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Biomedical subjects

L Dixon

Publications and source records attributed to L Dixon.

At least 55 records · Page 3Linked to original sources
PubMed1999

Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness.

BACKGROUND: Homelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed. AIMS: To evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland. METHODS: A total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed. RESULTS: Compared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0.58 in favour of ACT. Patterns of care and costs varied according to race. CONCLUSION: ACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.

Adult↗
PubMed1999

JIT II: the ultimate customer-supplier partnership.

JIT II, conceived and implemented by the Bose Corporation in 1987, is currently being reviewed and tried in other U.S. companies, possibly because it fits well with two cutting-edge concepts, partnering and concurrent reengineering. This article presents a brief introduction to JIT II, lists the benefits that Bose has been able to obtain by implementing it, and indicates where it can be used to best effect.

Contract Services↗
PubMed1998

Comparison of two dosage regimens of albuterol in acute asthma.

BACKGROUND: The standard therapy for acute episodes of asthma in the United States consists of three 2.5-mg doses of aerosolized albuterol given every 20 minutes. Whether this approach represents optimum therapy has never been tested. METHODS: This study employed a prospective, sequential design in which the effects of two doses of 5.0 mg of aerosolized albuterol administered during 40 minutes (high dose) were contrasted with the standard dose (three 2.5-mg doses). Improvements in pulmonary function, clinical resolution of the asthma attacks, and admission rates were used as primary endpoints. Both regimens were part of an overall care plan that involved objective, pretested decision algorithms. RESULTS: In an emergency department, 160 patients who presented with acute exacerbations of asthma received either standard (n = 80) or high-dose (n = 80) albuterol treatment. There were no significant baseline differences in gender, racial composition, clinical signs and symptoms, medication use, or peak expiratory flow (PEF) between the groups. Both treatment schedules were effective, but the high-dose regimen increased lung function more rapidly and to a greater extent than standard-dose therapy. It also resulted in lower charges to third party payers. More subjects attained the discharge criteria quicker and left the emergency department with peak expiratory flows closer to normal. Fewer patients in the high-dose group were admitted, but this trend did not quite reach statistical significance. CONCLUSIONS: Two 5.0-mg treatments of aerosolized albuterol at a 40-minute interval provide effective therapy for acute exacerbations of asthma. This combination of dose and frequency promotes maximum bronchodilatation, increases efficiency, and reduces the risks of undertreatment.

Acute Disease↗
PubMed1998

The participation of families of homeless persons with severe mental illness in an outreach intervention.

OBJECTIVES: This study describes how an Assertive Community Treatment (ACT) team which employs a family outreach worker (FOW) interacts with homeless persons with severe mental illness and their families. METHODS: The team's ratings of the frequency and importance of clients' and treatment team's family contact are summarized and compared with independent research reports on patients' satisfaction with family relations, housing and hospitalization outcomes. RESULTS: 73% of clients had contact with their families. ACT worked with families of 61% of clients. ACT had less contact with the families of men (p < .01) and substance abusers (p < .01). Client days in stable housing were associated with increased ACT family contact (p < .05). CONCLUSIONS: Most ACT clients had significant family contact. ACT established contact with most families, and the work with families appeared to be associated with higher levels of satisfaction with family relations and housing. The role of the FOW should be explored further.

Adult↗
PubMed1998

Remission of substance use disorder among psychiatric inpatients with mental illness.

OBJECTIVE: The authors assessed the nature and stability of remission of substance use disorder among persons with severe mental illness at index hospitalization and at 1-year follow-up. METHOD: Consecutively admitted inpatients with severe mental illness completed the Structured Clinical Interview for DSM-III-R, Quality of Life Interview, and Addiction Severity Index at admission and 1 year later. Of the 268 patients, 70 were classified as past substance abusers in remission at baseline. Baseline characteristics and 1-year outcomes of this group were compared with those of the 109 current substance abusers and the 89 patients who were not substance abusers. RESULTS: The past abusers were significantly more likely to be women, and they consistently differed significantly from the current abusers in variables involving frequency of drug and alcohol use at baseline. During the follow-up period, the patients with current abuse at baseline were significantly more likely to have recurrences of substance use disorders and to use substance abuse services, and they had significantly more months of alcohol use and alcohol use to excess during follow-up than did the past abusers. CONCLUSIONS: Baseline and follow-up assessments suggested that a substantial proportion of severely mentally ill patients with past substance use disorders are in stable remission.

Adult↗
PubMed1997

The influence of parasympatholytics on the resolution of acute attacks of asthma.

PURPOSE: To evaluate the role of parasympatholytics in the resolution of acute attacks of asthma. METHODS: This study employed a prospective sequential design in which the influence of 0.5 and 1.0 mg of ipratropium bromide on peak expiratory flow rates (PEFR), hospital admissions, and length of stay (LOS) in the emergency department (ED) was evaluated. The parasympatholytic was added to a well-investigated standard therapeutic regimen that was anchored by the use of repetitive doses of albuterol, and employed pretested decision algorithms. RESULTS: One hundred and thirty-one patients received ipratropium (l) and 123 who did not (NI) served as controls. There were no significant pretreatment between group differences in gender, racial composition clinical signs and symptoms, or PEFR. The presence of ipratropium in the regimen did not influence discharge/admission patterns, LOS, the rate of improvement of the patients, or the level of PEFR achieved. CONCLUSION: Anticholinergic agents such as ipratropium are not first-line treatments for acute asthma. They do not add any therapeutic benefit to the effects of albuterol given in divided doses over 1 hour, nor do they facilitate recovery in patients whose immediate response to sympathomimetics is impaired.

Acute Disease↗
PubMed1997

Consumers as staff in assertive community treatment programs.

The last decade has witnessed the increasing importance of consumers as providers of mental health services. Assertive Community Treatment (ACT) teams and ACT variants, with their emphasis on rehabilitation and support in the client's natural environment, have hosted consumer-professional collaborations. The authors discuss one such program in which an ACT program for homeless mentally ill adults employed consumer advocates (CAs). Consumer advocates were found to have a service profile similar to other staff. Further, there is suggestive evidence that the employment of CAs created a more positive attitude toward persons with mental illness. Issues of role definition, boundaries, support with supervision and the importance of CAs' experiences with mental illness are discussed.

Adult↗
PubMed1997

The next generation of research: views of a sibling-psychiatrist-researcher.

A sibling of a person with severe mental illness who is also a psychiatrist and a researcher responds to the next generation of research proposed in the articles in this special section. Four issues are emphasized: benefit vs. burden; association, causation, and statistical modeling; strengths and limitations of study samples; and interventions.

Adult↗
PubMed1997

Observations on the effects of aerosolized albuterol in acute asthma.

To determine the dose of albuterol required to terminate acute episodes of asthma, 92 acutely ill subjects received three doses of 2.5 mg each by nebulization every 20 min. Peak expiratory flow rates (PEFR) and signs and symptoms were serially monitored. A dose-response increase in pulmonary function was found, but only 66% of the subjects improved sufficiently to be sent home. Of these, 56% required < or = 5.0 mg of drug to reach the discharge threshold, whereas the remainder needed 7.5 mg. In 34% of participants, albuterol was ineffectual. These individuals were characterized by more severe obstruction at presentation, and after three doses of medication their PEFR still did not exceed 40% of the expected value. Further treatment in the emergency department (ED) or hospital was not immediately helpful, and these patients ultimately required 3.8 +/- 0.4 d of inpatient care to become asymptomatic. There were no discernible differences between responders and nonresponders in the type or quantity of medications used. However, the nonresponders had more severe disease as measured by recurrent hospitalizations and ED visits. This study demonstrates that, in emergency situations, albuterol does not relieve acute airway obstruction in all asthmatic individuals with equal efficacy. Two-thirds of patients are sensitive, and in these patients 5 to 7.5 mg of albuterol provides optimal treatment. In the remainder, albuterol, even in high doses, has little effect for days.

Acute Disease↗
PubMed1997

One-year follow-up of secondary versus primary mental disorder in persons with comorbid substance use disorders.

OBJECTIVE: Service utilization and outcomes of dually diagnosed patients with independent mental disorders and those with substance-induced mental disorders were compared. METHOD: Diagnosis, service use, and severity of substance use problems at baseline and 1 year later were assessed in consecutively admitted inpatients with independent mental disorders plus substance use disorders (N = 71), substance-induced mental disorders plus substance use disorders (N = 38), and independent mental disorders only (N = 59). RESULTS: At follow-up, patients with substance-induced mental disorders at baseline were more likely to have been rehospitalized than the other groups, were more likely to have used outpatient substance abuse services, were less likely to have an independent mental disorder, and had the most severe alcohol- and drug-related impairment. CONCLUSIONS: Treatment programs for both types of dual diagnosis patients must address mental health concerns.

Adolescent↗
PubMed1997

Assertive community treatment and medication compliance in the homeless mentally ill.

OBJECTIVE: This study describes medication compliance rates among a group of homeless mentally ill subjects who received assertive community treatment. METHOD: The medication compliance of 77 homeless persons who had been referred to an assertive community treatment program was prospectively evaluated at baseline and quarterly for 1 year. RESULTS: A minority of the cohort (29%) was compliant at entry into the assertive community treatment program. Compliance significantly increased after 3 months (57%) and remained high through the year. Medication compliance was associated with fewer psychiatric symptoms but not with better housing placements or fewer days in the hospital. CONCLUSIONS: Medication compliance rates among a cohort of homeless persons with severe mental illness were markedly higher after they entered a program of assertive community treatment.

Adolescent↗
PubMed1996

Chondromyxoid fibroma of the sternum.

We report the fourth case of chondromyxoid fibroma of the sternum described in the literature. The clinical, radiographic, pathologic and treatment aspects of this case are presented, and the literature on chondromyxoid fibroma in this unusual location is reviewed.

Adult↗
PubMed1995

Protocol therapy for acute asthma: therapeutic benefits and cost savings.

BACKGROUND: To evaluate the therapeutic and financial benefits of protocol therapy for acute asthma using standard medications. MATERIALS AND METHODS: This study employed a sequential design in which the influence of an asthma care path on hospital admissions, length of stay (LOS) in the emergency department, and return visits were evaluated for 1 year. This information was contrasted with similar data obtained from the 8 months immediately before the protocol was implemented (preprotocol) and a 12-month period after strict adherence to it had declined (admixture). RESULTS: In all, 526 acute exacerbations of asthma were treated with the care path, and 429 and 558 episodes were evaluated during the preprotocol and admixture periods, respectively. There were no significant differences between the presenting clinical or physiologic features of any group. With the protocol, 77% of the patients resolved their symptoms within 1:47 +/- 0.02 hours:minutes of arrival in the emergency department with a 2% return rate within 24 hours. The algorithms used quickly identified those needing hospitalization. Patients not meeting the criteria for discharge after receiving the treatments employed typically did not resolve their symptoms for days (average hospital stay 4.1 +/- 0.2 days). Compared with the preprotocol period, the care path significantly reduced the LOS by 50 minutes, the number of urgent and intensive care unit admissions by 27% and 41%, respectively, and the frequency of return visits within 24 hours by 66%. Charges to patients and third-party payors decreased $395,000. When adherence to the protocol diminished, LOS, admissions, and returns rose significantly toward preprotocol values and the financial benefits were lost. CONCLUSIONS: Asthma protocol therapy, based primarily upon aggressive use of sympathomimetics in association with serial monitoring of key indices of improvement, provides prompt and efficient relief for acute exacerbations of asthma. Such an approach yields significant financial benefit while quickly identifying individuals who require hospitalization, and it also detects physician practice patterns that can have potentially detrimental impacts on patient care.

Acute Disease↗
PubMed1995

Substance abuse and family relationships of persons with severe mental illness.

OBJECTIVE: The authors sought to determine how substance abuse affects family relationships of persons with severe mental illness. METHOD: Patient reports of family relationships were compared between 101 psychiatric inpatients with a concurrent substance use disorder and 78 subjects with severe mental illness only. RESULTS: Patients with comorbid substance abuse reported significantly lower family satisfaction and a greater desire for family treatment. Objective indicators of frequency of family contact did not differ. CONCLUSIONS: Substance abuse is associated with low levels of satisfaction with family relationships among persons with severe mental illness. Family interventions would meet the stated needs of persons with mental illness and a comorbid substance use disorder and might help to engage them in treatment.

Adult↗