Outcome Quality of Inpatient and Day-Clinic Treatment in Child and Adolescent Psychiatry—A Naturalistic Study

Background: Child and adolescent psychiatry has only recently been established as a separate specialty and is practiced in different settings. The epidemiology of psychological problems in childhood is high and varied, thus qualitative work is essential. Assessment of outcome as part of quality management is central to assure the service of psychiatric care to be effective. Method: Over a three-year period consecutively admitted patients from inpatient and day-clinic treatment were prospectively evaluated. A total of 200 from 442 patients (m = 80, f = 120; age 15.1 ± 2.8 y) agreed to participate. Patients, caregivers, and therapists answered a range of questionnaires to provide a multi-personnel rating. Questionnaires used for outcome assessment were Child Behavior Checklist (CBCL) and Youth-Self-Report (YSR) (at admission, discharge, and 6 weeks after discharge) and the problem score of the Inventory of Quality of Life for children (ILK), treatment satisfaction, and process quality by the Questionnaire for Treatment Satisfaction (FBB, at discharge) and as real-life outcome control assessment of quality of life (ILK) was added (admission, discharge, and 6 wks after discharge). Results: There was a significant reduction in psychopathologicalsymptoms (CBCL, YSR) and in the problem score. Furthermore, there was a significant increase in quality of life. QoL score and YSR/CBCL scores returned to normal levels. Treatment satisfaction was high and so was satisfaction with process quality. Factors significantly influencing outcome were severity of disease and the relationship to the therapist. No differences were found for gender and setting. Conclusion: The quality management analysis revealed significant improvements of symptom load, a significant increase in QoL and a high treatment satisfaction. Furthermore, process quality was scored highly by parents and therapists.

Practice Characteristics of Pediatric Otolaryngology Same-Day Appointments

Objectives This study aims to assess characteristics of same-day clinic appointments in a pediatric population at an academic otolaryngology practice. Methods Retrospective chart review of patients aged 18 or younger who had same-day clinic appointments between January 1, 2016, and December 31, 2018, at a single academic institution. Demographic data, diagnosis(es), procedures, and operations completed were included in the analysis. Results There were 363 same-day visits by 322 patients in the 3-year study period. Two hundred sixty-nine (269) of these visits were from new patients. Otitis media and rhinosinusitis were the most frequently coded diagnoses. One hundred forty-four (144) procedures were completed the day of the visit and 169 operations were performed as a result of the same-day visit. If the patient had a procedure or operation performed, they were more likely to have been referred by another provider. Conclusions Providing same-day appointments can help provide timely and appropriate otolaryngology specialty care to pediatric patients. Further evaluation is needed to determine the effects on patient satisfaction as well as no-show rates.

“Nobody Listened”. Mothers’ Experiences and Needs Regarding Professional Support Prior to Their Admission to an Infant Mental Health Day Clinic

Challenges during the perinatal period can lead to maternal distress, negatively affecting mother-infant interaction. This study aims to retrospectively explore the experiences and needs regarding professional support of mothers with difficulties in mother-infant interaction prior to their admission to an infant mental health day clinic. In-depth semi-structured interviews were conducted with 13 mothers who had accessed an infant mental health day clinic because of persistent severe infant regulatory problems impairing the wellbeing of the infant and the family. Data were transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). Three themes were identified: ‘experience of pregnancy, birth, and parenthood’; ‘difficult care paths’; and ‘needs and their fulfillment’. The first theme consisted of three subthemes: (1) ‘reality does not meet expectations’, (2) ‘resilience under pressure’, and (3) ‘despair’. Mothers experienced negative feelings that were in contradiction to the expected positive emotions associated with childbirth and motherhood. Resilience-related problems affected the mother-child relationship, and infants’ regulatory capacities. Determined to find solutions, different healthcare providers were consulted. Mothers’ search for help was complex and communication between healthcare providers was limited because of a fragmented care provision. This hindered the continuity of care and appropriate referrals. Another pitfall was the lack of a broader approach, with the emphasis on the medical aspects without attention to the mother-child dyad. An integrated care pathway focusing on the early detection of resilience-related problems and sufficient social support can be crucial in the prevention and early detection of perinatal and infant mental health problems.

Detection of Babesia odocoilei in Humans with Babesiosis Symptoms

Human babesiosis is a life-threatening infectious disease that causes societal and economic impact worldwide. Several species of Babesia cause babesiosis in terrestrial vertebrates, including humans. A one-day clinic was held in Ontario, Canada, to see if a red blood cell parasite, which is present in blacklegged ticks, Ixodes scapularis, is present in humans. Based on PCR testing and DNA sequencing of the 18S rRNA gene, we unveiled B. odocoilei in two of 19 participants. DNA amplicons from these two patients are almost identical matches with the type strains of B. odocoilei in GenBank. In addition, the same two human subjects had the hallmark symptoms of human babesiosis, including night sweats, chills, fevers, and profound fatigue. Based on symptoms and molecular identification, we provide substantive evidence that B. odocoilei is pathogenic to humans. Dataset reveals that B. odocoilei serologically cross-reacts with Babesia duncani. Clinicians must realize that there are more than two Babesia spp. in North America that cause human babesiosis. This discovery signifies the first report of B. odocoilei causing human babesiosis.

Helping Families of Infants With Persistent Crying and Sleep Problems in a Day-Clinic

Excessive crying and sleep problems affect up to 30% of infants and often coexist. Although usually benign and self-limiting, persistent crying, and sleep problems exceeding 6 months of age need attention as they may impair the mental health of the infant and its family. The source and the impact of these persistent regulatory problems is often not restricted to the infant, but extends to the parents and the parent–infant relationship. Clinical practice needs interdisciplinary and multi-method interventions focusing beyond regulatory problems of the infant but also on parental self-regulation and parent's co-regulatory responses toward the infant. Treating clinicians may encounter limitations of home-visits, outpatient, and pediatric residential settings when working with families in distress. We describe an infant mental health day-clinic treatment, drawing attention to this viable future direction. It offers a therapeutic climate based on forming a triangle of co-regulation between clinician, parent and infant to first help the parent and the infant settle down. This stress reduction restores parent–infant connectedness and parental learning and reflecting capacity. Clinicians then use established therapeutic modalities to support parental self- and co-regulatory skills which is important for the development of self-regulation in the infant. Experience with this treatment program suggests that a day-clinic setting facilitates interdisciplinary and integrative multi-method intervention, infant and parental stress reduction and integration of parental self- and co-regulatory skills in daily family life, improving overall outcomes. This perspective warrants further investigation.

Comparison of in-person and telegeriatric follow-up consultations

Introduction Telehealth has the potential to support the care of older adults and their desire to age at home by providing a videoconferencing connection to specialist geriatric care. However, more information is needed to determine how telehealth services affect the care of older adults, and how telehealth services for older adults compare to traditional in-person methods of care provision. The aim of this study was to compare telegeriatric and in-person geriatric consultation methods with respect to outcomes and costs. Methods This was a retrospective chart analysis of consultation letters from patients’ first follow-up appointment with a geriatric specialist during the 2017/2018 fiscal year ( N = 95) in a health jurisdiction of a Western Canadian province. Results Patients seen through telehealth and in person were similar in mean age ( M = 79.1 and 78.1 years, respectively) and were predominately female. Telegeriatric consultations resulted in more requests for further testing and screening ( p = 0.003), new diagnoses ( p = 0.002), medication changes ( p = 0.009) and requests for follow-up ( p = 0.03) compared to in-person consultations. An average one-day clinic with one geriatric specialist providing consultations through telehealth cost Can$1684–$1859 less than an equivalent in-person clinic. Discussion Although additional research is needed to explain the differences in outcomes further between telehealth and in-person consultations found in this work, telehealth consultations cost substantially less than in-person consultations and are a promising way to improve access to geriatric care for older adults in underserved areas.

Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT

Background Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. Methods In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. Discussion To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. Trial registration Identifier on clinicaltrials.gov: NCT03287362; September, 12, 2017

Thirteen-year analyses of medical oncology outpatient day clinic data: a changing field

BackgroundNovel treatment modalities like targeted therapy and immunotherapy are currently changing treatment strategies and protocols in the field of medical oncology.MethodsNumbers of patients and patient contacts admitted to medical oncology day clinics of a large European academic cancer centre in the period from 2006 to 2018 were analysed using our patient administration system.ResultsA patient cohort of 9.870 consecutive individual patients with 125.679 patient contacts was descriptively and retrospectively characterised. Mean age was 59.9 years. A substantial increase in both individual patients treated per year (+45.4%; 2006: 1.100; 2018: 1.599) and annual patient contacts (+63.3%; 2006: 8.857; 2018: 14.467) between 2006 and 2018 was detected. Hence and most interestingly, the ratio of visits per patient increased by approximately one visit per patient per year over the last 12 years (+12.4%; 2006: 8.0; 2018: 9.0). Further, a decrease of patient contacts in more prevalent entities like breast cancer was found, while contacts for orphan diseases like myeloma and sarcoma increased substantially. Interestingly, female patients showed more per patient contacts as compared with men (13.5 vs 11.9). Lastly, short-term safety data of outpatient day clinic admissions are reported.ConclusionsWe present a representative and large set of patient contacts over time that indicates an increasing load in routine clinical work of outpatient cancer care. Increases observed were highest for orphan diseases, likely attributed to centralisation effects and increased treatment complexity.