Bringing Evidence-Based Interventions into the Schools: An Examination of Organizational Factors and Implementation Outcomes.

Although schools are one of the largest providers of behavioral health services for youth, many barriers exist to the implementation of evidence-based interventions in schools. This study used the Stages of Implementation Completion (SIC) to examine school-based implementation outcomes for a computer-assisted cognitive behavioral therapy intervention for anxious youth. Organizational factors and predictors of program startup also were examined. Results indicated that the SIC detected implementation variability in schools and suggested that spending more time completing pre-implementation activities may better prepare schools for active implementation of program delivery. Furthermore, proficiency emerged as a potentially important organizational factor to examine in future school-based implementation research.

[Treatment of basal joint osteoarthritis by Swanson's trapezium implant arthroplasty]. / Behandlung der Rhizarthrose mittels Trapezium-Resektion und Swanson-Silikonprothese.

BACKGROUND: Goal of the present study was the evaluation of clinical and radiological results after treatment of the first carpometacarpal joint by trapezium resection and implantation of a Swanson silicone prosthesis by means of a retrospetive study. However, up to now, only a few long-term data for this surgical technique are available. METHODS AND PATIENTS: Retrospectively the results of 100 trapezium resections in 72 patients with subsequent joint replacement by a Swanson silicone prosthesis have been followed up over 8.6 years on average. Besides the range of motion, the strengh in grip, tip pinch and key pinch were measured. The quality of pain was determined using a visual analogus pain scale from 1-10. The postoperative subjective satisfaction of patients was recorded as well as the DASH, Mayo, modified Wrist and Krimmer scores. In follow-up X-ray controls, subluxations of the silicone implants as well as bony abnormalities were evaluated. RESULTS: The postoperative range of motion of the trapeziometacarpal joint in radial abduction was measured with 52° and at palmar abduction with 39°. The average grip strength amounted to 16.5 kg. This represented 80% of the value of the contralateral side. In tip pinch the force value was 3.3 kg, corresponding to 70% of that of the opposite side and in key pinch, it was 3.5 kg, corresponding to 71% of the healthy contralateral side. The DASH score was recorded with 22.5 points. Postoperative pain symptoms on the visual analogue pain scale were recorded at 2.4 points. The majority of the patients were satisfied or very satisfied after the surgical treatment. In X-ray controls, subluxations of the silicone implants could be detected in 54 cases (61.4%) as well as bony abnormalities in 41 cases (46.6%). However, there was no correlation between the radiological findings and patient satisfaction. CONCLUSION: Trapezium resection and joint replacement with a silicone prosthesis achieves good results. However, the high number of radiographic subluxations of the prothesis and bone abnormalities as a cause of foreign body reactions limits these results. Therefore, despite the good clinical findings, this method will not been conducted any more in our patient population.

Remission, continuation and incidence of eating disorders during early pregnancy: a validation study in a population-based birth cohort.

BACKGROUND: We internally validated previously published rates of remission, continuation and incidence of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort (MoBa) at the Norwegian Institute of Public Health. METHOD: A total of 77 267 pregnant women enrolled at 17 weeks gestation between 2001 and 2009 were split into a training sample (n = 41 243) from the version 2 dataset and a validation sample (n = 36 024) from the version 5 dataset who were not in the original study. Internal validation of original rate models involved fitting a calibration model to compare model parameters between the two samples and bootstrap estimates of bias in the entire version 5 dataset. RESULTS: Remission, continuation and incidence estimates remained stable. Pre-pregnancy prevalence estimates in the validation sample were: anorexia nervosa (AN; 0.1%), bulimia nervosa (BN; 1.0%), binge eating disorder (BED; 3.3%) and eating disorder not otherwise specified-purging disorder (EDNOS-P; 0.1%). In early pregnancy, estimates were: BN (0.2%), BED (4.8%) and EDNOS-P (<0.01%). Incident BN and EDNOS-P during pregnancy were rare. The highest rates were for full or partial remission for BN and EDNOS-P and continuation for BED. CONCLUSIONS: We validated previously estimated rates of remission, continuation and incidence of eating disorders during pregnancy. Eating disorders, especially BED, during pregnancy were relatively common, occurring in nearly one in every 20 women. Pregnancy was a window of remission from BN but a window of vulnerability for BED. Training to detect eating disorders by obstetricians/gynecologists and interventions to enhance pregnancy and neonatal outcomes warrant attention.

Disordered eating and suicidal intent: the role of thin ideal internalisation, shame and family criticism.

OBJECTIVE: We explored the effect of thin ideal internalisation, shame proneness and family criticism on disordered eating and suicidal intent in female Mexican adolescents. METHOD: We studied a probabilistic sample of 2537 high school students in central Mexico, stratified by marginalisation status and migratory intensity. We used a generalised logistic regression model to estimate the odds of disordered eating and suicidal intent across scores for three predictors: Internalisation of the thin ideal, shame and family criticism. RESULTS: Disordered eating was reported by 4.2% (95% CI = 0.9-7.5%) and suicidal intent by 13.2% (95% CI = 12.0-14.4%) of girls. The unadjusted odds ratios of any disordered eating for thin ideal internalisation, shame proneness and familial criticism were 1.2, 1.1 and 3.2, respectively. The positive association between thin ideal internalisation and disordered eating remained even after controlling for shame proneness and familial criticism. The association of these variables with suicidal intent was weaker. DISCUSSION: Results support stronger effects for disordered eating than suicidal intent across the three unadjusted predictors. It also highlights the presence of the relationship of criticism and disordered eating in female adolescents from low and middle socio-economic backgrounds.

Patterns and prevalence of disordered eating and weight control behaviors in women ages 25-45.

OBJECTIVE: The current study describes detailed eating behaviors, dieting behaviors, and attitudes about shape and weight in 4023 women ages 25 to 45. METHOD: The survey was delivered on-line and participants were identified using a national quota-sampling procedure. RESULTS: Disordered eating behaviors, extreme weight loss measures, and negative cognitions about shape and weight were widely endorsed by women in this age group and were not limited to White participants. Thirty-one percent of women without a history of anorexia nervosa or binge eating reported having purged to control weight, and 74.5% of women reported that their concerns about shape and weight interfered with their happiness. DISCUSSION: Unhealthy approaches to weight control and negative attitudes about shape and weight are pervasive even among women without eating disorders. The development of effective approaches to address the impact of these unhealthy behaviors and attitudes on the general well-being and functioning of women is required.

[What's the price of routine sonography--results of an analysis of costs and processes in a district hospital]. / Was kostet die Sonografie--Ergebnisse einer Kosten- und Prozessanalyse an einem Versorgungskrankenhaus.

PURPOSE: The introduction of Diagnostic Related Groups (DRG) in hospitals also requires a calculation of the costs for material and staff to perform ultrasonographic examinations. Ultrasonography is currently not part of the regular procedure catalog of the DRG. Is ultrasonography for inpatients cost-effective? How much is a given examination today? The goal of this study was the analysis of examination times, times during which staff is required, and non-personnel costs for defined activities within an ultrasound department. MATERIALS AND METHODS: Within three weeks we registered all activities which included 692 ultrasound examinations. We analyzed repetitive processes as well as selected procedures. The performances were registered including all activities by medical and non-medical staff. We calculated the complete non-personnel and following costs and also considered the different levels of qualification of the examiners (DEGUM-Level 1 or 2). RESULTS: With this method we were able to precisely determine the costs for frequent ultrasonographic examinations. The time of an abdominal ultrasound examination was 16 minutes. The costs for an inpatient abdominal ultrasound were under conditions of public institutions tariff east (90% of west tariff) 35.70 euros, for an emergency ultrasound 41.82 euros, for a contrast-enhanced ultrasound 105.91 euros and for an ultrasound-guided puncture 97.05 euros. For examinations of higher qualified staff (DEGUM 2), 4.29 euros were added to the basic costs. The revenue for abdominal sonography and puncture in the ambulant setting is by no means cost-effective. CONCLUSIONS: In this article we show the dimension of costs for ultrasound in the inpatient setting and make it calculable. We show what resources it requires to perform ultrasound. In perspective the next step will be the comparison and evaluation of the efficiency of the different imaging methods, but that was not the aim of this study.

[Sonographical diagnosis of pneumoretroperitoneum as a result of retroperitoneal perforation]. / Das sonografische Bild des Pneumoretroperitoneums als Folge einer retroperitonealen Perforation.

A retroperitoneal perforation is a rare incident. It can occur as a complication of ERCP with papillotomy (0.2-0.5%). Leakage of contrast agent during endoscopy raises the suspicion that this complication has occurred but doesn't always give sufficient information about the leakage extent. In the case of extreme gas emission, a plain abdominal X-ray shows classic pneumoretroperitoneum. The abdominal CT scan can display small amounts of free air which is why it is used for diagnosis in such cases. Ultrasonography also provides a reliable diagnosis and is a good method for monitoring the progression of the condition. Alternative causes of pneumoretroperitoneum can be: trauma, inflammation, infection, tumor as well as ERCP and other interventional procedures, especially endoscopies. Presacral retroperitoneal pneumoradiography was used for the diagnosis of retroperitoneal tumors in the 70 s but is no longer used today. Perforations into the retroperitoneal space come from several locations in the gastrointestinal tract. In the different types of lesions the gas can penetrate the compartments and reach as far as the mediastinum, the intraabdominal cavity, subcutaneum (cervical) or the scrotal compartment (compartment shift). Based on 11 cases (7 perforations during ERCP, 2 perforation during colonoscopy, 2 cases with damage of the distal esophagus), we show the most extensive presentation of the sonographical picture of pneumoretroperitoneum. Typical signs on abdominal ultrasound are an increased echogenicity around the right kidney ("overcasted" or "covered" kidney), air dorsal to the gallbladder, around the duodenum and the head of the pancreas and especially ventral to the great abdominal vessel which can lead to the picture of "vanishing" vessels. The extent of free air is easy to assess. Even very small amounts are detectable ventral to the right kidney. In most cases, a conservative approach with no oral intake, antibiotic coverage, and analgesia in close gastroenterological-surgical cooperation is indicated. Especially after ERCP abscess formation is repeatedly described, sometimes even with a lethal outcome. Sonography is a suitable method for detecting free air in the retro-peritoneum. Pneumoretroperitoneum following bowel-perforation can be effectively shown by ultrasound, it is possible to assess the extent of free air, and sonographic monitoring of the treatment is possible and successful.

[Choledochal cysts in adult patients--presentation and clinical course]. / Choledochuszysten im Erwachsenenalter--klinische Erscheinungsformen und Verlauf.

HISTORY: A 35-year-old male was admitted with recurrent acute pancreatitis of unknown origin. He was found to have a cystic lesion in the upper abdomen believed to be a pancreatic pseudocyst (patient 1). A 59-year-old female with a choledochal cyst developed acute pancreatitis (patient 2). A 32-year-old male who had been operated upon for a choledochal cyst during childhood was admitted for upper abdominal pain, fever and vomitus (patient 3). INVESTIGATIONS AND DIAGNOSIS: Patient 1 was found to have a choledochal cyst type IV a according to TODANI. Patient 2 was diagnosed to have a choledochal cyst type Ib according to TODANI. The cyst was believed to contain a bile duct carcinoma. In patient 3, sonography showed an advanced Klatskin tumour with infiltration of the portal vein, the hepatic artery and the liver. Bile cytology confirmed the carcinoma. In all patients cholestasis was found. Pancreatic enzymes were elevated in patients 2 and 3. TREATMENT AND COURSE: Patient 1 underwent left hemihepatectomy and received a biliodigestive anastomosis. In patient 2 the choledochal cyst was resected while undergoing pylorus-preserving resection of the pancreatic head. The tumour suspected was confirmed and R0 resected. Patient 3 presented with an incurable bile duct carcinoma. He died 3 months later from multiple lung emboli. CONCLUSION: Choledochal cysts are associated with a 20 fold increase in the incidence of bile duct carcinoma.

Microencapsulated cell-mediated treatment of inoperable pancreatic carcinoma.

Pancreatic cancer can seldom be resected, and chemotherapy has only a limited effect on survival or tumour load. We did a phase I/II trial in 14 patients with pancreatic cancer to assess the safety of local activation of low-dose ifosfamide. We encapsulated genetically modified allogeneic cells, which expressed a cytochrome P450 enzyme, in cellulose sulphate and delivered them by supraselective angiography to the tumour vasculature. These cells locally activated systemically administered ifosfamide. The tumours of four patients regressed after treatment, and those of the other ten individuals who completed the study remained stable. Median survival was doubled in the treatment group by comparison with historic controls, and 1-year survival rate was three times better. Further studies of this cell-therapy-based treatment combined with chemotherapy for inoperable pancreatic cancer are warranted.

[Anisakiasis of the stomach--a case report from Germany]. / Anisakiasis des Magens--ein Fallbericht aus Deutschland.

Anisakiasis or "herring worm disease" is one of the most important parasitic diseases of the gastrointestinal tract in Japan. In 1988 Lorenz and Warzok published 8 cases of intestinal anisakiasis in Eastern Germany. In 1988 Spehn et al. reported a case of gastric anisakiasis in an AIDS patient. Here, we describe a case of gastric anisakiasis in Germany with an impressive serious clinical course. The symptoms--acute abdominal cramps, severe chest pain, diarrhoea, sub-febrile temperatures and leucocytosis--followed 4 h after consumption of raw herring, which was homemade pickled in vinegar. The conventional and the endoscopic ultrasonography showed a thickened gastric wall made of mainly thickened submucosa. The larvae of Anisakis in the gastric mucosa were found and extracted endoscopically. Acute and severe abdominal pain after eating raw fish is an indication for early gastroscopy. The endoscopical extraction of possible larvae is the only effective therapy, as anthelmintics against nematodes (mebendazole, albendazole, thiabendazole) are ineffective.

Pancreatitis in systemic scleroderma.

We report the case of a 61-year-old woman, who suffered from abdominal pain, nausea, vomiting and fever. She had a past medical history of acute rheumatism, pyelonephritis and systemic scleroderma. Since 1971 she was hospitalized many times because of recurrent abdominal pain with increased serum amylase and lipase values. On admission, she was in distress and demonstrated clinical signs of acute pancreatitis. The link between systemic lupus erythematosus and acute pancreatitis is discussed in view of the reported cases of the world literature.

[Neuromyeloencephalopathy caused by high-dose muzolimine medication in patients with renal failure]. / Neuromyeloenzephalopathie (NME) unter hochdosierter Muzolimin-Medikation bei niereninsuffizienten Patienten.

We report on 7 patients suffering from chronic renal failure (2 females, 5 males; aged 35-75 (phi 53.5) years) who showed severe neuromyeloencephalopathy (NME) after high doses of a new Henle's loop diuretic, Muzolimine. The temporal and phenomenological development of these systems was strikingly parallel. The neurological deficit was revealed on neurophysiological, neuroradiological and in 2 cases on neuropathological tests (gross demyelinisation of the posterior column, mainly of the fasciculus gracilis, less in the lateral corticospinal tract and in some spinal roots). The critical drug dose for first neurological impairment was 52 g on average; at this point the patients had been treated for 78 days. The maximal daily dose was 1.440 mg. Dominant clinical features were pallhypaesthesia, ataxia, signs of peripheral neuropathy in combination with hyperreflexia and progressive para- to tetraspastic paresis. Constellation of symptoms, course of disease and findings of additional investigations, especially those of neuropathology, very much resemble Vitamin B12 deficiency and SMON-(Subacute Myelo Optic Neuropathy) syndrome. The rare entity of Muzolimine-NME is discussed in respect to other endogenous and exotoxic neuromyelopathies. We present the hypothesis of a toxic, partially dialysable metabolite of Muzolimine.

[Carcinoid tumor with cystic liver metastases]. / Karzinoid mit zystischen Lebermetastasen.

Generally metastases of carcinoid tumours are pseudocystic in nearly 10% of the patients. In our case the guiding diagnostic importance of sonography and computed tomography could be proved. Results have to be completed by histologic findings and hormonal analysis (serotonin, 5-hydroxyindol acetic acid). - Morphological signs especially of the new imaging techniques are often a supposition for the modern therapy, e.g. the application of serotonin antagonists, local perfusion of cytostatic substances and if possible transplantation of the liver.