recommend for treatment with a community treatment order, if such a provision existed. The psychiatrists were asked to match each such ‘nominated’ patient for age, sex and diagnosis with one or two control patients, not considered to require compulsory treatment in the community. From specific data collected, it was found that: the two groups did not differ in their ‘lifetime’ histories of psychiatric admissions, substance misuse, criminal charges or dangerousness; 65–72% of the total sample had a history of serious dangerousness; but in the 12 months before nomination, the ‘nominated’ patients were significantly less likely than the controls to have complied with psychiatric treatment, and more likely to have defaulted from follow-up. The results indicate that a psychiatrist's decision to recommend a patient for treatment with a community treatment order will depend predominantly on specific criteria related to the patient's recent past.

scholarly journals Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure

2021 ◽  
Author(s):  
S. Sze ◽  
P. Pellicori ◽  
J. Zhang ◽  
J. Weston ◽  
I. B. Squire ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Clinical Frailty Scale ◽  
Mineralocorticoid Receptor Antagonist ◽  
Reduced Ejection Fraction ◽  
Frail Patients ◽  
History Of ◽  
Poor Outcomes ◽  
To Receive

Abstract Background Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown. Methods Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF. Results 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin–angiotensin–aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF. Conclusion Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV. Graphical abstract

scholarly journals A rare case of paratesticular leiomyosarcoma

2012 ◽  
Vol 2 (1) ◽  
pp. 29 ◽  
Author(s):  
James Moloney ◽  
John Drumm ◽  
Deirdre M. Fanning
Keyword(s):  
Soft Tissue ◽  
Adjuvant Radiotherapy ◽  
Spermatic Cord ◽  
Soft Tissue Sarcomas ◽  
Solid Mass ◽  
Urological Malignancies ◽  
History Of ◽  
To Receive ◽  
Groin Swelling

Soft-tissue sarcomas of the genitourinary tract account for only 1-2% of urological malignancies and 2.1% of soft-tissue sarcomas in general. A 69-year-old male complained of a 4 month history of a painless right groin swelling during routine urological review for prostate cancer follow-up. Clinical examination revealed a non-tender, firm right inguinoscrotal mass. There was no discernible cough impulse. Computed tomography of abdomen and pelvis showed a non-obstructed right inguinal hernia. During elective hernia repair a solid mass involving the spermatic cord and extending into the proximal scrotum was seen. The mass was widely resected and a right orchidectomy was performed. Pathology revealed a paratesticular sarcoma. He proceeded to receive adjuvant radiotherapy. Only around 110 cases of leiomyosarcoma of the spermatic cord have been described in the literature. They commonly present as painless swellings in the groin. The majority of diagnoses are made on histology.

scholarly journals Acute Cardiogenic Shock Induced by Infusional 5-Fluorouracil

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Jeffrey Sulpher ◽  
Franco Dattilo ◽  
Susan Dent ◽  
Michele Turek ◽  
M. Neil Reaume ◽  
...  
Keyword(s):  
Wall Motion ◽  
Clinical Status ◽  
Metastatic Carcinoma ◽  
Prior History ◽  
History Of ◽  
St Elevation ◽  
Wall Motion Abnormalities ◽  
Carcinoma Of The Bladder ◽  
To Receive

A 49-year-old patient with metastatic carcinoma of the bladder and no prior history of heart disease presented with diffuse ST elevation, elevated troponins, and biventricular dysfunction requiring intensive care unit admission and inotropic support after receiving her first course of infusional 5-fluorouracil (5-FU). Over the course of several days, the patient’s cardiac function and clinical status returned to baseline. A follow-up echocardiogram performed 5 days after initial presentation revealed an ejection fraction of 59 percent, with no evidence of wall motion abnormalities. Subsequent 5-FU chemotherapy was discontinued, and the patient went on to receive second-line chemotherapy.

scholarly journals Coercion in mental health: a trial of the effectiveness of community treatment orders and an investigation of informal coercion in community mental health care

2016 ◽  
Vol 4 (21) ◽  
pp. 1-354 ◽  
Author(s):  
Tom Burns ◽  
Jorun Rugkåsa ◽  
Ksenija Yeeles ◽  
Jocelyn Catty
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Primary Outcome ◽  
Research Programme ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Informal Coercion ◽  
Treatment Order ◽  
Community Treatment Order

BackgroundCoercion comprisesformal coercionorcompulsion[treatment under a section of the Mental Health Act (MHA)] andinformal coercion(a range of treatment pressures, includingleverage). Community compulsion was introduced in England and Wales as community treatment orders (CTOs) in 2008, despite equivocal evidence of effectiveness. Little is known about the nature and operation of informal coercion.DesignThe programme comprised three studies, with associated substudies: Oxford Community Treatment Order Evaluation Trial (OCTET) – a study of CTOs comprising a randomised controlled trial comparing treatment on CTO to voluntary treatment via Section 17 Leave (leave of absence during treatment under section of the MHA), with 12-month follow-up, an economic evaluation, a qualitative study, an ethical analysis, the development of a new measure of capabilities and a detailed legal analysis of the trial design; OCTET Follow-up Study – a follow-up at 36 months; and Use of Leverage Tools to Improve Adherence in community Mental Health care (ULTIMA) – a study of informal coercion comprising a quantitative cross-sectional study of leverage, a qualitative study of patient and professional perceptions, and an ethical analysis.ParticipantsParticipants in the OCTET Study were 336 patients with psychosis diagnoses, currently admitted involuntarily and considered for ongoing community treatment under supervision. Participants in the ULTIMA Study were 417 patients from Assertive Outreach Teams, Community Mental Health Teams and substance misuse services.OutcomesThe OCTET Trial primary outcome was psychiatric readmission. Other outcomes included measures of hospitalisation, a range of clinical and social measures, and a newly developed measure of capabilities – the Oxford Capabilities Questionnaire – Mental Health. For the follow-up study, the primary outcome was the level of disengagement during the 36 months.ResultsCommunity treatment order use did not reduce the rate of readmission [(59 (36%) of 166 patients in the CTO group vs. 60 (36%) of 167 patients in the non-CTO group; adjusted relative risk 1.0 (95% CI 0.75 to 1.33)] or any other outcome. There were no differences for any subgroups. There was no evidence that it might be cost-effective. Qualitative work suggested that CTOs’ (perceived) focus on medication adherence may influence how they are experienced. No general ethical justification was found for the use of a CTO regime. At 36-month follow-up, only 19 patients (6% of 329 patients) were no longer in regular contact with services. Longer duration of compulsion was associated with longer time to disengagement (p = 0.023) and fewer periods of discontinuity (p < 0.001). There was no difference in readmission outcomes over 36 months. Patients with longer CTO duration spent fewer nights in hospital. One-third (35%) of the ULTIMA sample reported lifetime experiences of leverage, lower than in the USA (51%), but patterns of leverage experience were similar. Reporting leverage made little difference to patients’ perceived coercion. Patients’ experiences of pressure were wide-ranging and pervasive, and perceived to come from family, friends and themselves, as well as professionals. Professionals were committed to patient-centred approaches, but felt obliged to assert authority when patients relapsed. We propose a five-step framework for determining the ethical status of offers by mental health professionals and give detailed guidance for professionals about how to exercise leverage.ConclusionsCommunity Treatment Orders do not deliver clinical or social functioning benefits for patients. In the absence of further trials, moves should be made to restrict or stop their use. Informal coercion is widespread and takes different forms.Trial registrationCurrent Controlled Trials ISRCTN73110773.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

scholarly journals Combining 308-monochromatic excimer phototherapy with monthly IM triamcinolone acetonide for the treatment of resistant alopecia totalis

2021 ◽  
pp. 37
Author(s):  
Keyword(s):  
General Practice ◽  
Triamcinolone Acetonide ◽  
Overall Response Rate ◽  
Response Rate ◽  
Young Patients ◽  
Interventional Study ◽  
Younger Patients ◽  
History Of ◽  
To Receive

Background: Treatment of resistant alopecia totalis AT is a major problem in general practice. Some studies reported the use of either excimer-308 or intra-muscular triamcinolone acetonide as a monotherapy, with conflicting results. Objective: To evaluate the therapeutic effect of combining 308-excimer phototherapy and intramuscular triamcinolone acetonide for the treatment of alopecia totalis. Methods and Material: Ten patients with alopecia totalis were evaluated in this prospective interventional study. All patients were assigned to receive the thera-peutic regimen that includes monthly IM triamcinolone acetonide (TAC) for a maximum of six pulses and twice-weekly excimer phototherapy for 24 sessions. Results: The overall response rate for this regimen was 90%, with four patients 40% achieving complete regrowth of hair (100%). Three patients have exhibited a satisfactory response (>70% regrowth). Unsatisfactory response ( >10-< 70% regrowth) was reported in two patients . Younger patients responded better, as did those with a shorter history of the disease P < 0.05. At follow-up, which continued for 8–12 months, recurrence was noted in two (22.2%) of the nine responders. Conclusions: Combining excimer phototherapy with triamcinolone acetonide showed a promising effect on resistant AT. This treatment modality was effective and well tolerated particularly in young patients.

Cystic Hygroma with Multiple Benign bone Lymphangiomas in an Adult Patient: a rare Entity in the Differential Diagnosis of Multiple Osseous Lesions in Oncology Practice

2020 ◽  
Vol 17 ◽  
Author(s):  
Ferit Aslan ◽  
İnanç Güvenç ◽  
Aydın Aslan ◽  
Elif Günaydın
Keyword(s):  
Differential Diagnosis ◽  
Adult Patient ◽  
Cystic Hygroma ◽  
Cystic Lymphangioma ◽  
Bone Lesions ◽  
Lytic Bone Lesions ◽  
History Of ◽  
Oncology Practice ◽  
To Receive

: Cystic lymphangioma presenting with multiple bone lesions in an adult patient is a rare occurrence, with a limited number of reported cases in the literature. In this case report, we describe a 32-year old female patient with chronic neck and pelvic pain, and multiple lytic bone lesions on radiological imaging, which were eventually discovered to originate from cystic hygroma and widespread bone lymphangiomas that were present for more than 10 years. It should be kept in mind that there may be benign causes in the differential diagnosis in patients presenting with findings suggestive of diffuse bone metastasis.Because misdiagnosis may cause the patient to receive unnecessary treatments, especially radiotherapy. In this case, we reached the diagnosis of benign disease, diffuse bone lymphangiomatosis, and the long and stable medical history of the patient with the findings of BT, ultrasound and bone scintigraphy. We think that as long as there are no stable and serious results in the company with the clinical and radiological findings of the patient, it should be approached with medical follow-up without treatment.

Use of antibiotics in patients who were attacked by animals that can transmit rabies v1

2021 ◽  
Author(s):  
Jorge Machado Alba
Keyword(s):  
Clavulanic Acid ◽  
Significant Proportion ◽  
Caribbean Region ◽  
Lower Probability ◽  
Pharmacological Data ◽  
Amoxicillin Clavulanic Acid ◽  
The Caribbean ◽  
Low Prevalence ◽  
To Receive

Introduction:Animal bites have a high probability of becoming infected. In high-risk wounds, the use of antibiotics that kill the associated microorganisms is recommended. Objective: To determine the use of antibiotics in patients in different regions of Colombia who were attacked in 2020 by animals that can transmit rabies. Materials and methods: This was a retrospective follow-up study of a cohort of patients with wounds caused by animals; the patients were affiliated with the Colombian Health System. Sociodemographic, clinical and pharmacological data were collected. Results: A total of 280 patients were analyzed. The median age was 28.0 years, and 52.1% were men. The attacks were attributed to dogs (85.0%) and cats (15.0%), and 9.6% were classified as severe exposure. Antibiotics were used in 71.1% of cases for prophylaxis and in 4.3% of the cases for the treatment of superinfection; cephalexin (37.5%), amoxicillin/clavulanic acid (15.7%) and dicloxacillin (10.4%) were the predominant antibiotics used. A total of 72.0% of patients who received antibiotics received inadequate prescriptions, and 49.2% had no indication to receive prophylaxis. Being treated in the Caribbean region (OR:4.09; 95%CI:1.79-9.30) and receiving analgesics (OR:3.15; 95%CI:1.25-7.94) were associated with a greater probability of being prescribed antibiotics inadequately; attacks resulting in severe exposure were associated with a lower probability (OR:0.40; 95%CI:0.16-0.98). Conclusions: A significant proportion of patients had no indication for prophylactic antibiotics or were prescribed antibiotics not recommended by clinical practice guidelines. There was a low prevalence of prescriptions for amoxicillin/clavulanic acid, the most recommended antibiotic.

Foreign bodies in the throat: a prospective study of 388 cases

1991 ◽  
Vol 105 (2) ◽  
pp. 104-108 ◽  
Author(s):  
N. S. Jones ◽  
F. J. Lannigan ◽  
N. Y. Salama
Keyword(s):  
Foreign Body ◽  
Prospective Study ◽  
Significant Proportion ◽  
Careful Examination ◽  
Barium Swallow ◽  
Retained Foreign Body ◽  
History Of ◽  
A Prospective Study ◽  
Symptoms And Signs

AbstractWe present the results of a prospective study of 388 patients presenting with a history of swallowing a foreign body. We indicate whether the patients' symptoms and signs were associated with a retained foreign body. While tenderness on palpation was an unreliable sign, pooling at indirect laryngoscopy invariably predicted a retained object. In many patients, initial careful examination of the oropharynx by casualty officers would have shown a retained fishbone in the tonsil or tongue and would have resulted in 16 per cent fewer radiographs and 17 per cent fewer referrals to the ENT department. Radiography only improved management in a small minority and 35 per cent of films were interpreted incorrectly by casualty officers. A follow-up barium swallow disclosed a pathological lesion in a significant proportion of patients with bolus obstruction, whether or not this was passed spontaneously.

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