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Adoption of practice guidelines and assessment tools in substance abuse treatment
Traci Rieckmann, Bret E Fuller, Goal Saedi, Dennis McCarty
Substance Abuse Treatment, Prevention, and Policy , 2010, DOI: 10.1186/1747-597x-5-4
Abstract: Participants included substance abuse treatment programs from the Northeastern United States. Structural equation models were constructed with agency level data to explore two outcome variables: adoption of practice guidelines and assessment tools at two points in time; models also included organizational, staffing and service variables.In 1997, managed care involvement and provision of primary care services had the strongest association with increased use of assessment tools, which, along with provision of counseling services, were associated with a greater use of practice guidelines. In 2001, managed care involvement, counseling services and being a stand-alone drug treatment agency were associated with a greater use of assessment tools, which was in turn related to an increase in the use of practice guidelines.This study provides managers, clinicians and policy-makers with a framework for understanding factors related to the adoption of new technologies in substance abuse treatment.A "widespread unease with the slow pace of adoption of research findings" has developed in the United States field of alcohol and drug treatment [1]. Simultaneously, the complexity of treatment needs, and pressure for high quality services for fewer treatment dollars, has increased the need for educated and highly skilled clinicians. However, the "hodgepodge" of funding streams and lack of formal training in the treatment of alcohol and drug disorders at the graduate level prevent some counselors and agencies from adopting innovations [2]. One such area in which this gap exists is the adoption of practice guidelines that incorporate the use of standardized assessment tools and empirically supported treatments for substance abuse treatment.Variations in practice styles, inappropriate and unnecessary use of services, uncertain health outcomes and risk management have all been linked to the increased need for outcome and effectiveness research and application of science-based practice str
Consumption of antihypertensive drugs dispensed under the pharmacy benefit management program
Rocha, Aline Pereira;Santos, Brigitte Rieckmann Martins dos;
Brazilian Journal of Pharmaceutical Sciences , 2011, DOI: 10.1590/S1984-82502011000400018
Abstract: pharmacy benefit management (pbm) programs provide attractive discounts for drug purchase, a relevant measure to address costs, mainly of drugs for the treatment of chronic diseases. this study investigated whether pbm may be used as a tool to provide information about the use of antihypertensive medications when they are purchased. the profile of medicines taken to treat high blood pressure by large it company employees and their dependents was evaluated from january to december 2009. the mean rate of drug boxes purchased to control hypertension was 9.4 ± 10.0 in 2009. men purchased more drugs than women. the number of drugs purchased for the treatment of hypertension was lower than expected in all age groups except for individuals aged 54-58 and >59 years. among men, the purchase of drugs to treat hypertension was higher than expected in the 24-28, 34-38 and 54-58 age groups. among women, results matched expectations, except for the age group 34-38 years, in which purchase was lower than expected. individuals in the age group 0-18 years were found to consume antihypertensive drugs. although the pbm system may be used to identify drugs purchased by users, it does not ensure patient adherence to recommended drug treatment to control hypertension.
Concepts of care for people with dementia
Rieckmann, Nina,Schwarzbach, Christoph,Nocon, Marc,Roll, Stefanie
GMS Health Technology Assessment , 2009,
Abstract: Introduction: Today there are approximately one million people with dementia in Germany. If current demographic trends continue, this number is likely to rise substantially in the coming years. In the older population, dementia is the most frequent reason for long-term care. Because most forms of dementia cannot be cured, the aim of treatment is to delay disease progression and to maintain functioning and quality of life. Research questions: What is the evidence on different approaches to the long-term usual care of patients with dementia in terms of common endpoints such as quality of life, and social behaviour? How is the cost-effectiveness of these concepts to be evaluated? Which ethical, social, or legal issues are discussed in this context? Methods: Based on a systematic literature review, we include randomized, controlled studies that had at least 30 participants and investigated one or more of the following approaches of dementia care: validation therapy/emotion-oriented usual care, ergotherapy, sensory stimulation, relaxation techniques, reality orientation therapy, and reminiscence therapy. Studies had to be published after 1996 (after 1990 for the economic part) in English or German. Results: A total of 20 studies meet the inclusion criteria. Of these, three focus on validation therapy/emotion-oriented usual care, five on ergotherapy, seven on different kinds of sensory stimulation, two on reality orientation, two on reminiscence therapy, and one on a type of relaxation technique. There are no significant differences between the intervention and control groups in two of the three studies on validation therapy or emotion-oriented usual care, in two of the five studies on ergotherapy, in three of the seven studies on sensory stimulation, in both of the two studies on reminiscence therapy, and in the one study on relaxation. In the remaining ten studies, seven report some positive results in favour of the respective interventions, and three studies (ergotherapy, aroma therapy, and music/massage) report positive effects with respect to all of the endpoints measured. Six publications present economic results for usual-care-concepts. One study reports additional costs of 16 GBP (24.03 Euro (2006)) per patient per week for occupational therapie. Two publications declare incremental cost of 24.30 USD (25.62 Euro (2006)) per mini-mental-state-examination-(MMSE)-point gained per month respectively 1,380,000 ITL (506.21 Euro (2006)) per MMSE-point gained. Two publications focus on mixed interventions. One study reports the additional costs of an activity
Excitability decreasing central motor plasticity is retained in multiple sclerosis patients
Zeller Daniel,Dang Su-Yin,Weise David,Rieckmann Peter
BMC Neurology , 2012, DOI: 10.1186/1471-2377-12-92
Abstract: Background Compensation of brain injury in multiple sclerosis (MS) may in part work through mechanisms involving neuronal plasticity on local and interregional scales. Mechanisms limiting excessive neuronal activity may have special significance for retention and (re-)acquisition of lost motor skills in brain injury. However, previous neurophysiological studies of plasticity in MS have investigated only excitability enhancing plasticity and results from neuroimaging are ambiguous. Thus, the aim of this study was to probe long-term depression-like central motor plasticity utilizing continuous theta-burst stimulation (cTBS), a non-invasive brain stimulation protocol. Because cTBS also may trigger behavioral effects through local interference with neuronal circuits, this approach also permitted investigating the functional role of the primary motor cortex (M1) in force control in patients with MS. Methods We used cTBS and force recordings to examine long-term depression-like central motor plasticity and behavioral consequences of a M1 lesion in 14 patients with stable mild-to-moderate MS (median EDSS 1.5, range 0 to 3.5) and 14 age-matched healthy controls. cTBS consisted of bursts (50 Hz) of three subthreshold biphasic magnetic stimuli repeated at 5 Hz for 40 s over the hand area of the left M1. Corticospinal excitability was probed via motor-evoked potentials (MEP) in the abductor pollicis brevis muscle over M1 before and after cTBS. Force production performance was assessed in an isometric right thumb abduction task by recording the number of hits into a predefined force window. Results cTBS reduced MEP amplitudes in the contralateral abductor pollicis brevis muscle to a comparable extent in control subjects (69 ± 22% of baseline amplitude, p < 0.001) and in MS patients (69 ± 18%, p < 0.001). In contrast, post-cTBS force production performance was only impaired in controls (2.2 ± 2.8, p = 0.011), but not in MS patients (2.0 ± 4.4, p = 0.108). The decline in force production performance following cTBS correlated with corticomuscular latencies (CML) in MS patients, but did not correlate with MEP amplitude reduction in patients or controls. Conclusions Long-term depression-like plasticity remains largely intact in mild-to-moderate MS. Increasing brain injury may render the neuronal networks less responsive toward lesion-induction by cTBS.
Communication Regarding Sustainability: Conceptual Perspectives and Exploration of Societal Subsystems
Jens Newig,Daniel Schulz,Daniel Fischer,Katharina Hetze,Norman Laws,Gesa Lüdecke,Marco Rieckmann
Sustainability , 2013, DOI: 10.3390/su5072976
Abstract: Sustainability issues are typically characterized by high complexity and uncertainty. In light of this, communication plays a crucial role in coping with these challenges. The previous debate on sustainability communication has largely focused on how to communicate sustainability issues to others. Sustainability communication, however, involves more than sender oriented communication to persuade others (“communication of sustainability”); it also embraces processes of dialogue and discourse (“communication about sustainability”). Based on this distinction, we develop a typology of communication modes, including communication for sustainability. Inspired by the notion of functional communication systems, we explore sustainability communication in six societal subsystems, applying the typology of communication modes. Drawing mostly on examples from Germany, we find a shift from “communication of” towards “communication about” sustainability in most subsystems. While communication subsystems have a tendency towards operational closure, a variety of interlinkages exist. We discuss three key areas of “opening up” communication subsystems, leading to transdisciplinarity, societal deliberation and governance, each meeting one of sustainability’s core challenges.
Impact of Negative Emotion on the Neural Correlates of Long-Term Recognition in Younger and Older Adults
Grégoria Kalpouzos,H?kan Fischer,Anna Rieckmann,Stuart W. S. MacDonald,Lars B?ckman
Frontiers in Integrative Neuroscience , 2012, DOI: 10.3389/fnint.2012.00074
Abstract: Some studies have suggested that the memory advantage for negative emotional information over neutral information (“negativity effect”) is reduced in aging. Besides the fact that most findings are based on immediate retrieval, the neural underpinnings of long-term emotional memory in aging have so far not been investigated. To address these issues, we assessed recognition of neutral and negative scenes after 1- and 3-week retention intervals in younger and older adults using functional magnetic resonance imaging. We further used an event-related design in order to disentangle successful, false, and true recognition. This study revealed four key findings: (1) increased retention interval induced an increased rate of false recognitions for negative scenes, canceling out the negativity effect (present for hit rates only) on discrimination in both younger and older adults; (2) in younger, but not older, adults, reduced activity of the medial temporal lobe was observed over time for neutral scenes, but not for negative scenes, where stable or increased activity was seen; (3) engagement of amygdala (AMG) was observed in older adults after a 3-week delay during successful recognition of negative scenes (hits vs. misses) in comparison with neutral scenes, which may indicate engagement of automatic processes, but engagement of ventrolateral prefrontal cortex was unrelated to AMG activity and performance; and (4) after 3 weeks, but not after 1 week, true recognition of negative scenes was characterized by more activity in left hippocampus and lateral occipito-temporal regions (hits vs. false alarms). As these regions are known to be related to consolidation mechanisms, the observed pattern may indicate the presence of delayed consolidation of true memories. Nonetheless, older adults’ low performance in discrimination of negative scenes could reflect the fact that overall, after long delays of retention, they rely more on general information rather than on perceptual detail in making recognition judgments.
Glioblastoma multiforme with oligodendroglial component (GBMO): favorable outcome after post-operative radiotherapy and chemotherapy with nimustine (ACNU) and teniposide (VM26)
Dirk Vordermark, Klemens Ruprecht, Peter Rieckmann, Wolfgang Roggendorf, Giles H Vince, Monika Warmuth-Metz, Oliver K?lbl, Michael Flentje
BMC Cancer , 2006, DOI: 10.1186/1471-2407-6-247
Abstract: We analyzed overall and progression-free survival in a group of ten consecutive patients initially diagnosed with GBMO between 1996 and 2004 (4.2% of all GBM patients). Median (range) age was 54 (34–73) years, 90% were resected and median radiotherapy dose was 54 (45–60.6) Gy. 80% of patients received post-operative chemotherapy with nimustine (ACNU) and VM26 (teniposide) for a median of 3.5 (1–6) cycles, the remainder were treated with post-operative radiotherapy alone. All specimens were reviewed by an experienced neuropathologist.Neuropathological re-evaluation revealed GBM with an oligodendroglial component of 30% or less in five cases, predominant oligoastrocytic tumors with focal areas of GBM in four patients and WHO grade III oligoastrocytoma with questionable transition to GBM in one patient. Four of ten patients were alive at at 40, 41, 41 and 82 months. The median overall survival (Kaplan-Meier) was 26 months, the 2-year survival rate was 60% (progression-free survival: 9.8 months and 40%, respectively).In conclusion, patients with GBMO treated with post-operative radiotherapy and chemotherapy with ACNU/VM26 had a better prognosis than reported for GBM in modern chemoradiation series.Although glioblastoma multiforme with oligodendroglial component (GBMO) is not considered as a distinct disease entity in the most recent World Health Organization (WHO) classification of central nervous system tumors [1], the increased chemosensitivity and radiosensitivity of WHO grade III anaplastic oligodendrogliomas [2,3] has led to the assumption that patients with GBMO might similarly have a better prognosis than patients with classic glioblastoma multiforme (GBM). To the authors' knowldedge, data from phase III clinical trials on the outcome of the subgroup of patients with GBMO have not been published. In trial 83-02 of the Radiation Therapy Oncology Group (RTOG), a four-arm randomized phase I/II trial assessing different radiotherapy fractionation schedules with carmu
Evaluation of Soluble Junctional Adhesion Molecule-A as a Biomarker of Human Brain Endothelial Barrier Breakdown
Axel Haarmann,Annika Dei?,Jürgen Prochaska,Christian Foerch,Babette Weksler,Ignacio Romero,Pierre-Olivier Couraud,Guido Stoll,Peter Rieckmann,Mathias Buttmann
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0013568
Abstract: An inducible release of soluble junctional adhesion molecule-A (sJAM-A) under pro-inflammatory conditions was described in cultured non-CNS endothelial cells (EC) and increased sJAM-A serum levels were found to indicate inflammation in non-CNS vascular beds. Here we studied the regulation of JAM-A expression in cultured brain EC and evaluated sJAM-A as a serum biomarker of blood-brain barrier (BBB) function.
Blood pressure levels and adherence to treatment of hypertensive patients, users of a school pharmacy
Santos, Brigitte Rieckmann Martins dos;Teixeira, Juliana;Gon?alves, Débora;Gatti, Reynaldo Mascagni;Yavo, Boni;Arag?o, Cicera Cristina Vidal;
Brazilian Journal of Pharmaceutical Sciences , 2010, DOI: 10.1590/S1984-82502010000300004
Abstract: adherence to pharmacological treatment for hypertension is considered a key factor in guaranteeing successful therapy outcomes. knowledge of the disease, its complications, as well as the need for changes in lifestyle, call for patient motivation and continuous interactive education. the evidence regarding the beneficial effects of changes in life style by hypertensive individuals in reducing the complications of the disease, as well as in its prevention are indisputable. however, the challenges posed by patient adherence to treatment prescribed by doctors remain. the aim of this study was to assess blood pressure levels together with degree of adherence to pharmacological treatment with enalapril maleate by means of the morisky-green test, in hypertensive patients who were users of a school pharmacy. of the 102 patients interviewed, 65.7% had controlled blood pressure, but only 36.3% indicated total compliance with the pharmacological treatment. the morisky-green test proved ineffective in associating controlled blood pressure levels and positive attitudes toward taking antihypertensive medicines.
Zinc deficient diet consequences for pregnancy andoffsprings of Wistar rats
Solé, Dirceu;Rieckmann, Brigitte;Lippelt, Raquel Mattos Costa;Lippelt, Ronaldo Tadeu Tucci;Amancio, Olga Maria Silverio;Queiroz, Suzana de Souza;Naspitz, Charles Kirov;
Sao Paulo Medical Journal , 1995, DOI: 10.1590/S1516-31801995000100003
Abstract: adult female wistar rats (90 days old; weight 180 to 220 grams) were submitted to different zinc deficient diets (zn; severe = 2.6 ppm; mild = 9.0 ppm and normal diet = 81.6 ppm), during 6 weeks. after this time they were coupled with normal male wistar rats. no differences regarding fecundity and sterility were observed between the groups. during pregnancy, part of the animals from severe and mild zn deficient groups received the same diet and the others received normal diet. the animals from the group receiving normal diet, were divided into other 3: the first received severe, the second mild zn deficient diet and the third normal diet. during the study we observed that animals submitted to a zn deficient diet (acute or chronic) had tendency to lower weight gain, lower weight of the offspring, lower serum levels of zn in maternal and newborn (pool) blood. a significant reduction in the number of alive newborns was observed in the group of animals submitted to severe zn deficiency. these data reinforces that zn is a very important trace element overall during pregnancy.
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