Use Of Alternative Interventions Research Articles

Comments on the position UEMS paper “Maintaining Human Rights and recovery principles when Coercive Practices are considered”

AbstractProf. dr. sc. Slađana Štrkalj Ivezić, psychiatrist, University psychiatric hospital Vrapče, CroatiaThe aim is to present the importance of educating psychiatrists to acquire competencies relate to knowledge, attitudes and behavior in holistic understanding of patients, implementation of principles of recovery and respect for human rights and use of alternative interventions to coercion in order to eliminate or reduce coercive practice such as involuntary hospitalizations and coercive measures. All the necessary competences such as clinical assessment, skills to form therapeutical relationship and application of evidence base interventions that can prevent or significantly reduce the use of coercive measures: de-escalation; availability of a comfort room with sensory modulation; a trained response team; joint crisis intervention, advance directives and successful multimodal strategies will be presented including the elimination of potential environmental triggers of aggression in the hospital setting. The training and education of psychiatrists on human rights, recovery and alternatives to coercive practice can abolish or significantly reduce coercion.Disclosure of InterestNone Declared

The Effects of the COVID-19 Pandemic on Mastectomy Outcomes for Breast Cancer

BackgroundSingle center studies have shown that during the Coronavirus Disease 2019 (COVID-19) pandemic, many patients had surgical procedures postponed or modified. We studied how the pandemic affected the clinical outcomes of breast cancer patients who underwent mastectomies in 2020. MethodsUsing the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, we compared clinical variables of 31,123 and 28,680 breast cancer patients who underwent a mastectomy in 2019 and 2020, respectively. Data from 2019 served as the control, and data from 2020 represented the COVID-19 cohort. ResultsFewer surgeries of all kinds were performed in the COVID-19 year than in the control (902,968 vs. 1,076,411). The proportion of mastectomies performed in the COVID-19 cohort was greater than in the control year (3.18% vs. 2.89%, <0.001). More patients presented with ASA level 3 in the COVID-19 year vs. the control (P < .002). Additionally, the proportion of patients with disseminated cancer was lower during the COVID-19 year (P < .001). Average hospital length of stay (P < .001) and time from operation to discharge were shorter in the COVID vs. control cohort (P < .001). Fewer unplanned readmissions were seen in the COVID year (P < .004). ConclusionThe ongoing surgical services and mastectomies for breast cancer during the pandemic produced similar clinical outcomes to those seen in 2019. Prioritization of resources for sicker patients and the use of alternative interventions produced similar results for breast cancer patients who underwent a mastectomy in 2020.

Prevention and Reduction of Care Against Someone’s Will in Cognitively Impaired People at Home: A Feasibility Study

Sometimes care is provided to a cognitively impaired person against the person’s will, referred to as involuntary treatment. An intervention (PRITAH) was developed to prevent and reduce involuntary treatment comprising 4 components: client-centered care policy, workshops, coaching on the job by a specialized nurse and the use of alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

The Role of Deposit Guarantee Schemes in Preventing and Managing Banking Crises: Governance and Least Cost Principle

The Deposit Guarantee Directive enlarges the role of DGSs in supporting and financing with alternative interventions the early research of “market solutions”, that may avoid the failure of a bank. Despite the broad mandate formally set out in the Directive, the feasibility of the failure prevention measures by a DGS is restricted according to the current legal framework. More specifically, constraints to the use of alternative interventions could derive both from State aid rules and the super priority rule coupled with the least cost criterion. As regards the first point, the European Commission ruled that the Italian DGS’s alternative measures in favour of a bank named ‘Tercas’ constituted an illegal State aid, claiming that intervention was attributable to the Italian government and that the resources employed were subject to public control. With reference to the second point, according to the BRRD, within the creditor insolvency hierarchy, depositors are preferred to any of the bank’s other unsecured creditors. As the DGS, after the payout, is subrogated to the preferred claims of covered depositors, it will have a big recovery rate in the bank liquidation. This effect might hamper the DGS’s ability to undertake alternative interventions, since under the least cost criterion these could be more expensive than a depositor payout. Given the importance of the role of DGSs in preventing and minimizing the overall cost of a banking crisis, this paper aims at analysing the two issues above, in order firstly to suggest a governance model which allows a national DGS to intervene in a banking crisis without breaking State aid rules. Secondly, regarding the least cost principle, the paper suggests the adoption of some criteria, extrapolated by the DGSD, which may allow DGSs to overcome the problems arising from the combination of the above criterion with the super priority rule.

Estimulación Cognitiva en un caso de Afasia Primaria Progresiva no fluente

La APPvnF se caracteriza por un marcado agramatismo, que conforme a la progresión de la enfermedad puede traer declives cognitivos y funcionales. Su reconocimiento etiológico y semiológico es fundamental en la vinculación a un tratamiento adecuado. El objetivo del estudio fue identificar los efectos de la estimulación cognitiva del lenguaje basada en estrategias CAA en una paciente con APPvnF. Se observó el caso de una mujer de 67 años, con un año de escolaridad y diagnóstico de trastorno neurocognitivo mayor debido a degeneración del lóbulo frontotemporal, APPvnF. Esta paciente hace parte de la población que acude a consulta en el INDEC. Se utilizó un diseño experimental de caso único, realizando mediciones repetidas con los instrumentos ESAPP y DAD-E. Tras 19 sesiones de estimulación cognitiva del lenguaje, el análisis cualitativo para el instrumento ESAPP indicó mejora en la participación, interacción comunicativa y mayor tolerancia a la frustración. Para el instrumento DAD-E, el análisis visual indica tendencia de conducta estable en línea de base, con cambio de nivel retardado tras el inicio de intervención. El porcentaje de datos no solapados (PND), el porcentaje de datos que exceden la mediana (PEM) y el no solapamiento de todos los pares (NAP), dieron como resultado que el tratamiento fue bastante efectivo, moderadamente efectivo y tuvo un efecto grande. Los resultados obtenidos en otras investigaciones de caso único, así como en esta, ponen en evidencia que el uso de intervenciones alternativas trae consigo beneficios a nivel de la participación y; por ende, en la calidad de vida de las personas con APPvnF.

Influence of a Combined Gluten-Free and Casein-Free Diet on Behavior Disorders in Children and Adolescents Diagnosed with Autism Spectrum Disorder: A 12-Month Follow-Up Clinical Trial.

The use of alternative interventions, such as gluten-free and casein-free (GFCF) diets, is frequent due to limited therapies for Autism Spectrum Disorder (ASD). Our aims were to determine the influence of a GFCF diet on behavior disorders in children and adolescents diagnosed with ASD and the potential association with urinary beta-casomorphin concentrations. Thirty-seven patients were recruited for this crossover trial. Each patient consumed a normal diet (including gluten and casein) for 6months and a GFCF diet for another 6months. The order of the intervention (beginning with normal diet or with GFCF diet) was assigned randomly. Patients were evaluated at three time-points (at the beginning of the study, after normal diet and after GFCF diet). Questionnaires regarding behavior and autism and dietary adherence were completed and urinary beta-casomorphin concentrations were determined at each time-point. No significant behavioral changes and no association with urinary beta-casomorphin concentrations were found after GFCF diet. A 6-month GFCF diet do not induce significant changes in behavioral symptoms of autism and urinary beta-casomorphin concentrations. Further studies with a long follow-up period similar to ours and including placebo and blinding elements are needed to identify better those respondents to GFCF diets.

Enteral lactoferrin does not reduce late-onset infection in very preterm infants.

Late-onset sepsis is a major cause of morbidity and mortality in neonates, but predominantly in preterm infants. In survivors, it can prolong length of hospital stay, worsen long-term neurodevelopmental outcomes and increase the associated social burden of disease.1 Lactoferrin, a mammalian iron-binding whey glycoprotein with important bacteriostatic and anti-inflammatory properties, plays a role in promoting growth of probiotic bacteria in the gut.2 A recent Cochrane review suggested reductions in both sepsis and necrotizing enterocolitis with oral lactoferrin supplementation.3 Many of these studies enrolled small numbers and had limitations in study design and implementation. The ELFIN randomised, placebo-controlled trial is the largest trial of this intervention. A major strength lies in the large number (>2000) of participating babies with more than 99% of outcome data being available. Important consideration was given to limit bias for the study; randomisation was successful in balancing baseline demographic and prognostic characteristics. Measures were put in place to define the spectrum of late-onset infection in order to reduce potential sources of bias. This is in contrast to most previous studies, in which only culture-proven late-onset sepsis was used as a marker.4 This does not necessarily completely rule out bias. The primary outcome used encompasses both microbiologically confirmed and clinically suspected late-onset infection, from trial entry until hospital discharge. Although these results were confirmed, using pre-defined criteria, by masked central end-point review committees, clinically suspected late-onset infection remains a subjective outcome. As it accounts for more than 40% of the cases in this study, this might be considered a confounding factor. Based on the GRADE system (grading of recommendation, assessment, development and evaluation), due to the relative imprecision of the primary outcome and inconsistency of the main result, lactoferrin is not recommended as a routine intervention to prevent late-onset sepsis in very preterm infants. Although other trials of lactoferrin are ongoing (Mooselmokadem trial; NCT01821989, estimated n = 180), NEOLACTO (NCT01525316, n = 414) and LIFT (ACTRN12611000247976, target sample size of 1500), it would be difficult to anticipate that these would bring about a change in the grade of recommendation, unless a substantial positive effect were seen in the largest of these trials. Although the risk of adverse outcomes in more mature preterm infants is generally lower, the effect size, favouring lactoferrin, was larger in this study in infants born at 30 or more weeks of gestation. Although not statistically significant, this finding may be clinically relevant. Lactoferrin promotes growth of probiotic bacteria, so this finding begs the question of whether this effect could be related to lower rates of exclusive breastmilk feeding and more restricted use of broad-spectrum antibiotics in larger infants. Evidently, there is still a need for novel research into the use of alternative interventions as adjuvants in preventing late-onset sepsis, and reducing mortality and morbidity in the very preterm population. Is there, for example, a need for further large scale studies to look at the effectiveness of using lactoferrin in combination with probiotic therapy or other interventions designed to decrease infection risk?5 https://ebneo.org/2019/11/enteral-lactoferrin-late-onset-infection/ None.

Use of restraint with hospitalized children: A survey of nurses' perceptions of practices.

Restraint is often perceived as necessary to ensure that medical procedures are carried out safely. The limited research into nurses' perceptions of restraint practices with hospitalized children hinders understanding the extent of the problem. A survey design was used to investigate nurses' perceptions of restraint use from five units in one children's hospital in Ireland. Findings revealed that restraint is a common practice, with physical and psycho- logical restraints most commonly used and newborn to 4-year-old children most likely to be restrained. Restraint was most often used for cannulation and latterly for administering medication and preventing interference to intravenous lines. To promote the use of thera- peutic holding for the safe delivery of procedures, nurses require education and skills training. Restraint should only be used as a last resort and in all situations, nurses should assess the need to use restraint and explore any alternatives in order to gain the child's cooperation. More research is needed into the situational variables that can lead to restraint usage in order to identify learning needs and promote the use of alternative interventions.

Belt restraint reduction in nursing homes: design of a quasi-experimental study

BackgroundThe use of physical restraints still is common practice in the nursing home care. Since physical restraints have been shown to be an ineffective and sometimes even hazardous measure, interventions are needed to reduce their usage. Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. However, the success rate of these interventions has been inconsistent. We developed a new multi-component intervention (EXBELT) comprising an educational intervention for nursing home staff in combination with a policy change (belt use is prohibited by the nursing home management), availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes. However, the reduction of belts should not result in an increase of other restrictive restraints (such as a chair with locked tray table) or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes.Methods and designEffects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement. Furthermore, changing attitudes will become an important addition to the educational part of EXBELT.DiscussionA quasi-experimental study is presented to investigate the effects of EXBELT on the use of belts on wards in psychogeriatric nursing homes. The study will be conducted in 26 wards in 13 psychogeriatric nursing homes. We selected the wards in a manner that contamination between control- and intervention group is prevented.Trial registration(NTR2140)

Treatment-Resistant Mood Disorders

Back to table of contents Previous article Next article Book Forum: Aspects of TreatmentFull AccessTreatment-Resistant Mood DisordersA. JOHN RUSH, M.D., A. JOHN RUSHSearch for more papers by this author, M.D., Dallas, Tex.Published Online:1 Jan 2003https://doi.org/10.1176/appi.ajp.160.1.201-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The recognition of treatment resistance in mood disorders has grown substantially in the last 5 years. Until just recently, how to deal effectively with depressions not remitting or responding to the initial treatment remained largely defined anecdotally by “experts.” This much-needed, timely publication provides a thorough review of the available evidence (including consecutive case series as well as randomized controlled trials) addressing this important and common clinical dilemma. The approach taken is evidence based and pragmatic. Importantly, most chapters provide a distillation of the empirical evidence as well as clinically relevant commentary on the implication of the available evidence for clinical practice.The intended audience for this book includes clinicians and clinical researchers. Residents will also benefit substantially from this volume. The chapters are generally well written and to the point. Clinicians will find the book of immense practical value in deciding what to do when one or even several treatments do not produce a satisfactory clinical outcome.After a chapter defining the concept of treatment resistance and a chapter on its economic impact, five chapters discuss the biological basis for treatment resistance (e.g., neuroendocrine, sleep physiological, immunologic, and brain imaging findings). The next six chapters review the evidence for treatment with serotonin and serotonin-norepinephrine reuptake inhibitors, the monoamine oxidase inhibitors, medication combinations, ECT, thyroid augmentation, and psychotherapeutic and psychosocial treatments.Important subsequent chapters discuss the recognition and management of treatment resistance in special populations (e.g., children and adolescents, the elderly) or special situations (e.g., depression during pregnancy or in the postpartum period, depression caused by general medical conditions). The final chapters discuss ethical issues in conducting research in patients with treatment-resistant mood disorders and provide treatment algorithms for refractory bipolar disorder. Particularly thorough and articulate discussions are presented for depression in the elderly, bipolar depression, and depressions caused by general medical conditions. Any clinician managing treatment-resistant depression will find useful the wide variety of treatment possibilities discussed in this volume.The book is generally thorough in its discussion of most of the topics and is broadly inclusive in the range of topics. However, I would be remiss if I did not highlight important areas not covered by this text. They include medication adherence, the use of alternative interventions (e.g., acupuncture, St. John’s wort), the psychological/psychosocial basis for treatment resistance, and the long-term management of patients with treatment-resistant mood disorders.On the other hand, this book does provide a great deal of clinically relevant and valuable information for clinicians and clinical researchers. It summarizes the current state of our knowledge. More than 30 international experts not only detail this knowledge but also provide a clinically informed synthesis of the evidence. This volume is truly a timely and useful contribution.Edited by Jay D. Amsterdam, Mady Hornig, and Andrew A. Nierenberg. New York, Cambridge University Press, 2001, 535 pp. $95.00. FiguresReferencesCited byDetailsCited ByNone Volume 160Issue 1 January 2003Pages 201-a-202 Metrics History Published online 1 January 2003 Published in print 1 January 2003

Evidence suggests that water fluoridation has an effect over and above that of fluoridated toothpaste

Objective If water fluoridation is shown to have beneficial effects, what is the effect over and above that offered by the use of alternative interventions and strategies? Data sources See page 37. Study selection Studies were included that were carried out after 1974 in industrialised countries because, in those, any modifying effect of fluoride toothpaste and other sources of dental fluoride (eg, mouthrinses, tablets) should be apparent. Of the 24 studies that met the inclusion criteria for Objective 1, 10 were completed after 1974 (1978–1997). The mean validity score of these 10 studies was 5.0 (range, 3.5–6.8 out of 8). Data extraction and synthesis See page 37. Results Only 10 studies qualified to address this issue, although none of these identified this objective as the purpose of the investigation. The study with the highest validity score showed a statistically-significant difference in caries increment between fluoridated and nonfluoridated areas. Those in the nonfluoridated area had the greatest increment, in spite of fluoridated toothpaste being used by both groups (94% versus 95% used fluoride toothpaste only in the fluoridated and nonfluoridated groups, respectively). Conclusions The evidence suggests that water fluoridation has an effect over and above that of fluoridated toothpaste (and other sources of fluoride). McDonagh M, Whiting P, Bradley M, Cooper J, Sutton A, Chestnutt I, et al. A Systematic Review of Public Water Fluoridation. York: Publications Office, NHS Centre for Reviews and Dissemination, University of York. ISBN 1 900640 16 3; 2000

Assessment of Residents’ Ability to do Psychotherapy

The authors describe the development of an evaluation instrument constructed to assess residents’ grasp of elements basic to the conduct of psychoanalytically-oriented psychotherapy. They stress assessment of the resident’s ability to employ previously acquired skills and knowledge in the moment-by-moment development of a psychotherapy interview. The instrument employs actual verbatim transcript material taken from psychotherapy conducted by experienced clinicians but makes use of alternative interventions devised after the fact. Although only the group of first year residents could be distinguished by its mean score, the instrument yielded useful information about specific learning problems.