Predicting clinically signficant change in an inpatient program for people with severe mental illness

Objective: The first aim of this study was to assess the proportion of patients who achieved reliable and clinically significant change over the course of treatment in an inpatient psychosocial rehabilitation program. The second aim was to determine whether age, gender, length of stay, and diagnosis and co-morbid diagnosis predicted those who were classified as improved or not improved, using clinical significance criteria. Method: Three hundred and thirty-seven patients from inpatient units at Bloomfield Hospital, Orange, New South Wales, Australia were assessed at admission, 3-month reviews and discharge using the expanded Brief Psychiatric Rating Scale, the Health of the Nation Outcome Scales and the Kessler 10. Results: Reliable and clinically significant improvement was found for 32.4% of inpatients on psychiatric symptomatology, 19.5% on psychosocial functioning and 20.2% on psychological distress. Logistic regression analyses found that the predictor variables collectively predicted those who made reliable and clinically significant improvement on psychiatric symptomatology, but not on psychosocial functioning or psychological distress. Those with a primary diagnosis of schizoaffective disorder had higher rates of improvement in psychiatric symptomatology compared to those with a diagnosis of schizophrenia. Those with co-morbid substance abuse disorders showed a trend towards greater improvement. Conclusions: Inpatient treatment is associated with clinically significant improvements for some patients with a severe mental illness. Patients with schizo-affective disorders are proportionally more likely to make improvement

Benchmarking across sectors: Comparisons of residential dual diagnosis and mental health programs

[extract] A Question to Ponder: How does your service compare to other similar services in the industry? How would knowing this help your organisation

Characterization of the effects of intestinal physiology modified by exogenous enzymes and direct-fed microbial on intestinal integrity, energy metabolism, body composition and performance of laying hens and broiler chickens

The objective of this dissertation was to evaluate the effects of exogenous enzymes (EE) and direct-fed microbial (DFM) supplementation on bird intestinal integrity, energy metabolism, body composition and performance of laying hens and broiler chickens. The effects of reduced dietary metabolizable energy (ME) on performance, intestinal integrity and body composition of laying hens were evaluated in two experiments. A reduction of 90 kcal/kg of dietary ME over a period of 12 weeks did not significantly alter performance or nitrogen corrected apparent ME (AMEn), but reduced abdominal fat pad. In the follow-up experiment, no significant differences were noted in performance of laying hens when fed a diet with 100 kcal/kg reduced ME supplemented with EE or EE and DFM for 16 weeks. However, EE significantly increased AMEn and nutrient transport, whereas DFM increased intestinal epithelial barrier function, mucin gene expression and reduced zoonotic pathogen colonization. These data indicate that modern laying hens have little or no sensitivity to small differences in dietary ME contributed by EE and DFM, as they prioritize to meet the energy demands of production. The effects of DFM on performance and intestinal integrity of broiler chickens exposed to coccidial challenge or raised on built-up litter. Ileal nutrient transport, mucin gene expression and intestinal epithelial barrier function and were increased by DFM, although no difference in performance was observed. The effects of EE and DFM on dietary energy utilization in broilers were determined in two experiments. Both additives increased apparent ileal starch and amino acid digestibility non-additively, while the combination additively increased AMEn. The effects of EE were exerted through increased activity of brush border digestive enzymes, and DFM through increased cecal butyrate synthesis. The final experiment examined the effects of EE and DFM on performance, energy utilization, and body composition in broiler chickens. The combination of EE and DFM additively increased feed efficiency and the birds were in a positive energy state. Changes in body composition indicated that the combination tends to increase lean accretion during early stages of life. Overall, the combination of EE and DFM increased broiler performance additively through pathways independent of each other.</p

Corrigendum II: Phytogenic feed additives as an alternative to antibiotic growth promoters in broiler chickens

The recent trend toward reduction of antibiotic growth promoters (AGP) in North American poultry diets has put tremendous pressure on the industry to look for viable alternatives. In this context, phytogenic feed additives (PFA) are researched to improve gut health and thereby performance. An experiment was conducted with the objective to evaluate the effects of PFA as an alternative to AGP on small intestinal histomorphology, cecal microbiota composition, nutrient digestibility, and growth performance in broiler chickens. A total of 432, day-old Vencobb 400 broiler chicks were randomly assigned to one of three dietary groups, each consisting of 12 replicate pens (n = 12 chicks/pen). The chicks were fed a corn-soybean meal based control (CON), CON + 500 mg/kg of AGP (bacitracin methylene disalicylate containing 450 mg active BMD/g), or CON + 150 mg/kg of proprietary blend of PFA (Digestarom® Poultry) until 39 days of age when samples were collected. Birds fed either AGP or PFA had increased villus height in all three segments of the small intestine in comparison to the birds fed CON (P ≤ 0.05). Furthermore, the PFA fed birds had significantly increased villus height and lower crypt depth compared to AGP fed birds (P ≤ 0.05). Birds fed either additive also had increased total tract digestibility of dry matter, crude protein and ether extract (P ≤ 0.05). The strong effect of the PFA on villus height in the jejunum may suggest augmented nutrient absorption in PFA fed birds. Although both additives reduced total cecal counts of anaerobic bacteria and Clostridium spp., PFA alone reduced the total coliform count while increasing the Lactobacillus spp. count (P ≤ 0.05). These results suggest the establishment of beneficial microbial colonies in PFA fed birds. Overall both PFA and AGP increased body weight gain while lowering the feed conversion ratio (P ≤ 0.05). Hence data from this experiment demonstrate the efficacy of PFA as a substitute to AGP in poultry diets

Effects of Protease, Phytase and a <i>Bacillus sp</i>. Direct-Fed Microbial on Nutrient and Energy Digestibility, Ileal Brush Border Digestive Enzyme Activity and Cecal Short-Chain Fatty Acid Concentration in Broiler Chickens

<div><p>Two experiments were conducted to determine the effects of protease and phytase (PP) and a <i>Bacillus sp</i>. direct-fed microbial (DFM) on dietary energy and nutrient utilization in broiler chickens. In the first experiment, Ross 308 broiler chicks were fed diets supplemented with PP and DFM in a 2×2 factorial arrangement. The 4 diets (control (CON), CON + PP, CON + DFM, and CON + PP + DFM) were fed from 15–21 days of age. In Experiment 1, significant interaction (<i>P</i>≤0.01) between PP and DFM on the apparent ileal digestibility coefficient for starch, crude protein, and amino acid indicated that both additives increased the digestibility. Both additives increased the nitrogen retention coefficient with a significant interaction (<i>P</i>≤0.01). Although no interaction was observed, significant main effects (<i>P</i>≤0.01) for nitrogen-corrected apparent ME (AMEn) for PP or DFM indicated an additive response. In a follow-up experiment, Ross 308 broiler chicks were fed the same experimental diets from 1–21 days of age. Activities of ileal brush border maltase, sucrase, and L-alanine aminopeptidase were increased (<i>P</i>≤0.01) by PP addition, while a trend (<i>P</i> = 0.07) for increased sucrase activity was observed in chickens fed DFM, in Experiment 2. The proportion of cecal butyrate was increased (<i>P</i>≤0.01) by DFM addition. Increased nutrient utilization and nitrogen retention appear to involve separate but complementary mechanisms for PP and DFM, however AMEn responses appear to have separate and additive mechanisms.</p></div

Interactions of exogenous protease and phytase (PP) and direct-fed microbial (DFM) on apparent ileal digestibility coefficient^†.

a,b<p>Least square means in the same column without a common superscript differ significantly, <i>P</i>≤0.05.</p><p>n = 8 samples per treatment for interactions.</p>1<p>Formulated to meet breeder requirements for 14–21 d old broiler chicks except with a reduction of 0.94 MJ/kg of ME.</p>2<p>Crude protein.</p>†<p>Determined in broiler chickens at 21 days of age in Experiment 1.</p

Effects of exogenous protease and phytase (PP) and direct-fed microbial (DFM) on nitrogen retention (NR) coefficient and nitrogen-corrected apparent metabolizable energy (AMEn)^†.

a,b<p>Least square means in the same column without a common superscript differ significantly, <i>P</i>≤0.05.</p><p>n = 8 samples per treatment for interactions and 16 samples per treatment group for main effects.</p>1<p>Formulated to meet breeder requirements for 14–21 d old broiler chicks except with a reduction of 0.94 MJ/kg of ME.</p>†<p>Determined in broiler chickens at 21 days of age in Experiment 1.</p

Composition of diets^†.

1<p>Contained 50.7% of L-lysine in the form of L-lysine sulfate, 0.1% Methionine, 0.1% Cystine, 0.3% Threonine, 0.1% Tryptophan, 0.6% Arginine, 0.3% Isoleucine, 0.5% Leucine, and 0.4% Valine.</p>2<p>Provided per kg of diet: Selenium-250 µg; Vitamin A (retinyl palmitate)-4.54 mg; Vitamin D₃ (cholecalciferol)-0.069 mg; Vitamin E (alpha-tocopherol)-11.94 mg; Menadione- 1.1 mg; Vitamin B₁₂-12 µg; Biotin-41 µg; Choline-447 mg; Folic acid-1.4 mg; Niacin-41.3 mg; Pantothenic acid-11 mg; Pyridoxine-1.1 mg; Riboflavin-5.5 mg; Thiamine-1.4 mg; Iron-282 mg; Magnesium-125 mg; Manganese-275 mg; Zinc-275 mg; Copper-27.5 mg; Iodine-844 µg.</p>†<p>Diets were fed to broiler chickens from 15 to 21 days of age in Experiment 1 and from 1 to 21 days of age in Experiment 2.</p

Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection

Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients