1,654 research outputs found
Development and Preliminary Validation of the Scale for Evaluation of Psychiatric Integrative and Continuous Care—Patient’s Version
This pilot study aimed to evaluate and examine an instrument that integrates
relevant aspects of cross-sectoral (in- and outpatients) mental health care,
is simply to use and shows satisfactory psychometric properties. The
development of the scale comprised literature research, held 14 focus groups
and 12 interviews with patients and health care providers, item-pool
generation, content validation by a scientific expert panel, and face
validation by 90 patients. The preliminary scale was tested on 385 patients
across seven German hospitals with cross-sectoral mental health care (CSMHC)
as part of their treatment program. Psychometric properties of the scale were
evaluated using genuine and transformed data scoring. To check reliability and
postdictive validity of the scale, Cronbach’s α coefficient and multivariable
linear regression were used. This development process led to the development
of an 18-item scale called the “Scale for Evaluation of Psychiatric
Integrative and Continuous Care (SEPICC)” with a two-point and five-point
response options. The scale consists of two sections. The first section
assesses the presence or absence of patients’ experiences with various CSMHC’
relevant components such as home treatment, flexibility of treatments’
switching, case management, continuity of care, cross-sectoral therapeutic
groups, and multidisciplinary teams. The second section evaluates the
patients’ opinions about these relevant components. Using raw and transformed
scoring resulted into comparable results. However, data distribution using
transformed scoring showed a smaller deviation from normality. For the overall
scale, the Cronbach’s α coefficient was 0.82. Self-reported experiences with
relevant components of the CSMHC were positively associated with the patients
approval of these components. In conclusion, the new scale provides a good
starting point for further validation. It can be used as a tool to evaluate
CSMHC. Methodologically, using transformed data scoring appeared to be
preferable because of a smaller deviation from normality and a higher
reliability measured by Cronbach’s α
An education and training programme for radiological institutes: impact on the reduction of the CT radiation dose
Objectives: To establish an education and training programme for the reduction of CT radiation doses and to assess this programme's efficacy. Methods: Ten radiological institutes were counselled. The optimisation programme included a small group workshop and a lecture on radiation dose reduction strategies. The radiation dose used for five CT protocols (paranasal sinuses, brain, chest, pulmonary angiography and abdomen) was assessed using the dose-length product (DLP) before and after the optimisation programme. The mean DLP values were compared with national diagnostic reference levels (DRLs). Results: The average reduction of the DLP after optimisation was 37% for the sinuses (180 vs. 113mGycm, P < 0.001), 9% for the brain (982 vs. 896mGycm, P < 0.05), 24% for the chest (425 vs. 322mGycm, P < 0.05) and 42% for the pulmonary arteries (352 vs. 203mGycm, P < 0.001). No significant change in DLP was found for abdominal CT. The post-optimisation DLP values of the sinuses, brain, chest, pulmonary arteries and abdomen were 68%, 10%, 20%, 55% and 15% below the DRL, respectively. Conclusions: The education and training programme for radiological institutes is effective in achieving a substantial reduction in CT radiation dos
Distributing Reflexivity through Co-laborative Ethnography
In ethnographic research and analysis, reflexivity is vital to achieving constant coordination between field and concept work. However, it has been conceptualized predominantly as an ethnographer’s individual mental capacity. In this article, we draw on ten years of experience in conducting research together with partners from social psychiatry and mental health care across different research projects. We unfold three modes of achieving reflexivity co-laboratively: contrasting and discussing disciplinary concepts in interdisciplinary working groups and feedback workshops; joint data interpretation and writing; and participating in political agenda setting. Engaging these modes reveals reflexivity as a distributed process able to strengthen the ethnographer’s interpretative authority, and also able to constantly push the conceptual boundaries of the participating disciplines and professions.Heinrich Böll Stiftung
https://doi.org/10.13039/100009379Deutsche Forschungsgemeinschaft
https://doi.org/10.13039/501100001659Deutsche Forschungsgemeinschaft
https://doi.org/10.13039/501100001659Peer Reviewe
Introduction: Open Dialogue around the world – implementation, outcomes, experiences and perspectives
nonPeerReviewe
Interagency Cooperation in a Community Mental Health Centre - A Qualitative Study about the Stakeholders' Experiences
OBJECTIVE
This study explores the conditions for the stakeholders' cooperation in an integrative care model for people with psychosocial problems.
METHODS
Expert interviews on various community mental health care providers were led and content analyzed.
RESULTS
Joint objectives and conceptually comparable financing models were found to be essential for cooperation across mental health and social integration services.
CONCLUSIONS
Implementation of intersectoral financing for both clinical and social integration services can promote interagency cooperation.ZIEL
Untersucht werden die Kooperationsbedingungen der beteiligten Akteure in einem Modellprojekt zur Koordination von SGB V- und XII-Leistungen.
METHODE
Interviews mit gemeindepsychiatrischen Akteuren aus der Modellregion und qualitativ-inhaltsanalytischer Auswertung.
ERGEBNISSE
Ă„hnliche Steuerungsziele und VergĂĽtungsmodelle sind Voraussetzungen rechtskreisĂĽbergreifender Zusammenarbeit. Gemeindeferne Versorgung sowie (infra-)strukturelle Defizite wirken sich hinderlich aus.
SCHLUSSFOLGERUNGEN
Die Implementierung sektorenĂĽbergreifender Finanzierung fĂĽr Behandlungs- als auch Eingliederungsleistungen sind ein erster Schritt in Richtung rechtskreisĂĽbergreifender Kooperation
Neuroendocrine Differentiation in Conventional Colorectal Adenocarcinomas: Incidental Finding or Prognostic Biomarker?
Background Colorectal mixed adenoneuroendocrine carcinomas (MANECs) are clinically highly aggressive neoplasms. MANECs are composed of variable adenocarcinoma components combined with morphologically distinct neuroendocrine carcinoma components, which are confirmed by synaptophysin immunohistochemistry, the gold standard marker of a neuroendocrine differentiation. However, the biological behavior of adenocarcinomas that express synaptophysin but do not show a typical neuroendocrine morphology remains unclear. Methods We investigated synaptophysin expression in 1002 conventional colorectal adenocarcinomas and correlated the results with clinicopathological characteristics and patient survival and compared the survival characteristics of synaptophysin expression groups to MANECs. Results Synaptophysin expression in conventional colorectal adenocarcinomas was associated with a shortened disease-free survival (p = 0.037), but not with overall survival or disease-specific survival (DSS) in univariate analyses and without any survival impact in multivariate analyses. Patients with "true" MANECs, on the other hand, showed a significantly shorter survival than all conventional adenocarcinomas with or without synaptophysin expression in uni- and multivariate analyses (e.g., multivariate DSS: p < 0.001, HR: 5.20). Conclusions Our study demonstrates that synaptophysin expression in conventional colorectal adenocarcinomas, in contrast to MANECs, is not associated with a significantly poorer clinical outcome when compared to adenocarcinomas without synaptophysin expression. Furthermore, our data suggest that conventional adenocarcinomas with a diffuse synaptophysin expression should not be classified as MANECs, also strongly arguing that synaptophysin testing should be reserved for carcinomas with an H&E morphology suggestive of a neuroendocrine differentiation.Simple Summary Colorectal MANECs are highly aggressive carcinomas defined by a distinct neuroendocrine morphology and positivity for synaptophysin in the neuroendocrine component. It is unclear whether a neuroendocrine differentiation in conventional adenocarcinomas without a suggestive morphology is of clinical relevance. We tested 1002 conventional colorectal carcinomas with a non-neuroendocrine morphology for synaptophysin expression and correlated the results with clinicopathological characteristics as well as patient survival and compared the survival characteristics of synaptophysin expression groups to those of true MANECs. We found no survival differences between synaptophysin expression groups within conventional colorectal adenocarcinomas. MANECs, on the other hand, showed significantly worse survival characteristics. Our data suggest that synaptophysin expression in conventional colorectal adenocarcinomas is of minor prognostic relevance and that conventional adenocarcinomas with a diffuse synaptophysin expression should not be classified as MANECs. Abstract Background: Colorectal mixed adenoneuroendocrine carcinomas (MANECs) are clinically highly aggressive neoplasms. MANECs are composed of variable adenocarcinoma components combined with morphologically distinct neuroendocrine carcinoma components, which are confirmed by synaptophysin immunohistochemistry, the gold standard marker of a neuroendocrine differentiation. However, the biological behavior of adenocarcinomas that express synaptophysin but do not show a typical neuroendocrine morphology remains unclear. Methods: We investigated synaptophysin expression in 1002 conventional colorectal adenocarcinomas and correlated the results with clinicopathological characteristics and patient survival and compared the survival characteristics of synaptophysin expression groups to MANECs. Results: Synaptophysin expression in conventional colorectal adenocarcinomas was associated with a shortened disease-free survival (p = 0.037), but not with overall survival or disease-specific survival (DSS) in univariate analyses and without any survival impact in multivariate analyses. Patients with “true” MANECs, on the other hand, showed a significantly shorter survival than all conventional adenocarcinomas with or without synaptophysin expression in uni- and multivariate analyses (e.g., multivariate DSS: p < 0.001, HR: 5.20). Conclusions: Our study demonstrates that synaptophysin expression in conventional colorectal adenocarcinomas, in contrast to MANECs, is not associated with a significantly poorer clinical outcome when compared to adenocarcinomas without synaptophysin expression. Furthermore, our data suggest that conventional adenocarcinomas with a diffuse synaptophysin expression should not be classified as MANECs, also strongly arguing that synaptophysin testing should be reserved for carcinomas with an H&E morphology suggestive of a neuroendocrine differentiation
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