Attending physician judgment is the traditional standard of care for emergency department (ED) admission decisions. The extent to which variability in admission decisions affect cost and quality is ...not well understood. We sought to determine the impact of variability in admission decisions on cost and quality.
We performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days), and quality indicators (15- and 30-day ED returns; delayed hospital admissions). We asked each Attending to estimate their inpatient admission rate and correlated their personal assessment with actual admission rates.
Admission rates, even after adjusting for known confounders, were highly variable (15.2%-32.0%) and correlated with Medicaid denied-payment day rates (p=0.038). There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission). There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%.
Emergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality.
Disturbed interpersonal relationships and misreading of others’ intentions are core symptoms of borderline personality disorder (BPD). Despite these impairments, some studies have found an enhanced ...theory of mind (ToM) in BPD patients. Taking this into consideration, the current study attempts to further understand these discrepancies by separating ToM into two domains: affective and cognitive. Moreover, the study considered the role of comorbid symptoms of depression in these patients. Subjects were 21 patients with BPD, 23 patients with BPD and comorbid major depressive disorder (MDD), and 25 healthy controls (HC). ToM was measured with the Reading the Mind in the Eyes Test (RMET) and the Faux Pas Task, which assessed the affective and cognitive aspects of ToM, respectively. In addition, all participants were evaluated with the Beck Depression Inventory (BDI). Results showed that in both BPD groups (i.e., BPD without MDD and BPD with MDD) affective ToM scores were higher than in the HC group; however, in the cognitive ToM, the HC group performed better than the both BPD groups. Also, overall the BPD group with MDD had decreased ToM skills. Finally, BPD groups received greater scores on the BDI as compared to the HC group.
•We assessed theory of mind in BPD and co-morbid MD.•We found different theory of mind cognitive and affective abilities.•BPD with co-morbid MD was more impaired than BPD alone.
Caffeine is a common psychoactive substance with a documented addictive potential. Caffeine withdrawal has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but ...caffeine use disorder (CUD) is considered to be a condition for further study. The aim of the current study is (1) to test the psychometric properties of the Caffeine Use Disorder Questionnaire (CUDQ) by using a confirmatory factor analysis and an item response theory (IRT) approach, (2) to compare IRT models with varying numbers of parameters and models with or without caffeine consumption criteria, and (3) to examine if the total daily caffeine consumption and the use of different caffeinated products can predict the magnitude of CUD symptomatology.
A cross-sectional study was conducted on an adult sample (N = 2259). Participants answered several questions regarding their caffeine consumption habits and completed the CUDQ, which incorporates the nine proposed criteria of the DSM-5 as well as one additional item regarding the suffering caused by the symptoms.
Factor analyses demonstrated the unidimensionality of the CUDQ. The suffering criterion had the highest discriminative value at a higher degree of latent trait. The criterion of failure to fulfill obligations and social/interpersonal problems discriminate only at the higher value of CUD latent factor, while endorsement the consumption of more caffeine or longer than intended and craving criteria were discriminative at a lower level of CUD. Total daily caffeine intake was related to a higher level of CUD. Daily coffee, energy drink, and cola intake as dummy variables were associated with the presence of more CUD symptoms, while daily tea consumption as a dummy variable was related to less CUD symptoms. Regular smoking was associated with more CUD symptoms, which was explained by a larger caffeine consumption.
The IRT approach helped to determine which CUD symptoms indicate more severity and have a greater discriminative value. The level of CUD is influenced by the type and quantity of caffeine consumption.
•The 10-item Caffeine Use Disorder Questionnaire demonstrated a one-factor structure.•Failure to fulfill obligations and social problems were the most severe symptoms.•Suffering from the symptoms was the best item for distinguishing individuals with lower or higher levels of CUD.•Coffee, energy drink and cola use were positive predictors of caffeine use disorder.•Tea consumption was a negative predictor of caffeine use disorder.
Does it make sense that Alexa can remind me when I need to purchase more cereal but not when I need to take my insulin? Rather than applying ill-fitting old laws to new digital medicine ...interventions, we could tailor a new regulatory regime to new technologies.
Background. During the past three decades, research interest in work addiction has increased significantly. Most definitions concerning work addiction have specifically contained personality-related ...elements. However, the results of empirical studies concerning personality and work addiction are both few and mixed. The aim of the present study was to explore the role of personality in the background of work addiction. Methods. The present study systematically reviewed and empirically carried out a meta-analysis on all the published studies examining the association between personality variables and work addiction (n = 28). Results. The results of the meta-analysis indicated that perfectionism, global and performance-based self-esteem, and negative affect had the strongest and most robust associations as personality risk factors of work addiction. Among the Big Five traits, extraversion, conscientiousness, and intellect/imaginations showed positive relationships with work addiction. However, these associations were weak. Conclusions. Based on the meta-analysis, personality appears to explain only a small amount of the variance of work addiction and further studies are needed to assess the interaction between individual and environmental factors.
In both the academic and popular press, the related concepts of risk, protection, and resilience have emerged as constructs for conceptualizing social and health problems. The idea of “risk” is ...ubiquitous in social work. In everyday use, the term conveys the notion that an individual, family, group, school, neighborhood, or organization is likely to experience a negative outcome. Although the ideas of protection and resilience conjure up images of extraordinary feats in overcoming adversity, they are elusive. In light of the growing salience of what some call the “risk-and-resilience” perspective, this special issue of Social Work Research highlights social work research that uses the concepts of risk, protection, and resilience. In this introductory article, the authors define key terms, discuss methodological issues, and explore implications for the profession.
The therapeutic communication between psychotherapist and client is highly dependent on their socio-cultural background. The purpose of this study was to examine the effects of culture on ...decision-making style of psychotherapists in three dimensions of decision-making: expedience vs. realism, individualism vs. collectivism, and long-term orientation vs. short-term orientation. The sample of this study consisted of 144 psychotherapists (40 Iranians educated in Iran, 33 Iranians educated in the west, 36 Americans, and 35 Canadians). Each of the participants were presented with three scenario that involved clinical challenging situations. For each area of decision-making a statement was considered and the psychotherapist was requested to rate them based on importance in his/her clinical decision-making. Findings indicated that the groups differed significantly on all dimensions with few exceptions when American and Canadian psychotherapists were compared. The decision-making style of Iranian psychotherapists was more with expediency, collectivism and long-term orientation, while the decision-making style of American and Canadian psychotherapists was more with realism, individualism, and short-term orientation. According to the results of current study, socio-cultural background of psychotherapists, as a frame of reference, significantly influenced their clinical decision-making style.
•Culture, as an implicit frame of reference, influences the clinical judgment of psychotherapists.•Iranian psychotherapists are expedient and family-oriented in clinical decisions.•American and Canadian psychotherapists are realistic and client-oriented clinical decisions.•The socio-cultural background of therapeutic relationship influence on goals of therapy.
Methylphenidate (MPH) is the most frequently prescribed drug in Attention Deficit Hyperactivity Disorder (ADHD). Hitherto mostly the dopamine transporter gene has been studied in MPH-response and ...only a few studies analyzed the norepinephrine transporter (NET, SLC6A2) gene, although MPH is a potent inhibitor of both dopamine and norepinephrine transporters. We aimed to analyze this monoamine transporter gene in relation to ADHD per se and MPH-response in particular to gain further knowledge in ADHD pharmacogenetics using a Caucasian sample.
Six single nucleotide polymorphisms (rs28386840, rs2242446, rs3785143, rs3785157, rs5569, rs7194256 SNP) were studied across the NET gene in 163 ADHD children (age: 9.3±2.6; 86.5% male) using ADHD-RS hyperactivity-impulsivity and inattention scales. For case-control analysis 486 control subjects were also genotyped. At the MPH-response analysis responders had minimum 25% decrease of ADHD-RS total score after 2months of treatment, and chi-square test compared 90 responders and 32 non-responders, whereas ANOVA was used to assess symptom improvement after the first month among the 122 ADHD patients.
The classical case-control analysis did not yield any association with ADHD diagnosis, which was supported by meta-analysis conducted on the available genetic data (combining previously published and the present studies). On the other hand, the intronic rs3785143 showed nominal association with inattention symptoms (p=0.01). The haplotype analysis supported this association, and indicated the importance of the first haploblock encompassing the intronic and 2 promoter SNPs. With MPH-response only the promoter rs28386840 showed nominal association: Those with at least one T-allele were overrepresented in the responder group (42% vs 19%, p=0.08), and they had better improvement on the hyperactivity-impulsivity scale compared to the AA genotype (p=0.04).
Although none of our single SNP findings remained significant after correcting for multiple testing, our results from the MPH-response analysis indicate the potential importance of promoter variants in the NET gene.
•Case-control analysis of NET polymorphisms in childhood ADHD yielded negative results.•Meta analyses confirmed lack of association between the NET gene and ADHD.•NET rs3785143 SNP showed association with inattention symptoms among ADHD patients.•Haplotype analyses of NET gene intron-1 and promoter SNPs supported this association.•ADHD children with NET rs28386840 T-allele showed better methylphenidate response.
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