Experiences of Dutch ambulance nurses in emergency care for patients with acute manic and/or psychotic symptoms : a qualitative study

Purpose: To explore the experiences of ambulance nurses in emergency care of patients with acute manic and/or psychotic symptoms. Methods: In this qualitative study, 14 interviews were conducted and analyzed using thematic analysis according to Braun and Clarke (2006). Findings: Psychiatric emergency care causes stress and uncomfortable feelings for ambulance nurses due to a lack of information on the patients, being alone with the patient in a small place and the unpredictability of the situation. Practice implications: More information about the specific patient, education, and good collaboration with other professionals could improve care

Erfahrungen mit Sandersatz im Küstenschutz - Eine allgemeine Entscheidungsunterstützung für die Praxis mit aktuellen Erkenntnissen aus der Wissenschaft

Die SWOT-Analyse zeigt, dass jedes Verfahren für die Materialentnahme und die Aufspülung eine Reihe von Vor- und Nachteilen mit sich bringt, die der Anwender gegeneinander abwägen muss. Mit weiteren Forschungsergebnissen, v.a. hinsichtlich der langfristigen ökologischen und morphologischen Auswirkungen der Verfahren, könnten einige der potenziellen Chancen und Risiken zu bekannten und absehbaren Stärken bzw. Schwächen werden. Bis dahin muss der Anwender unter Berücksichtigung aller Faktoren ein Verfahren auswählen, das für den geplanten Anwendungsfall geeignet ist und bei dem die Risiken für die Region vertretbar sind. Dabei muss jedoch beachtet werden, dass viele bisher unbekannte biologische Prozesse möglicherweise weitere Auswirkungen auf das Küstenökosystem haben könnten. Daher sind Eingriffe in die Küstenumwelt immer mit gewissen Risiken für das Ökosystem und den Menschen verbunden und sollten nur dann erfolgen, wenn sie unter Abwägung der wesentlich beeinflussten marinen und terrestrischen Kompartimente und nach Diskussion und Priorisierung der primären Schutzziele (Lebens-, Natur- und Wirtschaftsraum) unbedingt erforderlich sind

Tools for the Improvement of the Efficiency and Sustainability of Shore Nourishments – Results of the research project STENCIL

Online First, geplanter Druck 202

To continue or not to continue? Antipsychotic medication maintenance versus dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized controlled trial

BACKGROUND: Antipsychotic medication is effective for symptomatic treatment in schizophrenia-spectrum disorders. After symptom remission, continuation of antipsychotic treatment is associated with lower relapse rates and lower symptom severity compared to dose reduction/discontinuation. Therefore, most guidelines recommend continuation of treatment with antipsychotic medication for at least 1 year. Recently, however, these guidelines have been questioned as one study has shown that more patients achieved long-term functional remission in an early discontinuation condition-a finding that was not replicated in another recently published long-term study. METHODS/DESIGN: The HAMLETT (Handling Antipsychotic Medication Long-term Evaluation of Targeted Treatment) study is a multicenter pragmatic single-blind randomized controlled trial in two parallel conditions (1:1) investigating the effects of continuation versus dose-reduction/discontinuation of antipsychotic medication after remission of a first episode of psychosis (FEP) on personal and social functioning, psychotic symptom severity, and health-related quality of life. In total 512 participants will be included, aged between 16 and 60 years, in symptomatic remission from a FEP for 3-6 months, and for whom psychosis was not associated with severe or life-threatening self-harm or violence. Recruitment will take place at 24 Dutch sites. Patients are randomized (1:1) to: continuation of antipsychotic medication until at least 1 year after remission (original dose allowing a maximum reduction of 25%, or another antipsychotic drug in similar dose range); or gradual dose reduction till eventual discontinuation of antipsychotics according to a tapering schedule. If signs of relapse occur in this arm, medication dose can be increased again. Measurements are conducted at baseline, at 3, and 6 months post-baseline, and yearly during a follow-up period of 4 years. DISCUSSION: The HAMLETT study will offer evidence to guide patients and clinicians regarding questions concerning optimal treatment duration and when to taper off medication after remission of a FEP. Moreover, it may provide patient characteristics associated with safe dose reduction with a minimal risk of relapse. TRIAL STATUS: Protocol version 1.3, October 2018. The study is active and currently recruiting patients (since September 2017), with the first 200 participants by the end of 2019. We anticipate completing recruitment in 2022 and final assessments (including follow-up 3.5 years after phase one) in 2026. TRIAL REGISTRATION: European Clinical Trials Database, EudraCT number 2017-002406-12. Registered 7 J

A proof of principle for using adaptive testing in routine Outcome Monitoring: the efficiency of the Mood and Anxiety Symptoms Questionnaire -Anhedonic Depression CAT

<p>Abstract</p> <p>Background</p> <p>In Routine Outcome Monitoring (ROM) there is a high demand for short assessments. Computerized Adaptive Testing (CAT) is a promising method for efficient assessment. In this article, the efficiency of a CAT version of the Mood and Anxiety Symptom Questionnaire, - Anhedonic Depression scale (MASQ-AD) for use in ROM was scrutinized in a simulation study.</p> <p>Methods</p> <p>The responses of a large sample of patients (<it>N </it>= 3,597) obtained through ROM were used. The psychometric evaluation showed that the items met the requirements for CAT. In the simulations, CATs with several measurement precision requirements were run on the item responses as if they had been collected adaptively.</p> <p>Results</p> <p>CATs employing only a small number of items gave results which, both in terms of depression measurement and criterion validity, were only marginally different from the results of a full MASQ-AD assessment.</p> <p>Conclusions</p> <p>It was concluded that CAT improved the efficiency of the MASQ-AD questionnaire very much. The strengths and limitations of the application of CAT in ROM are discussed.</p

Uncertainties in Simulating Crop Performance in Degraded Soils and Low Input Production Systems

Many factors interact to determine crop production. Cropping systems have evolved or been developed to achieve high yields, relying on practices that eliminate or minimize yield reducing factors. However, this is not entirely the case in many developing countries where subsistence farming is common. The soils in these countries are mainly coarse-textured, have low water holding capacity, and are low in fertility or fertility declines rapidly with time. Apart from poor soils, there is considerable annual variability in climate, and weeds, insects and diseases may damage the crop considerably. In such conditions, the gap between actual and potential yield is very large. These complexities make it difficult to use cropping system models, due not only to the many inputs needed for factors that may interact to reduce yield, but also to the uncertainty in measuring or estimating those inputs. To determine which input uncertainties (weather, crop or soil) dominate model output, we conducted a global sensitivity analysis using the DSSAT cropping system model in three contrasting production situations, varying in environments and management conditions from irrigated high nutrient inputs (Florida, USA) to rainfed crops with manure application (Damari, Niger) or with no nutrient inputs (Wa, Ghana). Sensitivities to uncertainties in cultivar parameters accounted for about 90% of yield variability under the intensive management system in Florida, whereas soil water and nutrient parameters dominated uncertainties in simulated yields in Niger and Ghana, respectively. Results showed that yield sensitivities to soil parameters dominated those for cultivar parameters in degraded soils and low input cropping systems. These results provide strong evidence that cropping system models can be used for studying crop performance under a wide range of conditions. But our results also show that the use of models under low-input, degraded soil conditions requires accurate determination of soil parameters for reliable yield predictions