RTCs play an increasingly significant role in the continuum of treatment of emotionally disturbed adolescents. However, outcome research in this area has lagged behind the growth of treatment centers. More specifically, there has been very little investigation of the relative efficacy of the many different aspects of residential treatment, which are referred to as mechanisms of change in other research. The present study attempts to develop a phenomenological understanding of RTC patients' experience of all of the interventions that make up residential treatment. Results suggest that patients view social support, non-therapist staff members, family involvement and family therapy, as most prominent in their change process. Patient articulations indicate that they are able to understand a great deal about the importance of multi-modal treatment, and the importance of receiving a broad range of treatment interventions. Limited four year follow-up data is also included.

Ensuring adequate and timely follow-up is one of the essential parts of providing good patient care in a primary care setting. If the next visit is not scheduled prior to a patient leaving the clinic, it often results in them being “lost to follow-up.” This results in inadequate care, delays in treatment, and increased burden of disease. Using the currently available scheduling mechanism in our EHR is a tedious and time-consuming process that makes it difficult to arrange for follow up visits prior to the patient arriving at the checkout window after they leave the exam room. This often resulted in no appointment being scheduled at all or one much later than the provider intended. Our proposed solution to this problem was to replace the electronic scheduling mechanism with small paper “follow-up cards” that patients are given to take to the checkout desk with them. We implemented this new process in our clinic for a 3-month period and evaluated resident satisfaction with follow-up and checkout procedures before and after the change. We found that residents preferred using the card system because they felt it improved their workflow in clinic and improved efficiency of scheduling follow up visits. Given the positive reviews, it was decided to implement the follow up cards as a permanent mechanism for scheduling appointments in our clinic until a more efficient electronic system can be arranged.

<p>OBJECTIVES: The primary objective of this systematic review was to illustrate the various definitions authors of methodology articles have offered for intention to treat (ITT) in relation to loss to follow up (LTFU).</p> <p> METHODS: We searched MEDLINE® for publications appearing between 1950 to 2008. Eligible papers devoted at least one paragraph to ITT and two other paragraphs to either ITT or LTFU. Investigators independently extracted relevant information from each eligible article. Discrepancies between data extractors were adjudicated. Data was extracted and variables used during data extraction were analyzed using the Landis and Koch guidelines kappa values.</p> <p> RESULTS: The MEDLINE® search yielded 1007 articles. One-hundred and ten articles underwent full text screening yielding 66 articles. All kappa's were substantial to near perfect agreement (>0.74). Of the 66 articles, five (8%) did not define ITT, 25 (41%) mentioned LTFU but did not discuss its relationship with ITT, 36 (59%) commented on LTFU in the context of ITT. These 36 articles segregated into three distinctive definitions for ITT: "full-follow-up required" (mentioned 58%), "ITT and LTFU are separate issues" (mentioned 17%), and "ITI involves specific strategy for LTFU" (mentioned 78%). Of the 36 articles, 17 (47%) had multiple definitions for ITT. The most frequent strategies mentioned for handling LTFU were last outcome carried forward (50%), sensitivity analysis (50%), and use of available data to impute (46%). Most articles (81%) specifically excluded complete case analysis under ITI.</p> <p> CONCLUSION : The most striking finding of our systematic review is that there is no meaningful consensus on the definition of ITI. This review, considered alongside previous reviews of RCTs, demonstrates that simply stating a study employed ITT is useless at best and misleading and dangerous at worst. It is the recommendation of this thesis that trialists replace the term ITI with a clear statements about analytic strategies applied to participants who were followed and with those not followed.</p> / Thesis / Master of Science (MS)

No description available.

Objective: Test changes in (a) perceived coping efficacy, (b) negative self-statements, and (c) interpretive biases to threat as potential mediators of the relationship between treatment condition and long-term follow-up (average of 6.5 years after intervention). Test moderating effect of age at time of randomization on mediational effect for the 3 putative mediators. Method: Participants included 301 youth who had participated in the Child/Adolescent Multimodal Study (CAMS) and agreed to participate in a naturalistic follow-up study beginning an average of 6.5 years after the end of the acute treatment phase. In the intervention phase, participants (ages 7 to 17) were randomized to cognitive behavioral therapy (CBT), pharmacotherapy (sertraline), combined CBT and sertraline, or pill placebo. Putative mediators were measured at 4 time-points over the course of the intervention phase. The follow-up study consisted of five annual assessment visits that included ratings of current anxiety based on an interview by an independent evaluator who was blind to the randomization of participants. Results: Reductions on a measure of interpretive biases to threat over the course of the combined intervention condition mediated anxiety outcomes at the first follow-up visit. No other significant mediated effects were found for any of the putative mediators. Age did not significantly moderate any mediated effects. Conclusions: The findings suggest that interpretive biases to threat, an often elevated characteristic of anxious youth, may be important to address as part of the treatment of anxiety in order to maintain reductions in anxiety in the years following treatment. The specificity of this finding to the combined CBT and sertraline condition offers support for the synergistic effect of CBT and sertraline when implemented in tandem to reduce anxiety-related cognitive factors with long-term implications. / Psychology

Objective: To examine the impact of treatment outcome and treatment condition (Cognitive-behavioral therapy, CBT; Sertraline, SRT; COMB, CBT and SRT; Placebo) for youth treated for anxiety disorders on global and domain-specific functioning across a 3 to 12 year, naturalistic follow-up. Method: A subset (319) of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated in an average of 3.38 assessments during the follow-up period. All youth met criteria for a principal anxiety disorder pretreatment. Growth curve modeling examined the impact of treatment outcomes (response/remission) and treatment condition on global functioning, global and domain- specific impairment, and life satisfaction across the follow-up period. Logistic regression explored the impact of treatment response and condition on low frequency events (arrests/convictions) and educational achievement (high school graduation/college enrollment). Results: Growth curve analyses revealed that treatment responders/remitters demonstrated better global functioning, increased life satisfaction, and decreased overall impairment at their first follow-up assessment (growth curve mean intercept). The positive effect of treatment response on life satisfaction, but not global functioning or overall impairment, attenuated across the follow-up period. Treatment response also predicted decreased academic impairment at first follow-up. Participants in the COMB condition demonstrated improved functional trajectories with regards to family life and academic grade-point average. CBT participants demonstrated a greater decline in overall impairment and problems with self-care/independence across the follow-up. Treatment response and condition did not predict legal outcomes, school attendance, high school graduation, college attendance, occupational outcomes, or social/peer relationships. Conclusion: Response to early intervention is associated with improved overall functioning, as well as functioning within specific domains (academics) 3 to 12 years posttreatment. Treatment type differentially predicted functional trajectories. Findings support the positive impact of pediatric anxiety treatment on functioning during adolescence and emerging adulthood. / Psychology

Implementation of provider-made follow-up appointments for depression in primary care Rebecca Vaughn College of Nursing, East Tennessee State University; Whitson Hester School of Nursing, Tennessee Technological University Author Note Rebecca Vaughn https://orcid.org/0009-0007-0731-3316 College of Nursing, East Tennessee State University There are no conflicts of interest to disclose. Corresponding concerning this manuscript should be addressed to Rebecca Vaughn 108 Reed Mill Lane Monroe TN 38573 Zrev2@etsu.edu Abstract Depression is a common condition diagnosed and managed in primary care. Follow-up is inconsistent and low in these settings, creating a gap in care that impacts management, adherence to treatment, and patient outcomes. The purpose of this quality improvement project was to implement in-room scheduling of follow-- up appointments by providers of newly diagnosed depression patients. The project aimed to improve follow-up of newly diagnosed depression patients and adherence to treatment in primary care. The setting of the project was a primary care clinic care located in North-East Tennessee. The IRB determined that no approval was needed. A 12-week retrospective chart review was conducted to determine baseline rates and demographics for the project. During the six-week project , providers scheduled follow-up appointments and documented them on the data collection form. Providers were given a pre/post-test before and after implementation to measure providers confidence levels. While the study is ongoing , and results are pending, the expected outcomes include improved follow-up rates and improved adherence to treatment which will lead to improved outcomes in depression. Keywords: depression, primary care, follow-up, adherence

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-10-23T12:03:01Z No. of bitstreams: 1 Gessyka Wnaglon Veleda.pdf: 1641786 bytes, checksum: fcc4d51b17c8f41056d82f3ec8d5cec9 (MD5) / Made available in DSpace on 2018-10-23T12:03:01Z (GMT). No. of bitstreams: 1 Gessyka Wnaglon Veleda.pdf: 1641786 bytes, checksum: fcc4d51b17c8f41056d82f3ec8d5cec9 (MD5) Previous issue date: 2018-08-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Behavioral Cognitive Therapy (CBT) has been indicated as first-line treatments for Major Depressive Disorder (MDD), due to its effectiveness and effectiveness. However, little is known about the maintenance of these results in the medium and long term. These findings are of particular importance in view of the high rates of relapse and recurrence of depressive episodes throughout the subjects' lives. . The objective of this study is to investigate the efficacy and effectiveness of psychotherapeutic treatment from CBT for the response of post-follow-up depressive symptoms, indicating related clinical and social aspects. From a quasi-experimental study nested to a randomized clinical study, 94 patients were evaluated through the Beck Depression Inventory (BDI-II), 6 and 12 months post intervention of 16 sessions with CBT. There were significant differences between the median depressive symptoms of the baseline with the scores of all other follow-up moments (p <0.001). There were no differences in the scores of depressive symptoms at the end of treatment when compared to 6 (p <0.486) and 12 months (p <0.098). Only the initial BDI score was associated with a decrease in depressive symptoms (p <0.001). The findings indicate that CBT significantly reduces depressive symptoms by maintaining this condition for up to 12 months after the intervention. The intensity of depressive symptoms at the beginning of the therapeutic process is associated with a decrease in post-intervention depressive symptoms. / A Terapia Cognitiva - Comportamental (TCC) tem sido indicada como tratamento de primeira linha para o Transtorno Depressivo Maior (TDM), devido sua eficácia e efetividade. Contudo, pouco se sabe sobre a manutenção desses resultados a médio e longo prazo. Esses achados têm especial importância, tendo em vista, as altas taxas de recidivas e recorrência de episódios depressivos ao longo da vida dos sujeitos. O objetivo deste estudo é pesquisar a eficácia e efetividade do tratamento psicoterápico a partir da TCC para a resposta dos sintomas depressivos um ano pós-acompanhamento, indicando aspectos clínicos e sociais relacionados. A partir de um estudo quase experimental aninhado a um clínico randomizado, 94 pacientes foram avaliados, através do Inventário Beck de Depressão (BDI- II), 6 e 12 meses pós intervenção de 16 sessões com TCC. Houve diferenças significativas entre as medianas de sintomas depressivos do baseline com os escores de todos os momentos de acompanhamento (p < 0,001). Não houve diferenças em relação aos escores de sintomas depressivos do final do tratamento quando comparados com aos 6 (p < 0,486) e 12 meses (p < 0,098). Apenas o escore de BDI inicial estava associado à diminuição dos sintomas depressivos (p < 0,001). Os achados indicam que a TCC reduz significativamente os sintomas depressivos mantendo essa condição até 12 meses após a intervenção. A intensidade dos sintomas depressivos no início do processo terapêutico está associada a uma diminuição dos sintomas depressivos pós intervenção.

Einleitung Die aneurysmale Subarachnoidalblutung und ihre Komplikationen stellen eine akut lebensbedrohliche Erkrankung dar. Aufgrund einer hohen Letalität und Morbidität sowie zahlreichen, nicht modifizierbaren Risikofaktoren und fehlenden eindeutigen Präventionsmaßnahmen bleibt diese Krankheit eines der aktuellen Themen der Neurochirurgie. Ziel Ziel dieser Studie ist der Vergleich der Behandlungsergebnisse von Patienten mit aneurysmaler SAB im Klinikum Chemnitz mit aktuellen Literaturdaten. Material und Methode In dieser Arbeit wurden die Daten von insgesamt 200 Patienten mit aneurysmaler Subarachnoidalblutung retrospektiv zusammengefasst. Es wurde eine Populationsanalyse zusammen mit einer Analyse der Korrelationen zwischen verschiedenen Ausgangs- und Verlaufsparametern mit dem allgemeinen Outcome und der Mortalität durchgeführt. Zusätzlich erfolgte eine Follow-up-Analyse der Mortalität und Morbidität bei 108 Patienten. Im statistischen Modell wurden eine Uni- und Bivariatanalyse sowie binäre und multinomiale logistische Regression angewendet. Kaplan-Meier-Kurven in Verbindung mit Cox-Regressionsanalysen wurden zur Beurteilung der Mortalität eingesetzt. Die Ergebnisse wurden mit Literaturdaten verglichen. Das Votum der Ethikkommission der TU Dresden liegt vor (EK 181052014 vom 15.09.2014). Ergebnisse Von 200 Patienten mit einem Durchschnittsalter von 52 J (20-82 J, Medianalter 51 ± 13,6 J) waren 69 Patienten männlich (34,5 %), 131 – weiblich (65,2 %). Das männlich : weiblich Verhältnis betrug 1:1,9. Der klinische Schweregrad der Patienten bei Aufnahme wurde durch die WFNS- und die HH-Skalen evaluiert. Zusätzlich wurden die BNI- und Fisher-Skalen zwecks Evaluation des radiologischen Schweregrades der aSAB eingesetzt. Die Patientendistribution anhand der WFNS-Skala war: WFNS °I – 42,0 %, WFNS °II – 10,0 %, WFNS °II – 16,5 %, WFNS °IV – 22,5%, WFNS °V – 9,0 %. Die Verteilung der Patienten durch die HH-Skala war vergleichbar. 14,5 % der Patienten hatten eine BNI 1, 41,5 % - BNI 2, 32,0 % – BNI 3, 10,5 % - BNI 4, 1,5 % - BNI 5 Blutung. Bei 5,5 % der Patienten lag eine Fisher 1, 10,5 %– Fisher 2, 28,0% - Fisher 3 und 56,0 % - Fisher 4 SAB vor. 77,5 % der Aneurysmata waren klein (<11mm), 18,5 % - groß (11-25mm), 4 % - Giant (>25mm). Die Aneurysmen war meist im Bereich der Acom (41,5 %) und MCA (36,5 %) lokalisiert. Insgesamt 94,5 % der Aneurysmen gehörten zur vorderen Zirkulation. Die primäre Mortalitätsrate betrug 14,5 %. 21,5% der Patienten hatten einen mRS von 0-1 bei Entlassung, 26,0 % - einen mRS 2-3, 38,0 % - einen mRS 4-5. Die mittlere Follow-up-Dauer betrug 71,3 ± 43,2 Monate (Spannweite 2-168 Monate). Von den initial Überlebenden und im Follow-up eingeschlossenen Patienten sind 10,2 % im Verlauf verstorben. 48,1 % hatten einen mRS 0-1, 30,6% mRS 2-3, 11,1 % - mRS 4-5. Diskussion Das Outcome der Patienten mit einer aSAB trägt einen multifaktoriellen Charakter. Die wesentlichen Prädiktoren des Outcomes sind das Alter, der klinische und radiologische Schweregrad der Blutung, die Notwendigkeit der Versorgung eines posthämorrhagischen Hydrozephalus (temporäre und dauerhafte CSF-Ableitung), ein Vasospasmus, DIND und Entgleisun-gen im Serum-Natrium-Spiegel. Die Mortalitätsrate bei der primären Versorgung der Patienten mit einer aSAB in unserer Ko-horte ist um etwa 5 % niedriger als in der Literatur angegeben. Die Mortalitätsrate steigert sich allmählich während der ersten 3 Wochen. Sie wird im Wesentlichen vom Patientengeschlecht, dem klinischen und radiologischen Schweregrad der Blutung, der Notwendigkeit einer Akutversorgung eines aufgetretenen Hydrozephalus, einem Vasospasmus, Entgleisungen im Serum-Natrium-Spiegel sowie der Notwendigkeit einer CSF-Dauerableitung beeinflusst. Die Notwendigkeit einer CSF-Außenableitung bei Aufnahme korreliert mit einem schlechten Zustand der Patienten bei Entlassung und im Follow-up. Der Vasospasmus ist ein unabhängiger Prädiktor eines primär schlechten Outcomes und einer hohen Mortalität, zeigt sich aber als nicht signifikanter Faktor im Langzeit-Follow-up. Die Shuntpflicht ist bei Patienten mit Elektrolytentgleisungen, beidseitigen EVDs und DIND 3-4fach erhöht, beeinflusst jedoch nur die primäre Morbidität/Mortalität. Entgleisungen im Serum-Natrium-Spiegel zeigten sich als unabhängiger Prädiktor eines schlechten Outcomes und erhöhter Mortalität sowohl während des stationären Aufenthaltes, als auch im Langzeit-Follow-up. Die Notwendigkeit einer dekompressiven Kraniektomie wiederspiegelt sich in einem niedrigen BI der Patienten im primären Outcome und ist Prädiktor eines schlechten Outcomes und erhöhter Mortalität im Langzeit-Follow-up.

Despite growing scrutiny of Environmental Impact Assessment (EIA) in Canada and worldwide, the follow-up and monitoring component remains under practiced, leaving EIA decision-makers and practitioners with little understanding of the accuracy of impact predictions made and the effectiveness of mitigation measures developed during the EIA project-planning phase. The Minister’s Expert Panel further highlighted the importance of enhancing follow-up and monitoring during the recent review of EIA processes in Canada. The research identifies six leading edge practices for next generation EIA follow-up and monitoring: public and Indigenous participation, continuous learning, clear roles and responsibilities, independent oversight, adaptive management and traditional knowledge. Approaches to implement those practices in a Canadian context are explored and supported by guidance that captures the learning potential of EIA follow-up and monitoring. The six practices are intended as a package and are presented with practical guidance for proponents, regulators, consultants and others involved in EIA. / May 2017