Levels Of Initial Severity Research Articles

Clinical rationale for the treatment tactics of term patients diagnosed with transient neonatal tachypnoea without parenteral nutrition

Introduction. To analyze the efficacy and safety of treatment tactics for term patients diagnosed with TTN in an ICU without venous access and parenteral nutrition.Materials and methods. The study gives a retrospective analysis of the medical records of 241 ICU patients from January 2020 to March 2021. 83 children meet general criteria for inclusion in the study.Results and Discussion. While comparing the study group and the control group, no significant difference was detected in the incidence of risk factors during pregnancy and childbirth, such as gestational diabetes, ARVI during pregnancy, chorioamnionitis, preeclampsia, and the frequency of a prolonged anhydrous period, the frequency of induced labor, delivery by caesarean section, fetal distress and the use of vacuum extraction. Despite the same initial level of severity of respiratory disorders, when the child was admitted to the ICU, the duration of CPAP therapy was significantly higher in the control group: 7.5 (5.5-12) versus 5 (4-6) hours p = 5×10-5. The average length of hospital stay in the ICU and the total length of hospital stay was significantly higher in the control group (p = 4×10-11 and p = 0.006, respectively), as well as the need for treatment in the Neonatal Pathology unit conditions (p = 0.001).Conclusion. Analyzing the tactics of treating term patients diagnosed with TTN, the study proved that children without venous access require less time for respiratory therapy with CPAP in the NICU, the total duration of hospitalization in the NICU is significantly lower, as well as the need for additional treatment in the Neonatal Pathology unit. The study revealed that the early onset of enteral nutrition and the rapid expansion of the feeding portion, provided with child’s stable health condition, enable to avoid the installation of venous access and the prescription of parenteral nutrition at the ICU stage.

Uniformity of evidence-based treatments in practice? Therapist effects in the delivery of cognitive processing therapy for PTSD.

Various factors contribute to the effective implementation of evidence-based treatments (EBTs). In this study, cognitive processing therapy (CPT) was administered in a Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty clinic in which training and supervision were provided following VA implementation guidelines. The aim was to (a) estimate the proportion of variability in outcome attributable to therapists and (b) identify characteristics of those therapists who produced better outcomes. We used an archival database of veterans (n = 192) who completed 12 sessions of CPT by therapists (n = 25) who were trained by 2 nationally recognized trainers, 1 of whom also provided weekly group supervision. Multilevel modeling was used to estimate therapist effects, with therapists treated as a random factor. The supervisor was asked to retrospectively rate each therapist in terms of perceived effectiveness based on supervision interactions. Using single case study design, the supervisor was interviewed to determine what criteria she used to rate the therapists and emerging themes were coded. When initial level of severity on the PTSD Checklist (PCL; McDonald & Calhoun, 2010; Weathers, Litz, Herman, Huska, & Keane, 1993) was taken into account, approximately 12% of the variability in the PCL at the end of treatment was due to therapists. The trainer, blind to the results, identified the following characteristics and actions of effective therapists: effectively addressing patient avoidance, language used in supervision, flexible interpersonal style, and ability to develop a strong therapeutic alliance. This study adds to the growing body of literature documenting the importance of the individual therapist as an important factor in the change process.

Comparison of Foliar Spray Efficacy of Electrolytically Ozonated Water and Acidic Electrolyzed Oxidizing Water for Controlling Powdery Mildew Infection on Cucumber Leaves

We investigated and compared the effects of foliar sprays of electrolytically ozonated water (OW) and acidic electrolyzed oxidizing water (AEOW) on severity of powdery mildew infection (PMI) and occurrence of visible physiological disorder on cucumber leaves. Foliar spray of OW contained severity of PMI to almost the same level as the initial value, without any visible physiological disorder. Although severity of PMI on AEOW-sprayed leaves was significantly lower than on OW-sprayed leaves, the leaves showed a visible physiological disorder after the first spray. These results indicate that OW is a viable option for controlling PMI on cucumber leaves at low initial severity levels, or for prevention of PMI, and that AEOW can be used for controlling PMI with special efforts taken against a visible physiological disorder.

Evaluation of a Medicaid Asthma Disease Management Program

This study evaluates 1-year outcomes of an asthma disease management program implemented in an Oregon Medicaid population. A non-randomized pre-post study, a matched case-control study, and a "programmatic effects" analysis were conducted. Compared to matched controls, the treatment cohort had significantly fewer emergency room visits per thousand (7 vs. 28, P < 0.001) and higher office visits per thousand (57 vs. 7, P < 0.0001) but no significant difference in hospital admission rates. The programmatic effects model identified the participants' initial severity levels and the number of various communications they received as the most important variables in explaining the change in asthma severity from baseline to 12 months. These findings are supportive of the DM design, which is to reduce acute services by improving coordination of care between patients and their providers. Additionally, it appears that there is a close association between the number of patient contacts and their subsequent change in health status.

Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care.

To estimate the variability in outcomes attributable to therapists in clinical practice, the authors analyzed the outcomes of 6,146 patients seen by approximately 581 therapists in the context of managed care. For this analysis, the authors used multilevel statistical procedures, in which therapists were treated as a random factor. When the initial level of severity was taken into account, about 5% of the variation in outcomes was due to therapists. Patient age, gender, and diagnosis as well as therapist age, gender, experience, and professional degree accounted for little of the variability in outcomes among therapists. Whether or not patients were receiving psychotropic medication concurrently with psychotherapy did affect therapist variability. However, the patients of the more effective therapists received more benefit from medication than did the patients of less effective therapists.

Functional outcomes in patients with right hemisphere brain damage

Background : In this era of accountability in health care, the need to document treatment-related changes in health status is critical. However, few studies report outcomes in people with right cerebral hemisphere damage (RHD). Aims : The objective of this study was to document, in a single population of patients with RHD, selected functional outcomes at the termination of inpatient treatment. Of particular interest were cognitive performance and its influence on motor and overall recovery. Methods & Procedures : Functional outcomes were retrospectively examined in 101 RHD patients, at discharge from an in-patient rehabilitation programme. The Functional Independence Measure (FIM; Center for Functional Assessment Research, 1993) was the measurement tool. The five outcomes examined were: final functional status, amount of gain, efficiency of gain, length of stay (LOS), and discharge placement. FIM scores, produced on an ordinal rating scale, were statistically transformed by the Rasch method (Rasch, 1960) to generate interval-level data for regression analyses. Outcomes & Results : Summary by outcomes: Gains were evident in cognitive and motor realms, with greater and more efficient improvement in the latter. Regression analysis indicated that final functional status was best predicted by age, initial motor severity (FIM motor score), and initial total cognitive severity (FIM cognitive scores); amount of gain was best predicted by age, evidence of previous neurological incident, and gender; efficiency of gain by initial cognitive item scores, initial motor severity (FIM score) and age; LOS by initial motor severity (FIM score); and discharge placement by age, marital status, and initial severity (FIM status). Major predictors tended to be age and the family of cognitive FIM scores, especially Problem Solving (PS). Memory and PS were the most challenging cognitive items for these patients, as indicated by scores on admission and discharge reflecting less than functional ability. A sizeable number of patients began and ended rehabilitation with functional levels of ability in comprehension, expression, and social interaction. Significant differences existed between patients with neglect and those without, but neglect was not a significant predictor of any outcome measure. Low initial cognitive FIM scores, presence of neglect, and older age were associated with poorer performance in motor and cognitive realms. Previous neurological episodes were negatively associated with amount of gain. Number of comorbidities was not statistically associated with outcomes. Conclusions : Initial severity levels and age were the most influential factors on these outcomes. The presence of neglect had a relatively minor impact on most outcomes. Performance on the cognitive items was less impaired than motor items, and registered less gain and less efficient gain than motor items, but did predict various final status and gain-related measurements in overall and motor realms. Analyses in this study revealed that the FIM scale is less sensitive to cognitive change than to motor change.

Risk Factors Associated with the Chronicity of High Potential for Child Abuse and Neglect

The present 4-year follow-up study involves 56 mothers who were evaluated by social agencies as being abusive and neglectful or at high risk for child abuse and neglect. The aim of the study is to analyze the relationship between psychosocial risk factors (relating to the history and current situation of the mothers) that were present at the time the families were initially recruited and the fact that some of the mothers continue to show a high potential for child abuse and neglect (chronic abuse and neglect), whereas others were able to overcome the problem (transitory abuse and neglect). Results indicate that the following variables are particularly associated with situations involving chronic problems of abuse and neglect: initial level of severity of potential for abuse and neglect; dual-parent status; a large number of children at the time of intervention (3.13 times more risk of chronicity for large families); the fact that as a child the mother herself had been placed in a foster home (3.7 times more risk); that she had been sexually abused (3.5 times more risk); and that as an adolescent she had run away from home (3.02 times more risk). Our results indicate that mothers who have a combination of more than eight risk factors are four times more likely to be in the chronic group.

Psychotherapy outcomes in naturalistic settings: A reply to Hansen, Lambert, and Forman.

A recent article by Hansen, Lambert, and Forman (2002) comparing outcomes in naturalistic settings and clinical trials was based on the assumption that these samples are comparable. However, up to 50% of patients in naturalistic settings are either in the normal or mild ranges whereas no patients in clinical trial samples are in the normal range. When Hansen's data are analyzed controlling for initial level of severity, outcomes in clinical trial samples and naturalistic samples are roughly comparable. Thus, Hansen's conclusion that patients in naturalistic settings do not receive adequate exposure to psychotherapy is unsupported. Rather, the Hansen data suggest that adequate outcomes can be achieved with far less exposure to psychotherapy than that suggested by consensus clinical trial data.

Plato versus Aristotle: Categorical and dimensional models for common mental disorders

There are two quite different ways of conceptualizing common mental disorders: as categorically distributed or as dimensions. In the former case, individuals with "subthreshold" disorders may contain a small proportion of "true cases"; while in the latter, they are seen as having the same basic disorder, but in insufficient degree to warrant a diagnostic label. The categorical school postulates the phenomenon of "comorbidity" to account for those who are both depressed and anxious. The dimensional school regards them as cases of "anxious depression," and observes that the 2 dimensions are highly correlated with one another. This article considers 3 levels of severity of cases satisfying research diagnostic criteria for depression: mild, moderate, and severe. At ascending levels of initial severity, there is increasing disability, and a worse outcome at 12 months. The only positive treatment effect is that favoring antidepressants over sedatives at 3 months, and this effect is related to initial severity-being much greater for the "severe" group of depressions. Initial severity is linearly related to disability, and there is no disjunction at the usual division between "non-cases" and "cases" of depression. Clinicians are obliged to use categorical concepts, as they must decide who is sufficiently ill to justify treatment. But in our efforts to understand the relationships between social and biological variables, dimensional models are far more appropriate.

Predictors of long-term outcome in 45 men with antisocial personality disorder.

We sought to determine variables predictive of outcome in a group of 45 men with antisocial personality disorder followed up a mean of 29 years following hospitalization. Based on personal interviews, interviews with informants, and medical and legal records, sufficient information was available to rate the global outcome in 45 men. The Global Assessment Scale (GAS) was also used to measure functioning in 44 men at intake and follow-up. Twenty-six (57.8%) were rated as having "any improvement." Univariate analysis showed men experiencing improvement were more likely to have high GAS scores at intake, were not currently alcoholic, were older, and were followed over a longer period of time. Low GAS scores at intake and the interaction between the GAS score at intake and current alcoholism independently predicted poor outcome on regression analysis. A low GAS score at intake and shorter follow-up also independently predicted poor outcome, even though stepwise regression revealed the strongest single predictor to be the interaction between the initial GAS score and age at follow-up. In summary, long-term outcome in antisocial males is associated with an initial level of severity, alcohol consumption at follow-up, and both age at follow-up and length of follow-up. Initial severity best predicts outcome among men not currently alcoholic who have been followed over a long period of time.

A note on intelligence and recovery from aphasia: the relationship between Raven's Matrices Scores and change on the Schuell Aphasia Test.

A total of 134 aphasia cases were examined on average five months after the trauma (mainly CVA). Most of the cases were administered the Schuell test of aphasia, some were given the Coloured Matrices test (CM), and some the Standard Matrices test (SM). In addition, 53 of these cases were retested on average nine months after the trauma, to look for recovery phenomena. It was found that total score on the Schuell test did improve dramatically (error scores reducing by 37%) but that there was no change in either CM or SM (in fact there was a slight decline of about 10%). It was further found that non-verbal intelligence as measured by CM correlated in a negative direction with severity of aphasia and positively with recovery from aphasia (once certain key variables were partialled out statistically, such as initial level of severity). In contrast, SM failed to correlate with either severity or recovery, a finding that could be attributable to the small number of cases tested on SM. Various explanations of t...

Short-term effects of initial, nonsurgical periodontal treatment (hygienic phase).

Longitudinal studies have reported the effect of various modalities of periodontal surgery on pocket depth and attachment levels related to pretreatment measurements. However, possible changes in these measurements as a result of scaling, oral hygiene improvements and occlusal adjustment during the hygienic phase were not considered. The purpose of the present study was to examine the short-term effect of treatment of the hygienic phase in 90 patients with some pockets extending 4 mm or more apically to the CEJ. Pretreatment pocket depths and attachment levels related to the CEJ were measured by a thin probe in five sites at all 2,355 teeth in the sample. Scaling, root planing, instruction in oral hygiene and occlusal adjustment were completed during four to six sessions for each patient. Four weeks after completion of the hygienic phase, all variables were recorded. Mean measurements for pocket depths 1-3 mm, 4-6 mm, and greater than or equal to 7 mm prior to treatment were compared to their posttreatment scores. Pocket depth decreased significantly for pockets extending 4 mm or more apically to the FGM. For pockets 4-6 mm there was a mean difference in pocket depth of 0.96 +/- 0.47 mm (P < .0001) between pretreatment and posttreatment observations. For pockets 7 mm or greater the mean difference was 2.22 +/- 1.35 mm (P < .0001). Reduction in depth of pocket and improvement in attachment levels were related to the initial level of severity. Pocket reduction was in part due to the improvement in attachment levels. This study has demonstrated that the clinical severity of periodontitis is reduced significantly 1 month following the hygienic phase of periodontal therapy, and that need for surgical pocket treatment cannot be assessed properly until completion of the hygienic phase of treatment.