Outpatient Follow-up Treatment Research Articles

Liver Abscesses in Patients Who Have Had a New Coronavirus Infection

Aim of study To analyze clinical, laboratory, instrumental and microbiological data in patients with diagnosed liver abscesses who had previously had a new coronavirus infection.Material and methods An analysis of the work carried out with 13 patients who received treatment at the surgical clinic of the Botkin Hospital in the emergency surgical department No. 76 from September 2021 to October 2022 for liver abscesses and previous COVID-19 is presented.Results All presented patients were comprehensively examined. Surgical intervention was performed — transcutaneous drainage of liver abscesses under ultrasound guidance. Positive changes were revealed in the course of complex therapy, including antibacterial (based on the Results of a microbiological study with determination of the sensitivity of the flora to antibacterial drugs), anti-inflammatory, and daily sanitation of the abscess cavity. All patients were discharged for outpatient follow-up treatment in stable, satisfactory condition. Nine patients (69.2%) were discharged with drain under the supervision of clinic doctors. In 5 patients (30.8%) with regression of the abscess cavity, drainage from the abscess cavity was removed before discharge.Conclusion Patients with previous COVID-19 may develop liver abscesses. It is important to conduct thorough diagnostic measures in patients who present with fever and (or) abdominal pain after a coronavirus infection. Further prospective studies are needed, including morphological assessment of liver changes (upon autopsy in case of death).

Чрезвычайные ситуации в мегаполисе: организация и результаты оказания экстренной медицинской помощи детям c термической травмой

Summary. The purpose of the study is to analyze the organization and results of providing medical care to children (affected, patients) who received thermal injury in emergency situations (ES) in the metropolis. Materials and methods of research. Research materials – data contained in the automated information and analytical system “Disaster Medicine of the City of Moscow” of the Moscow Territorial Scientific and Practical Center for Disaster Medicine of the Moscow Department of Health (CEMP). Statistical data processing was performed using the StatTech program (Stattech LLC, Russia). During the research, the computing and graphic capabilities of Microsoft Office programs were used. When carrying out the study, historical, statistical and analytical methods were used. Research results and their analysis. Of the 285 children with thermal burns received in emergencies, 124 (43.5%) were pronounced dead at the scene of the event before the arrival of emergency medical services (EMS) and specialized emergency response teams. Of the 161 patients who received emergency medical care, 133 (82.6%) were referred to hospital; 28 (17.4%) – for outpatient follow-up treatment. 24.2% of the total number of patients who received medical care were in extremely serious and serious condition, including 3.1% who required invasive respiratory support. It was noted that in the prehospital period, in 20% of cases, the severity of the condition of patients subsequently hospitalized in the hospital was assessed incorrectly.

A Patient with 38 Years of Smoking History and Severe Shortness of Breath

Aim: to present a clinical case of post-COVID bronchiolitis in an adult.Key points. A 54-year-old female patient with a long history of smoking was hospitalized in the pulmonology department of the Clinic with a leading complaint of progressive shortness of breath after a COVID-19 infection. The diagnosis was established: bilateral bronchiolitis associated with a new coronavirus infection (SARS-CoV-2 polymerase chain reaction — positive); chronic obstructive pulmonary disease stage II according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), exacerbation. Against the background of the therapy, there was a significant positive dynamics in well-being and in CT-picture of bronchiolitis. The patient was discharged for outpatient follow-up treatment. One of the most common symptoms of post-COVID syndrome is shortness of breath. Diagnosis of bronchiolitis, in which this symptom may be the only one, is difficult, especially in patients with a long history of smoking and the presence of comorbid pulmonary pathology.Conclusion. A clinical case of bilateral bronchiolitis in the framework of the post-COVID syndrome is presented. The key to successful diagnosis of bronchiolitis is a thorough differential analysis of the totality of anamnestic and clinical laboratory data, as well as a characteristic CT pattern.

Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up.

Evidence concerning specific paraphilia treatment effectiveness is limited. We present observation data of 127 men convicted of paraphilic sexual offenses who attended inpatient and outpatient follow-up treatment in Czechia. We collected participants' sociodemographic and treatment-related information, including STATIC-99R scores, and used proportional hazards models to analyze variables' effect on recidivism risk. Within the observation period, the general recidivism and sexual recidivism rates were 33.1% and 16.5%, respectively, and the sexual contact recidivism rate was 4.7%. The total STATIC-99 score for those who re-offended was 5.65 (SD = 2.11) and for those who did not was 3.98 (SD = 2.02). Recidivism risk was 7.52 times higher for those diagnosed with exhibitionism than with pedophilia, sadomasochism, or antisocial personality disorder. General recidivism is comparable to others' findings. We attribute the lower sexual contact recidivism rate to the combined effects of psychological and pharmacological treatment, and higher numbers of non-contact offenses to limited antidepressant use.

First Clinical Experience of Venous Reconstruction With Autologous Vascular Prosthesis From the Sickle Ligament of the Liver With Partial Portosystemic Bypass Surgery

Aim of study. Presentation of our own first clinical experience of venous reconstruction in portosystemic bypass surgery with the use of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of liver cirrhosis of viral etiology.Material and methods. Clinical observation of a patient born in 1978 with a diagnosis of cirrhosis of the liver of viral etiology (HCV) Child-Pugh A (6). MELD 10 points. Inactive phase. Intrahepatic portal hypertension syndrome. Esophageal varices grade III according to A. G. Scherzinger, gastric varices type I (GOV1) according to Sarin. Condition after repeated recurrent esophageal-gastric bleeding. Due to the high risk of another bleeding, as a secondary prevention of esophageal-gastric bleeding, partial splenorenal anastomosis of “H” - type was performed with the use of an autologous vascular prosthesis of the falciform ligament of the liver in the splenorenal position.Results. A flap measuring 60.0x20.0 mm was cut from the falciform ligament of the patient’s liver. From the latter, after adjusting the size of the graft to the individual needs of the patient, an autologous conduit was formed. It was used as an insert in the formation of an “H” - type splenorenal anastomosis with the imposition of two end-to-side anastomoses between the splenic vein and one end of the conduit and between the left renal vein and the other end of the conduit. The patency of the anastomosis was checked using intraoperative sonography. In a satisfactory condition, the patient was discharged for outpatient follow-up treatment at the place of residence. At the moment of writing the article, the follow-up period was 8 months. The bleeding did not recur. No varicose veins were found in the esophagus and stomach during control endoscopic examinations. The patency of the splenorenal shunt was confirmed by ultrasound dopplerography.Conclusion. The first clinical experience of venous reconstruction with portosystemic bypass surgery using as a possible replacement of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of cirrhosis of the liver of viral etiology gives hope for the possibility of further successful testing of this method of splenorenal bypass surgery to reduce the risk of bleeding from varicose veins.

Clinical characteristics and biological treatment of adult patient with juvenile idiopathic arthritis

OBJECTIVE To explore the clinical characteristics and biological treatment of juvenile Idiopathic arthritis (JIA) after adulthood. METHODS Selected 358 patients with previous medical history diagnosed by JIA who were hospitalized in the Department of Rheumatology and Immunology, West China Hospital of Sichuan University from January 1, 2009 to January 1, 2019. Perform retrospective analysis of basic information, clinical symptoms, diagnostic indicators, treatment plans, outpatient follow-up (inpatients require outpatient follow-up treatment) and diagnosis and treatment process of 90 eligible cases included, and observe different ages and different courses of disease. The clinical characteristics of young and middle-aged idiopathic arthritis in adults and the outpatient situation of using biological agents for 6 months. RESULTS According to age, they were divided into ≤26 years old group (42 cases) and >26 years old group (48 cases). Under examination [rheumatoid factor (RF), anti-nuclear antibody (ANA), anti-neutrophil antibody (ANCA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-1β (IL-1β), interleukin 6 (IL-6), hemoglobin (HGB), white blood cell count (WBC), human leukocyte antigen-B27 (HLA-B27), complement 3 (C3), etc.], concurrent in terms of symptoms, treatment and prognosis, the ≤26-year-old group was generally lighter than the >26-year-old group; that was, the older the age, the heavier the onset of inflammation and other symptoms, the more complications, the worse the treatment effect, and the worse the prognosis, and there were statistical differences academic significance (P 19 years group (44 cases). In terms of examination (RF, ANA, ANCA, ESR, CRP, IL-1β, IL-6, HGB, HLA-B27, C3, etc.), complications, treatment and prognosis, the course of disease ≤19 years group was compared with the disease course> 19 years group Overall mild; that was, the longer the course of the disease, the more severe the onset of symptoms such as inflammation, the more complications, the worse the treatment effect, and the worse the prognosis, P < 0.05, the difference was statistically significant. After 6 months of outpatient treatment with biological agents, it was found that biological agents could improve some of the patients' clinical symptoms and delay the further development of the disease. Compared with the non-biological agent treatment group (48 cases), the biological agent group (42 cases) benefited, and the difference was statistically significant (P < 0.05). CONCLUSION Through retrospective analysis, this article believes that although adult JIA is diagnosed as connective tissue disease, it has special clinical characteristics with the course of the disease and age. Therefore, it should be recommended to give special attention to JIA patients after adulthood, require regular medical treatment in the adult rheumatology department, according to the corresponding connective tissue disease or JIA diagnosis, and standard treatment; at the same time, pay attention to the history of JIA. In the comparison of biological and non-biological treatment, it is proved that biological treatment can effectively improve some of the clinical symptoms of JIA patients after adulthood. Therefore, it is recommended that biological treatment be used as soon as possible if economic conditions permit to delay the development of the disease.

Midface trauma: outpatient follow-up and surgical treatment times

Introduction/aims: Surgical treatment of midface fractures should ideally occur within two weeks of injury, after which bony healing and consolidation makes repair more difficult for the operating surgeon. The OMFS unit at the Royal Surrey County Hospital is the tertiary referral centre for maxillofacial trauma from five regional hospitals. We present a completed audit cycle of midface trauma referrals managed over a one year period. Our standard was that clinical assessment of the midface fracture would take place in a consultant led outpatient clinic within 7 days, and when indicated, surgical fixation would occur within 10 days of referral.

&lt;p&gt;Care Needs of Community-Residing Male Patients with Vascular Cognitive Impairment&lt;/p&gt;

PurposeThe aim of this study was to identify the care needs of male patients with vascular cognitive impairment (VCI) and their caregivers.Patients and MethodsThis cross-sectional study enrolled 389 male patients with VCI and their caregivers who were cared for by the dementia collaborative care team at Changhua Christian Hospital, Taiwan. Fifteen care needs consisting of most of quality measures for people living with dementia and their caregivers were developed by the care team. Through face-to-face evaluations, individualized care needs were collected. The Apriori algorithm was used to identify care bundles for the patients and their caregivers.ResultsSix basic care needs for patients and their caregivers were identified, including appropriate schedule of activities, regular outpatient follow-up treatment, introduction and referral of social resources, referral to family support groups and care skills training, care for the mood of the caregiver, and health education for dementia and behavioral and psychological symptoms of dementia. Compared to subjects with all dementia subtypes from the previous studies, care for the mood of the caregiver was an important and frequent care need for the male patients with VCI and their caregivers. A comparison among the study and similar studies was made to highlight the strength of this study concentrating on the precise selection of care needs.ConclusionCollaborative dementia care teams should monitor for caregivers’ depression and include this care need into the care bundle when assessing male subjects with VCI.

Clinical courses of depressive and anxiety disorders over 1 year : Direct comparison of four treatment settings in psychiatry and psychosomatic medicine-results of the PfAD study

Inpatient care for patients with depressive and anxiety disorders (ICD-10 F3/F4 diagnoses) is provided in Germany in different settings of psychiatry and psychosomatic medicine. Apart from the question of the effectiveness of treatment, it is of interest whether the course of the disease differs between four different settings up to aperiod of 1 year after discharge. A total of 320 patients with main clinical diagnoses from the ICD-10 F3/F4 spectrum were recruited and interviewed consecutively in four treatment settings (psychiatric depression unit, psychiatric crisis intervention unit, psychiatric day hospital, psychosomatic acute hospital). The interviews were conducted after admission, before discharge and 6and 12months after discharge. Overall, treatment in all four settings was shown to be highly effective. The slight increase in symptoms in the postinpatient phase described in the literature was observed across all settings. In terms of treatment intensity, those treated in the crisis intervention unit received the most services after index treatment; however, this group was also the one with the most pronounced symptom burden at admission. Patients treated in the psychosomatic department had the lowest symptom burden at admission and overall received the least inpatient services over the observation period; however, outpatient follow-up treatment was apparently used most by those patients. The treatments proved to be effective in the long-term in both psychiatric and psychosomatic units. The different settings seem to be successful in adapting the treatments to the respective patient groups.

&lt;p&gt;An Inpatient Observational Study: Characteristics And Outcomes Of Avoidant/Restrictive Food Intake Disorder (ARFID) In Children And Adolescents In Japan&lt;/p&gt;

PurposeTo determine the clinical characteristics and course of severe avoidant/restrictive food intake disorder (ARFID) in hospitalized children and adolescents and compare them with those of patients with restricting-type anorexia nervosa (R-AN).Patients and methodsWe conducted a retrospective chart review of inpatients diagnosed with ARFID or R-AN based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at Jichi Children’s Medical Center Tochigi between April 1, 2007 and March 31, 2017. We compared the characteristics of the ARFID and R-AN patients at admission, during hospitalization, and after discharge.ResultsBoth the ARFID (n=13) and R-AN (n=79) patients required hospitalization for their medically unstable state. The features of ARFID group included concern about the aversive consequences of eating and avoidance of eating due to sensory concerns. Significant differences were found at admission between ARFID and R-AN groups in age (10.7 vs 12.7 years), family history of mental disorders (46.2% vs 17.7%), comorbid developmental disorders (6 vs 3 cases), and the time from onset to admission (3.9 vs 6.3 months). The body weight status, % ideal body weight (%IBW), % expected body weight (%EBW), <75% IBW rate, and <75% EBW rate did not differ significantly between the two groups at admission or discharge. The duration of post-discharge outpatient follow-up treatment did not differ significantly between ARFID and R-AN groups (15.3 vs 18.4 months); however, ARFID group recovery rate was significantly higher than that of R-AN group (77% vs 43%). The reasons that the patients with ARFID had significantly better outcomes than the R-AN patients remain unclear. Compared to those in previous studies, the present patients were younger and demonstrated better outcomes. Our results indicate that the body weight status is similar between ARFID and R-AN patients, but the ARFID patients achieved better outcomes.ConclusionThese findings suggest that early onset in childhood, early disease recognition, and early intervention are important factors for achieving better outcomes for patients with ARFID.

Using The Apriori Algorithm To Classify The Care Needs Of Patients With Different Types Of Dementia.

PurposeTo elucidate specific combinations of care needs for people living with dementia (PLWD) and their caregivers according to specific subtypes of dementia.Patients and methodsA cross-sectional study at memory clinics in Changhua Christian Hospital, Taiwan, was conducted. Five hundred and eight people living with dementia and their caregivers joined the dementia collaborative care model. The care team established 15 care needs containing most of quality measures for PLWD and their caregivers. Individualized care plans including different combinations of care needs were addressed through face-to-face assessments. Apriori algorithm was used to find specific combinations of care needs for particular groups of PLWD and their caregivers.ResultsThis study identified the basic care needs of PLWD and caregivers including appropriate scheduling of activities, regular outpatient follow-up treatment, introduction and referral of social resources, referral to family support groups and care skills training, and health education for dementia and behavioral and psychological symptoms of dementia. Patients with Alzheimer’s dementia required more care to prevent traffic accidents and getting lost, while patients with vascular dementia required more care to prevent falls. The older (≥75 years old) PLWD were associated with more needs of fall prevention and care for the mood of the caregiver, especially in the female patients with mild Alzheimer’s dementia (CDR = 1).ConclusionBundling the needed care needs might be a more effective means to care for a wide variety of patients with dementia.

Arbitration proceedings caused by communication problems

Functioning communication is one of the basic elements of a trusting doctor-patient relationship. Good medical communication is more important than ever in times of increasing personnel and time constraints. The aim of this study was to examine to what extent medical communication has an influence on the initiation of arbitration procedures. The analysis was based on arbitration cases of plastic surgery, which were processed and completed by the Arbitration Board for Medical Liability Issues of North Germany between 2005 and 2015. After eliminating cases with incomplete data, 280 cases were evaluated. The documents were examined for possible communication errors and other triggers of the proceedings. If communication errors were present, these were analysed more closely. Furthermore, it was verified if treatment errors were suggested to patients, e. g. by physicians in charge of aftercare. 53.6 % of all cases emerged from communication errors in primary care, mainly caused by the attending surgeon (93.7 %). The outpatient follow-up treatment was identified as the most critical period (48.7 %). The most common problem was that patients felt they were not taken seriously (30.9 %). Further aspects were non-availability of the treating doctor (12.2 %), insults or disrespect (8.5 %), inadequate provision of information (8.5 %), and a lack of therapeutic enlightenment (8.1 %). In 43.9 % of the cases, treatment errors were suggested to patients, primarily by the after-treatment physician (70.3 %). The results show that inadequate medical communication has a considerable influence on the overall satisfaction of patients. Statements that appear normal to the surgeon may cause significant emotional reactions in patients. This study shows that arbitration procedures are not only triggered by "real" treatment errors and damage, but also by communication problems. Good communication and empathy help to reduce dissatisfaction and the risk of possible legal disputes.

Psychotherapy for Personality Disorders: 18 Months' Follow-Up of the Ullevål Personality Project

The Ullevål Personality Project is a randomized controlled trial (N = 114) initiated as a response to the limited evidence justifying provision of day hospital treatment for patients with personality disorders (PDs). A step-down model (CP) consisting of initial short-term day hospital treatment followed by conjoint group and individual outpatient treatment was compared with outpatient individual psychotherapy (OIP). The patients were evaluated at baseline, 8 months, and 18 months on a wide range of clinical measures assessing symptoms, interpersonal problems, psychosocial functioning, and personality pathology. This study indicates that eclectic psychotherapy provided by private practitioners has at least as good an effect upon personality-disordered patients as a more comprehensive day hospital and outpatient follow-up treatment. However, this study has to be supplemented with a cost-benefit analysis before any consideration of implications for health care planning.

Teratoma intrapulmonar maduro

Relato de caso de um homem de 49 anos com quadro de dor torácica e escarros hemópticos de início há seis meses. Pela radiografia e tomografia de tórax visualizou-se opacificação em lobo superior esquerdo. A broncoscopia mostrou restos hemáticos em segmento brônquico lingular. Frente à necessidade diagnóstica e terapêutica, optou-se por submetê-lo a uma toracotomia inframamilar à esquerda. O estudo anatomopatológico da peça cirúrgica revelou teratoma intrapulmonar. O paciente evoluiu satisfatoriamente e segue em acompanhamento ambulatorial.

A hospitalização por asma e a carência de acompanhamento ambulatorial

To determine whether the children and adolescents with acute asthma attacks admitted to two public hospitals in the city of Recife, Brazil underwent outpatient follow-up treatment for the prevention and control of asthma. A prospective case series study of hospitalized patients with asthma. The patients were asked to complete a questionnaire at admission in order to determine the frequency of prophylactic outpatient follow-up treatment. Patients presenting two or more attacks of asthma that were responsive to bronchodilators were classified as having asthma. In the intervals between asthma attacks, 67% (112/167--data regarding 2 patients were not available) of the patients had been treated only in the emergency room. Although 53.3%(89/167--data regarding 2 patients were not provided) of the patients had been referred to outpatient treatment, only 16% (27/169) had visited an outpatient asthma clinic regularly for preventive treatment, and only 13% (22/169) had used prophylactic medication. Most of the children and adolescents hospitalized with asthma had not undergone preventive outpatient follow-up treatment. Various problems related to the health care system, such as non-referral for outpatient follow-up treatment at hospital discharge, limited access to outpatient clinics, and the cost of prophylactic medication, might have contributed to the low rate of outpatient follow-up treatment in the population studied. Public health care policies that allow asthma control programs to work effectively should be implemented.

Subklaviathrombose nach Portanlage bei metastasiertem Melanom

The use of implanted central venous catheters with ports has become almost irreplaceable in clinical treatment of cancer patients with advanced disease. It improves the patient's quality of life and simplifies medical treatment. For safe use during outpatient follow-up treatment, possible complications such as wound infections, thrombosis or even pulmonary embolism have to be considered. The incidence of catheter-associated thrombosis in cancer patients has been estimated as 25-66% in screening evaluations. Clinical symptoms were present in only in 6-28% of all patients with diagnosed thromboses. We report on a patient with metastatic malignant melanoma, who developed a deep arm vein thrombosis two weeks after port implantation. The prognosis of deep arm vein thrombosis is determined by the development of pulmonary embolism (8-36%). In such cases, early diagnosis and treatment are essential for the patient's survival.

Do benzodiazepines extend the duration of follow-up treatment in patients with bipolar disorder?

In patients with bipolar disorder, relapse and recurrence from the premature discontinuation of pharmacotherapy are serious clinical problems. Thus, clinicians must make every effort to ensure the sufficient duration of continual treatment even after the remission of acute episodes. Here, we examine whether there is any association between benzodiazepine (BZD) use and the duration of follow-up treatment in patients with bipolar disorder. The medical records of 70 bipolar patients hospitalized in a university hospital psychiatry ward were reviewed. Selected demographic and clinical variables, such as extent of BZD use and the total duration of outpatient follow-up treatment, were compared. The duration of maintenance treatment at the outpatient department differed significantly between patients who were or were not given BZDs during admission (571 vs. 179 days) and after discharge (836 vs. 154 days). The variables that differed significantly between patients who received follow-up treatment for 6 or more months and those who did not was the number of days of BZD administration during admission (11 vs. 5 days) and after discharge (280 vs. 7 days), and years of education (11 vs. 13 years). In the present study, BZDs are suggested as a possible adjunctive therapy for extending follow-up and thus preventing recurrence in patients with bipolar disorder.

Short-term clinical outcomes of acute treatment of childhood asthma

Acute exacerbations of asthma are the leading cause of emergency department visits in the pediatric patient. The present review is focused on the identification of those factors that may contribute to improving the short-term outcome of children after discharge from an emergency department visit for acute asthma. Several recent studies have documented that children treated at the emergency department because of an asthma-related event present a high morbidity at 7 and 15 days after discharge, mainly associated with symptom persistence, need for rescue bronchodilator medication, and absenteeism from school or day nursery. A better control of the disease, particularly adequate outpatient follow-up and maintenance treatment with inhaled steroids, could improve short-term clinical outcomes. All efforts of emergency room management of children with asthma, identification of severity of the current exacerbation episode, and intensive treatment of the acute asthma attack have usually been directed at reducing the rates of hospitalization and the return for medical care. However, according to reported data on short-term morbidity, it is necessary to define therapeutic and follow-up strategies after treatment for acute asthma and emergency department discharge. Besides standard treatment for an acute asthma exacerbation in a pediatric emergency department, action plans should include a review of the maintenance treatment of asthma to improve underlying disease control and a strong recommendation for close follow-up by the primary care pediatrician.

Alcoholism treatment of Vietnam veterans with post-traumatic stress disorder

Vietnam veterans with alcoholism and Post-Traumatic Stress Disorder (PTSD) are a clinically problematic population. Early self-medication of the PTSD with alcohol led for some to alcohol abuse and dependency. These may often be treated in an intensive alcoholism program. At evaluation both diagnoses are made, and patients are told that alcohol or drug use is not tolerated. The program first focuses on traditional alcoholism treatment issues. Early and consistent support to enhance self-esteem and to reduce guilt helps the patient later to tolerate the gradual investigation of the anger and self-loathing associated with both disorders. Important forces include family and peer support, effective limit setting in a structured milieu, supportive confrontation of alcoholic denial through multidisciplinary treatment in the absence of alcohol. Outpatient follow-up treatment groups include other PTSD sufferers and focus on establishing trust, interweaving the issues of adjustment to sobriety with discussion of the combat experience in a safe, accepting environment, with careful modulation of anxiety by the clinician. Medication must be conservative; benzodiazepines are not used after the detoxification period.

Effect of positive reinforcement, informational feedback, and contingency contracting on a bulimic anorexic female

Effects of reinforcement and feedback on the weight and caloric intake of a bulimic anorexic female were studied in a modified reversal design. Also studied was the effect of instructions on vomiting and effects of desensitization and contracting on weight and intake. The following phases were run: baseline, reinforcement, reinforcement plus feedback, reinforcement, reinforcement plus feedback plus desensitization, and desensitization plus contingency contracting. Results showed that feedback had a powerful influence. Also, instructions were effective in eliminating vomiting. When desensitization to thoughts which the patient had (which led her to feel as though she was a “bad person”) was initiated, there was an increase in intake and weight. Interpretation of weight data was complicated because the patient developed edema which required treatment. This complication emphasized the importance of making reinforcement contingent on both weight gain and intake. A 6-month outpatient follow-up treatment period, during which desensitization and contracting were employed, suggested that treatment results were maintained. The discussion emphasizes this study's uniqueness in that it reports treatment of a bulimic anorxic. The fact that data for a 6-month follow-up period are reported is particularly important in light of recent criticisms of behavioral treatment of anorexia nervosa.