Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

Background: The debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS), which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables. Methods: We considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables). We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS. Results: All but two syndrome scores (mania, hostility) were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%. Conclusions: Psychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent costs. This might be considered in the development of future costing systems in psychiatry

Cognitive behavioural therapy versus supportive therapy for persistent positive symptoms in psychotic disorders: The POSITIVE Study, a multicenter, prospective, single-blind, randomised controlled clinical trial

Background: It has been demonstrated that cognitive behavioural therapy (CBT) has a moderate effect on symptom reduction and on general well being of patients suffering from psychosis. However, questions regarding the specific efficacy of CBT, the treatment safety, the cost-effectiveness, and the moderators and mediators of treatment effects are still a major issue. The major objective of this trial is to investigate whether CBT is specifically efficacious in reducing positive symptoms when compared with non-specific supportive therapy (ST) which does not implement CBT-techniques but provides comparable therapeutic attention. Methods: The POSITIVE study is a multicenter, prospective, single-blind, parallel group, randomised clinical trial, comparing CBT and ST with respect to the efficacy in reducing positive symptoms in psychotic disorders. CBT as well as ST consist of 20 sessions altogether, 165 participants receiving CBT and 165 participants receiving ST. Major methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, analysis by intention to treat, data management using remote data entry, measures of quality assurance (e.g. on-site monitoring with source data verification, regular query process), advanced statistical analysis, manualized treatment, checks of adherence and competence of therapists. Research relating the psychotherapy process with outcome, neurobiological research addressing basic questions of delusion formation using fMRI and neuropsychological assessment and treatment research investigating adaptations of CBT for adolescents is combined in this network. Problems of transfer into routine clinical care will be identified and addressed by a project focusing on cost efficiency. Discussion: This clinical trial is part of efforts to intensify psychotherapy research in the field of psychosis in Germany, to contribute to the international discussion on psychotherapy in psychotic disorders, and to help implement psychotherapy in routine care. Furthermore, the study will allow drawing conclusions about the mediators of treatment effects of CBT of psychotic disorders. Trial Registration Current Controlled Trials ISRCTN2924287

Scaffolding teacher learning: Examining teacher practice and the professional development process of teachers with culturally and linguistically diverse (CLD) learners.

Teachers work in complex and demanding times with an increasing number of students from culturally and linguistically diverse backgrounds (CLD) in classrooms. These students are over represented in statistics of under achievement. All teachers are teachers of academic language, and while no child is born with school language as a first language, for some students the match between home and school is more closely aligned than for other students. Teachers are expected to be culturally responsive, ensuring the languages and culture of students is visible in the classroom environment and the classroom curriculum. Despite the increasing knowledge about the specific strategies and approaches that will most effectively support CLD students in classrooms, the teaching of CLD students within mainstream contexts remains far from ideal. Teachers need support to access the principles of effective teaching of CLD learners that are available, and importantly to transfer the knowledge into classroom practice. Professional development and learning is linked to improved teacher practice and student learning outcomes. When teachers have opportunities to be engaged in successful elements of in-depth professional learning such as in-class modelling, observation and feedback, and co-construction of teaching and planning they are able to demonstrate improved pedagogical content knowledge. Their beliefs may also need to be challenged. The study was conducted in two schools in a large city in New Zealand where I am employed as an ESOL and literacy adviser. Using an action research method I was able to examine how a professional development and learning process shaped my own knowledge and practice as well as teacher knowledge and practice. The study fills a research space to gain insights into the effective professional learning processes that impact on teacher strategies and approaches with their CLD learners A central tenet of this research is that teachers can improve their practice of teaching CLD students and they can specifically learn strategies and approaches that are considered effective for them

Analyse von Fern-Infrarot-Spektren zur Bestimmung der OH-Konzentration der mittleren Erdatmosphaere

Inverse problems are frequently encountered in many fields of natural science and engineering, e.g., retrieval of atmospheric parameters from remote sensing spectral measurements is a typical inverse problem. Inverse problems are well known to be ill-posed because small perturbations in the measured data can lead to extreme perturbations of the retrieved solution. Physically meaningful solutions can be found by regularization, i.e., by introducing additional information, e.g., by using quadratic constraints. The L-curve criterion is a convenient tool to automatically find the optimal weighting of this constraint. A numerically robust implementation delivers additional diagnostics of the inverse problem and allows an efficient implementation of the L-curve criterion. After solving the inverse problem the quality of the solution has to be investigated. Thus, a detailed assessment of all error sources is mandatory. The methods for solving inverse problems and the detailed error analysis developed in this work are applied to the determination of the middle atmospheric OH concentration from far infrared spectra. In the theoretically oriented ESA study PIRAMHYD three satellite based limbsounding instruments (Fabry-Perot interferometer, Fourier transform spectrometer, and heterodyne spectrometer) were compared. The higher sensitivity of low spectral resolution instruments to systematic error sources was a major result of this study. Furthermore pointing error was identified to be the dominant error source for all instruments. In the second application data measured by the vertical sounding heterodyne spectrometer THOMAS flown in the MAHRSI validation campaign were analysed. Agreement of MAHRSI mesospheric and upper stratospheric OH measurements and the OH concentration determined by THOMAS within the overall error of the THOMAS measurements has been shown. (orig.)103 refs.Available from TIB Hannover: RA 437(1999-48) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Flugzeuggestuetzte Fernerkundung von Wasserinhaltsstoffen im Bodensee

Zur Berechnung von Wasserinhaltsstoffen aus Daten flugzeuggetragener Multispektralscanner wird ein Inversionsverfahren vorgestellt. Es beinhaltet die Bestimmung von Aerosoltypen und -konzentrationen, die bildpunktweise Korrektur von Oberflaechenreflexionen des Sonnenlichtes und die Atmosphaerenkorrektur von Fernerkundungsdaten. Zur Erfassung der optischen Groessen im Wasser wurden umfangreiche Messkampagnen am Bodensee durchgefuehrt. Zusammen mit vieljaehrigen Datensaetzen des DFG-Sonderforschungsbereichs 248 wird damit erstmalig ein vollstaendiger Satz der inhaerenten optischen stoffspezifischen Groessen fuer den Bodensee bestimmt. Zur Validation werden diese anhand von verschiedenen Modellen zur Verknuepfung der inhaerenten Streu- und Absorptionskoeffizienten mit den messbaren Groessen Extinktion und diffuse Reflexion auf Konsistenz geprueft. Aus Befliegungen mit dem Multispektralscanner Daedalus werden mit den vorgestellten Verfahren und optischen Groessen georeferenzierte Verteilungskarten von Schwebstoff und Phytoplankton-Pigmenten berechnet. (orig.)An inversion scheme for the retrieval of water constituents in case II waters from airborne multispectral scanner data is presented. This method includes modules for the calculation of aerosol types and contents, for the correction of sun glitter radiances and for the atmospheric correction of the image data. In 1996 extensive measurements were performed to determine the optical properties in Lake Constance. In combination with data collected through many years within a project of the German Research Foundation (SFB 248), for the first time a data set of inherent optical parameters being specific for typical substances in the Lake could be established. By means of the inversions scheme and the specific optical properties, geo-coded maps of suspended matter and chlorophyll were calculated from the multispectral airborne measurements above Lake Constance. (orig.)SIGLEAvailable from TIB Hannover: RA 437(2000-40) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman