Organisation of diagnosis and treatment of idiopathic pulmonary fibrosis and other interstitial lung diseases in the Nordic countries

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageDifferences in the organisation of idiopathic pulmonary fibrosis (IPF) and interstitial lung diseases (ILDs) in the Nordic countries are not well described. Diagnostic setups, treatment modalities and follow-up plans may vary due to national, cultural and epidemiological features. The aim of the present study was to describe the different organisation of diagnostics and treatment of IPF and ILD in the Nordic countries. Methods All university and regional hospitals with respiratory physicians were invited to respond to a questionnaire collecting data on the number of physicians, nurses, patients with ILD/IPF, the presence of and adherence to disease-specific national and international guidelines, diagnosis and treatment including ILD-specific palliation and rehabilitation programmes. Results Twenty-four university and 22 regional hospitals returned the questionnaire. ILD and IPF incidence varied between 1.4 and 20/100,000 and 0.4 and 10/100,000, respectively. Denmark and Estonia have official national plans for the organisation of ILD. The majority of patients are managed at the university hospitals. The regional hospitals each manage 46 (5–200) patients with ILD and 10 (0–20) patients with IPF. There are from one to four ILD centres in each country with a median of two ILD specialists employed. Specialised ILD nurses are present in nine hospitals. None of the Nordic countries have national guidelines made by health authorities. The respiratory societies in Sweden, Norway and Denmark have developed national guidelines. All hospitals except two use the ATS/ERS/JRS/ALAT IPF guidelines from 2011. The limited number of ILD specialists, ILD-specialised radiologists and pathologists and the low volume of ILD centres were perceived as bottlenecks for implementation of guidelines. Twenty of the 24 university hospitals have multidisciplinary conferences (MDCs). Pulmonologists and radiologists take part in all MDCs while pathologists only participate at 17 hospitals. Prescription of pirfenidone is performed by all university hospitals except in Estonia. Triple therapy with steroid, azathioprine and N-acetylcysteine is not used. No hospitals have specific palliation programmes for patients with ILD/IPF, but 36 hospitals have the possibility of referring patients for palliative care, mostly based on existing oncology palliative care teams; seven hospitals have rehabilitation programmes for ILD. Conclusion There are obvious differences between the organisations of ILD patients in the Nordic countries. We call for national plans that consider the challenge of cultural and geographical differences and suggest the establishment of national reference centres and satellite collaborative hospitals to enable development of common guidelines for diagnostics, therapy and palliation in this patient group

Effects of cognitive-behavioral programs for criminal offenders

Cognitive-behavioral therapy (CBT) is among the more promising rehabilitative treatments for criminal offenders. Reviews of the comparative effectiveness of different treatment approaches have generally ranked it in the top tier with regard to effects on recidivism (e.g., Andrews et al., 1990; Lipsey & Wilson, 1998). It has a well-developed theoretical basis that explicitly targets “criminal thinking” as a contributing factor to deviant behavior (Beck, 1999; Walters, 1990; Yochelson & Samenow, 1976). And, it can be adapted to a range of juvenile and adult offenders, delivered in institutional or community settings by mental health specialists or paraprofessionals, and administered as part of a multifaceted program or as a stand-alone intervention. Meta-analysis has consistently indicated that CBT, on average, has significant positive effects on recidivism. However, there is also significant variation across studies in the size of those treatment effects. Identification of the moderator variables that describe the study characteristics associated with larger and smaller effects can further develop our understanding of the effectiveness of CBT with offenders. Of particular importance is the role such moderator analysis can play in ascertaining which variants of CBT are most effective. The objective of this systematic review is to examine the relationships of selected moderator variables to the effects of CBT on the recidivism of general offender populations

Effects of correctional boot camps on offending

Background: Correctional boot camps were first opened in United States adult correctional systems in 1983. Since that time they have rapidly grown, first within adult systems and later in juvenile corrections, primarily within the United States. In the typical boot camp, participants are required to follow a rigorous daily schedule of activities including drill and ceremony and physical training, similar to that of a military boot-camp. Punishment for misbehavior is immediate and swift and usually involves some type of physical activity like push-ups. Boot-camps differ substantially in the amount of focus given to the physical training and hard labor aspects of the program versus therapeutic programming such as academic education, drug treatment or cognitive skills. Objectives: To synthesize the extant empirical evidence on the effects of boot-camps and boot camp like programs on the criminal behavior (e.g., postrelease arrest, conviction, or reinstitutionalization) of convicted adult and juvenile offenders. Search Strategy: Numerous electronic databases were searched for both published an unpublished studies. The keywords used were: boot camp(s), intensive incarceration, and shock incarceration. We also contacted U.S and non-U.S. researchers working in this area requesting assistance in locating additional studies. The final search of these sources was completed in early December of 2003. Selection Criteria: The eligibility criteria were (a) that the study evaluated a correctional boot camp, shock incarceration, or intensive incarceration program; (b) that the study included a comparison group that received either probation or incarceration in an alternative facility; (c) that the study participants were exclusively under the supervision of the criminal or juvenile justice system; and (d) that the study reported a post-program measure of criminal behavior, such as arrest or conviction. Data Collection and Analysis: The coding protocol captured aspects of the research design, including methodological quality, the boot-camp program, the comparison group condition, the participant offenders, the outcome measures and the direction and magnitude of the observed effects. All studies were coded by two independent coders and all coding differences were resolved by Drs. MacKenzie or Wilson. Outcome effects were coded using the odds-ratio and meta-analysis was performed using the random effects model. Main Results: Thirty-two unique research studies met our inclusion criteria. These studies reported the results from 43 independent boot-camp/comparison samples. The random effects mean odds-ratio for any form of recidivism was 1.02, indicating that the likelihood that boot camp participants recidivating was roughly equal to the likelihood of comparison participants recidivating. This overall finding was robust to the selection of the outcome measure and length of follow-up. Methodological features were only weakly related to outcome among these studies and did not explain the null findings. The overall effect for juvenile boot camps was slightly lower than for adult boot camps. Moderator analysis showed that studies evaluating boot-camp programs with a strong treatment focus had a larger mean odds-ratio than studies evaluating boot camps with a weak treatment focus. Conclusions: Although the overall effect appears to be that of “no difference,” some studies found that boot camp participants did better than the comparison, while others found that comparison samples did better. However, all of these studies had the common element of a militaristic boot camp program for offenders. The current evidence suggests that this common and defining feature of a boot-camp is not effective in reducing post boot-camp offending

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