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In several countries including Hungary no emergency care guidelines are available, and studies regarding everyday clinical emergency practice are also lacking.
The aims of the present study was to assess practice related to emergency care of agitated-psychotic patients in emergency settings in Hungary as well as to compare it with internationals trends.
Anonymous survey questionnaires were dispatched to 210 institutions providing psychiatric care in Hungary in 2013 consisting of questions related to care of an agitated patient showing psychotic symptoms. The results were compared with data from the latest international studies carried out in this field.
155 completed questionnaires were returned. Of the participating clinicians 18.7% would apply monotherapy, 76.1% dual combination, 5.2% a triple combination of medications. 92.9% of participants indicated haloperidol among first-line medications. 80.6% of participants would take a combination with benzodiazepines. 59.4% would use IV and 23.9% IM therapy, and 9% would apply the combination of these two. 7.7% of participants did not answer this question.
Our results indicate that administration of haloperidol and benzodiazepines is a widespread practice in the emergency care of agitated psychotic patients in Hungary which corresponds to dominant trends in international practice as reflected by the latest international survey. The international survey including 21 countries indicate that three countries (India, Romania, Slovenia) regularly use IV medications, whereas others do not do this at all, and only use IM medication. Hungarian clinicians disagree on mode of administration, but the majority would prefer IV therapy.
The Baby-Mother-(Father) program started in 2007, after a preparatory phase in a collaboration with the Zentrum Für Soziale Psychiatrie - Mutter & Kind Behandlung, Heppenheim, Germany. In Hungary, this is the first dedicated program for a babymother unit, were initiated by National Institute of Child Health (OGYEI), and Saint John Hospital Psychiatric and Psychiatric Rehabilitation Department in Budapest.
Baby-mother unit introduction into the local and the Hungarian health service.
The aim of the program is to apply a collaborative therapeutic and rehabilitation model utilizing the multidisciplinary team work in the treatment of the pre-, peri- and post-natal period of mothers suffering mental disorders as well as to facilitate the early interactions and attachment with the baby.
Since 2007, 82 mothers, 1 father entered into the program. 54 mothers were participated as inpatient, 29 were treated only as outpatient. 24.9% of the cases were diagnosed (ICD 10 – F20–F29) schizophrenia or spectrum disorders, 27,6% were in the major affective disorders, including bipolar, (F 31, 14.5%). 38,6% were diagnosed in the anxiety disorders spectrum. 23% entered in the prenatal period (pregnancy), while 76,3% entered post-natal.
Therapeutic methods used
Case-management, individual, group and family interventions (psychotherapy), pharmacotherapy, case conferences, individual and staff supervision, video-feedback, mother-child consultation.
New treatment model introduction in Hungary, which may reduce the risk of the separation of the baby, enhances the mother recovery, as well as the utilization of the family's and the supportive network resources. Further research is needed to prove the higher efficacy.
To provide an overview on the magnitude of the impact of schizophrenia on the healthcare system in Europe and to gain a better understanding on the most important factors influencing the variation of costs.
Studies reporting costs and healthcare utilization among patients with schizophrenia were searched in MEDLINE (via Scopus), EMBASE (via Scopus) and Cochrane Database of Systematic Reviews on 19th January 2017.
Twenty-three studies, from the 1075 references initially identified, were included in this review. The annual cost per patient ranged from €533 in Ukraine to €13,704 in the Netherlands. Notably drug costs contributed to less than 25% of the direct healthcare cost per patient in every country, which might be explained by similar pharmaceutical prices among countries due to the reference pricing system applied in Europe. Inpatient costs were the largest component of health service costs in the majority of the countries. Despite methodological heterogeneity across studies, four major themes could be identified (age, severity of symptoms, continuation of treatment/persistence, hospitalization) that have substantial impact on the costs of schizophrenia.
Schizophrenia represents a substantial cost for the healthcare system in Europe driven by the high cost per patient. Substantial savings could potentially be achieved by increasing investment in the following areas: (1) reducing the number of hospitalizations e.g. by increasing the efficiency of outpatient care; (2) working out interventions targeted at specific symptoms; (3) improving patient persistence and adherence in antipsychotic therapy.
Recent studies have tried to find a reliable way of predicting the development of Alzheimer´s Disease (AD) among patients with mild cognitive impairment (MCI), often focusing on olfactory dysfunction or semantic memory. Our study aimed to validate these findings while also comparing the predictive accuracy of olfactory and semantic assessments for this purpose.
Six hundred fifty patients (median age 68, 58% females) including controls, SCD (subjective cognitive decline), non-amnestic MCI (naMCI), amnestic MCI (aMCI), and AD patients were tested for olfactory dysfunction by means of odor identification testing and semantic memory. Of those 650 patients, 120 participants with SCD, naMCI, or aMCI at baseline underwent a follow-up examination after two years on average. Of these 120 patients, 12% had developed AD at follow-up (converters), while 88% did not develop AD at follow-up (non-converters).
Analysis showed a significant difference only for initial olfactory identification between converters and non-converters. Sensitivity of impairment of olfactory identification for AD prediction was low at 46.2%, although specificity was high at 81.9%. Semantic memory impairment at baseline was not significantly related to AD conversion, although, when naming objects, significant differences were found between AD patients and all other groups and between naMCI and aMCI patients compared to controls and SCD patients.
Objective olfactory assessments are promising instruments for predicting the conversion to AD among MCI patients. However, due to their low sensitivity and high specificity, a combination with other neuropsychological tests might lead to an improved predictive accuracy. Further longitudinal studies with more participants are required to investigate the usefulness of semantic memory tests in this case.
This paper investigates how we infer the status of others from their social relationships. In a series of experimental studies, we test the effects of a social relationship's type and direction on the status judgments of others. We demonstrate empirically, possibly for the first time, a widely-assumed connection between network structure and perceptions of status; that is, that observers do infer the status positions of group members from their relationships. Moreover, we find that observers' status judgments vary with the direction and type of social relationship. We theorize that underlying this variance in status judgments are two relational schemas which differentially influence the processing of the observed social ties. Our finding that only the linear-ordering schema leads to status inferences provides an important scope condition to prior research on network cognition, and specifically on the perceptions of social status.
We estimate the column density of the Galactic foreground interstellar medium (GFISM) in the direction of extragalactic sources. All-sky AKARI FIS infrared sky survey data might be used to trace the GFISM with a resolution of 2 arcminutes. The AKARI based GFISM hydrogen column density estimates are compared with similar quantities based on HI 21cm measurements of various resolution and of Planck results. High spatial resolution observations of the GFISM may be important recalculating the physical parameters of gamma-ray burst (GRB) host galaxies using the updated foreground parameters.
The current study investigates potential pathways from socio-economic status (SES) to BMI in the adult population, considering psychological domains of eating behaviour (restrained eating, uncontrolled eating, emotional eating) as potential mediators stratified for sex.
Data were derived from the population-based cross-sectional LIFE-Adult-Study. Parallel-mediation models were conducted to obtain the total, direct and indirect effects of psychological eating behaviour domains on the association between SES and BMI for men and for women.
We studied 5935 participants aged 18 to 79 years.
Uncontrolled eating mediated the association between SES and BMI in men only and restrained eating in both men and women. Emotional eating did not act as mediator in this relationship. The total effect of eating behaviour domains on the association between SES and BMI was estimated as β=−0·03 (se 0·02; 95 % CI −0·062, −0·003) in men and β=−0·18 (se 0·02; 95 % CI −0·217, −0·138) in women.
Our findings do not indicate a strong overall mediation effect of the eating behaviour domains restrained eating, uncontrolled eating and emotional eating on the association between SES and BMI. Further research on other pathways of this association is strongly recommended. Importantly, our findings indicate that, independent from one’s social position, focusing on psychological aspects in weight reduction might be a promising approach.
Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.
To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.
A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.
The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.
Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.
We report an in situ measurement of the electric field attenuation length Lα at radio frequencies for the bulk ice at Summit Station, Greenland, made by broadcasting radio-frequency signals vertically through the ice and measuring the relative power in the return ground bounce signal. We find the depth-averaged field attenuation length to be at 75 MHz. While this measurement has clear radioglaciological applications, the radio clarity of the ice also has implications for the detection of ultra-high energy (UHE) astrophysical particles via their radio emission in dielectric media such as ice. Assuming a reliable extrapolation to higher frequencies, the measured attenuation length at Summit Station is comparable to previously measured radio-frequency attenuation lengths at candidate particle detector sites around the world, and strengthens the case for Summit Station as a promising northern site for UHE neutrino detection.
This practical guide to the diagnosis of neurodegenerative diseases discusses modern molecular techniques, morphological classification, fundamentals of clinical symptomology, diagnostic pitfalls and immunostaining protocols. It is based on the proteinopathy concept of neurodegenerative disease, which has influenced classification and provides new strategies for therapy. Numerous high-quality images, including histopathology photomicrographs and neuroradiology scans, accompany the description of morphologic alterations and interpretation of immunoreactivities. Diagnostic methods and criteria are placed within recent developments in neuropathology, including the now widespread application of immunohistochemistry. To aid daily practice, the guide includes diagnostic algorithms and offers personal insights from experienced experts in the field. Special focus is given to the way brain tissue should be handled during diagnosis. This is a must-have reference for medical specialists and specialist medical trainees in the fields of pathology, neuropathology and neurology working with neuropathologic features of neurodegenerative diseases. The book is packaged with a password, giving the user online access to all the text and images.