Nuove possibilità di valutazioni psichiatriche con sistemi web-based: uno studio pilota

Introduction. Telepsychiatry has raised to a role of growing importance, promoting experiments to provide rural areas clinical services and consultations, and to determine its reliability and feasibility to different clinical situations. In this study we describe a pilot experiment of psychiatric assessment of subacute patients via teleconferencing systems. Methods. 8 patients have been evaluated via web-based telecommunication systems. A general psychopathological assessment has been performed by a psychiatrist connected in videoconference to patients, using the Expanded version of BPRS (Brief Psychiatric Rating Scale). A second and original instrument, a toolbox called PERPS (Panama EmeRgency Psychiatric Scale), has been used to summarize urgency, severity, treatment strategy and need for involuntary commitment. Evaluations have been compared with those made by "control" psychiatrists and ICCs (Intraclass Correlation Coefficients) between couples of measures have been calculated. A second couple of evaluations has been performed by a normal face-to-face examination and used as a general comparison between ICCs. Results. For some BPRS factors and for all PERPS items, almost no differences have been found between ICCs from online and teleconferencing examinations. A slight difference has been found for thought disturbance and mood disturbance, and this could be hypothesized as a light bias of the instrument. Conclusions. Our study suggests that it may be possible and easy to perform psychiatric evaluations of mixed subacute patients by a web-based teleconferencing system

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

The Large Scale European XFEL Control System: Overview and Status of the Commissioning

The European XFEL is a 3.4km long X-ray Free Electron Laser in the final construction and commissioning phase in Hamburg. It will produce 27000 bunches per second at 17.5GeV. Early 2015 a first electron beam was produced in the RF-photo-injector and the commissioning of consecutive sections is following during this and next year. The huge number and variety of devices for the accelerator, beam line, experiment, cryogenic and facility systems pose a challenging control task. Multiple systems, including industrial solutions, must be interfaced to each other. The high number of bunches requires a tight time synchronization (down to picoseconds) and high performance data acquisition systems. Fast feedbacks from front-ends, the DAQs and online analysis system with a seamless integration of controls are essential for the accelerator and the initially 6 experimental end stations. It turns out that the European XFEL will be the first installation exceeding 2500 FPGA components in the MicroTCA form factor and will run one of the largest PROFIBUS networks. Many subsystem prototypes are already successfully in operation. An overview and status of the XFEL control system will be given

The Large Scale European XFEL Control System: Overview and Status of the Commissioning

The European XFEL is a 3.4 km long X-ray Free Electron Laser in the final construction and commissioning phase in Hamburg. It will produce 27000 bunches per second at 17.5 GeV. Early 2015 a first electron beam was produced in the RF-photo-injector and the commissioning of consecutive sections will follow during this and next year. The huge number and variety of devices for the accelerator, beam line, experiment, cryogenic and facility systems pose a challenging control task. Multiple systems, including industrial solutions, must be interfaced to each other. The large number of bunches requires a tight time synchronization (down to picoseconds) and high performance data acquisition systems. Fast feedbacks from front-ends, the DAQs and online analysis system with a seamless integration of controls are essential for the accelerator and the initially 6 experimental end stations. It turns out that the European XFEL will be the first installation exceeding 2500 FPGA components in the MicroTCA form factor and will run one of the largest PROFIBUS networks. Many subsystem prototypes are already successfully in operation. An overview and status of the XFEL control system will begiven

The Large Scale European XFEL Control System: Overview and Status of the Commissioning

The European XFEL is a 3.4 km long X-ray Free Electron Laser in the final construction and commissioning phase in Hamburg. It will produce 27000 bunches per second at 17.5 GeV. Early 2015 a first electron beam was produced in the RF-photo-injector and the commissioning of consecutive sections will follow during this and next year. The huge number and variety of devices for the accelerator, beam line, experiment,cryogenic and facility systems pose a challenging control task. Multiple systems, including industrial solutions, must be interfaced to each other. The large number of bunches requires a tight time synchronization (down to picoseconds) and high performance data acquisitionsystems. Fast feedbacks from front-ends, the DAQs and online analysis system with a seamless integration of controls are essential for the accelerator and the initially 6 experimental end stations. It turns out that the European XFEL will be the first installation exceeding 2500 FPGAcomponents in the MicroTCA form factor and will run one of the largest PROFIBUS networks. Many subsystem prototypes are already successfully in operation. An overview and status of the XFEL control system will be given