The multiple sclerosis patient’s journey in Poland – current diagnosis

The multiple sclerosis patient’s journey in Poland was described based on the data collected by the Therapeutic Programme Monitoring System (System Monitorowania Programów Terapeutycznych, SMPT) between 2014 and 2018 and a National Health Fund (Narodowy Fundusz Zdrowia, NFZ) report entitled “NFZ on Health. Multiple Sclerosis.” It was found that about 90% of patients had their first multiple sclerosis diagnosis code (ICD-10: G35) assigned by a neurologist, usually during hospital stay in the department of neurology. Further patient management was usually continued in a neurology clinic. The waiting time for further outpatient and inpatient specialist (neurology) care after the first G35 diagnosis is more than 100 days. Before G35 diagnosis, patients most often presented with their first symptoms to neurological and ophthalmic clinics and were probably referred from these clinics for a magnetic resonance imaging. The analysis of the data from the Therapeutic Programme Monitoring System showed that the median time from the onset of the first symptoms to the diagnosis of multiple sclerosis was 7.4 months, and the median time from the diagnosis to initiation of first-line disease modifying treatment was 14.82 months. The length of time from the diagnosis to disease modifying therapy had a significant impact on the degree of disability. Patients treated with highly active second-line therapies accounted for 8.5% of all patients treated in drug programmes, and the increase in the number of patients on second-line regimens and expenditure on this programme were disproportionately lower compared to the first-line programme. A programme to improve the diagnosis and the quality of care for patients with multiple sclerosis should be developed in Poland to achieve better treatment outcomes. It is crucial to reduce the waiting time for diagnosis and the time interval between diagnosis and the onset of disease modifying treatment.

Virtual Therapeutic Garden: A Promising Method Supporting the Treatment of Depressive Symptoms in Late-Life: A Randomized Pilot Study

The multifactorial genesis of old-age depression requires multi-professional therapy combining physical activity and psychosocial interventions; however, there is still a percentage of older people who do not exhibit satisfactory improvements. The aim of this study was to evaluate the effectiveness of virtual therapy in the elderly for whom the previous multimodal, biopsychosocial therapeutic programme had not brought the expected results. Twenty-five elderly women with depressive symptoms were randomly divided into a virtual reality group (VR, n = 13) and a control group (Control, n = 12). The average age was 70.73 and the average intensity of depression symptoms amounted to 12.26 in the Geriatric Depression Scale (GDS-30). As a virtual reality source, the VRTierOne (Stolgraf®) device was used. The therapeutic cycle consisted of eight virtual therapy sessions, twice a week for four weeks. As primary and secondary outcome measures, the GDS-30 was performed at three time points. In the VR group, the GDS-30 score was reduced by 36%, and the result persisted in the follow-up tests. Immersive virtual therapy significantly lowered the intensity of depressive symptoms, as well as stress and anxiety levels in older women taking part in the group-based multimodal therapeutic programme, whose earlier therapy had not brought the expected results.

Developing an air guitar group for an inpatient psychiatry unit

The phenomenon of air guitar has become increasingly popular in mainstream society and recognised as a potential means of enhancing one’s sense of mental well-being. It allows for engagement with music that involves physical activation and can be conducted in groups allowing for non-verbal socialisation. To date, there has been limited examination of its potential usefulness in therapeutic settings, including in mental health services. We describe the development of an air guitar group in an inpatient psychiatry service including an iterative approach to the design of sessions and the impact in terms of patient engagement and feedback. The format of the group evolved over time according to feedback from participants and staff involved in patient care on the unit. We found that the group successfully engaged patients of varying age, gender and diagnostic profiles and was perceived as a valuable addition to the inpatient therapeutic programme. Based upon our observations during this pilot study, we outline a suggested format for air guitar sessions that includes our experiences around selection of music, duration of sessions, use of props, managing the physical demands of sessions and ensuring participant safety. Future work can investigate the impact of air-guitar as a therapeutic activity in other settings (including community-based) and exploring how it can be best applied in combination with other therapeutic modalities for use in patients with differing diagnostic and demographic profiles.

Possibilities for Quality Assessment of Health Services in Therapeutic Rehabilitation

The main goal of therapeutic rehabilitation is to provide services that develop, maintain or restore mobility and functionality to the fullest extent possible throughout the patient’s life. This process should involve setting real goals both for the person who has mobility and functionality impairment as well as in the records of relevant therapeutic programme objectives. In evaluating this process, quality indicators can be used as ‘tools’ and they may also be used as parameters for quantitative characterization of healthcare processes and outcomes. The purpose of this paper is to systematise existing knowledge about quality in healthcare in the context of therapeutic rehabilitation, presenting a possible assessment of the level and degree of completion of goals through quality indicators.

Outcome measures of risk and recovery in Broadmoor High Secure Forensic Hospital: stratification of care pathways and moves to medium secure hospitals

Background Placements within high secure forensic hospitals consist of wards providing various different levels of relational security. They should form a coherent pathway through secure care, based on individual patient risks and needs. Moves to less secure wards within high secure forensic hospitals and moves on to lower secure hospital settings have rarely been systematically studied. Aims The aim of this study was to ascertain if placements within Broadmoor High Secure Hospital and moves from Broadmoor to medium secure hospitals corresponded to measures of violence risk, programme completion and recovery. Method A 13-month prospective cohort study was completed. Patients (n = 142) were rated at baseline for violence risk (Historical, Clinical and Risk – 20), therapeutic programme completion and recovery (DUNDRUM tool) and overall functioning (Global Assessment of Functioning). Placements on the care pathway and moves on to medium secure hospitals were observed. Results Placements on the care pathway within the high secure hospital were associated with dynamic violence risk (F = 16.324, P<0.001), therapeutic programme completion (F = 4.167, P = 0.003), recovery (F = 2.440, P = 0.050) with better scores on these measures being found in the rehabilitation wards and the poorest scores on the highest levels of dependency. Moves to medium secure hospitals were associated with better scores on dynamic risk of violence (F = 33.199, P<0.001), therapeutic programme completion (F = 9.237 P<0.001), recovery (F = 6.863, P = 0.001). Conclusions Placements within Broadmoor Hospital formed a coherent pathway through high secure care. Moves to less secure places were influenced by more than reduction in violence risk. Therapeutic programme completion and recovery in a broad sense were also important.

Time to recovery and determinants of severe acute malnutrition among 6–59 months children treated at outpatient therapeutic programme in North Gondar zone, Northwest Ethiopia: a prospective follow up study

Background Despite the available interventions to tackle nutritional problems, there is scarce information on time to recovery and its determinants among children with SAM in Ethiopia. Objective This study was aimed at finding the time to recovery and determinants among 6–59 months children with severe acute malnutrition treated at an outpatient therapeutic programme in North Gondar zone, northwest Ethiopia. Methods Facility based prospective follow up study was conducted from March 24 to May 24, 2017. A total of 408 children with the age of 6–59 months were included in the study. Structured interviewer administered questionnaire was used. Anthropometric measurements were conducted every week. The median time of recovery, Kaplan Meier (KM) curve, and log rank test were computed. Both bi-variable and multivariable Cox regression model was fitted. To establish an association between time to recovery and its determinants 95% confidence interval (CI) and p-value < 0.05 were used. Proportional hazard assumption was checked graphically and using Schoenfeld residual test. Results Out of 389 children, 254 (65.3%) recovered. The median time to recovery was 38.5 ± IQR of 14 days. Children with diarrhoea AHR = 0.81 with 95% CI (0.73, 0.99), children taken amoxicillin AHR = 2.304 with 95% CI (1.68–3.161), and had vomiting at admission AHR = 0.430 with 95% CI (0.205, 0.904) were significant predictors of time to recovery. Conclusions and recommendations The overall time to recovery has not met the minimum sphere international standard which was lower than 75%. It is advisable to give emphasis to patients with diarrhoea and vomiting.

High burden of co-morbidity and mortality among severely malnourished children admitted to outpatient therapeutic programme facilities in the conflict setting of Borno, Nigeria: a retrospective review

ObjectiveTo present evidence on the burden and outcomes of co-morbidities among severely malnourished (SAM) children admitted to outpatient therapeutic programme (OTP) facilities in the conflict setting of Borno, Nigeria.DesignRetrospective medical chart review.SettingFacility-based study.ParticipantsChildren aged 6–59 months with SAM enrolled in OTP between June and November 2016 whose medical records were analysed. Only pneumonia and diarrhoea were examined due to data limitations. Stata software was used for descriptive, multivariate and survival analyses.ResultsRecords of 396 children with median age of 15 months were identified and analysed from the date of enrolment to exit from OTP. Mean length of stay in OTP was 61d, with co-infected SAM children having shorter stay (P=0·006). Of the total, 148 (37·4 %) had at least one co-morbidity (pneumonia or diarrhoea), of which thirty-nine (26·4 %) had both. Cumulative rate of mortality during follow-up time was 9·5 (95 % CI 6·0, 15·1) per 10 000 child-days; SAM children with co-morbidities were ten times more likely to die than those without (hazard ratio=10·2; 95 % CI 3·4, 31·0). In multivariable analysis, co-morbidity (P=0·01), oedema (P=0·003), dehydration (P=0·02) and weight on admission (P=0·01) were associated with mortality. Both recovery and defaulter rates (57·8 and 36·1 %, respectively) did not meet SPHERE standards.ConclusionsChildren with SAM and co-morbidities are less likely to survive, presenting a significant barrier in improving child survival. The findings call for integrated OTP models that incorporate clinical algorithms and ensure prompt referral for SAM children with co-morbidity.

Evaluation of the preventive and therapeutic programme implementation “Let’s take care of a healthy smile” among 17- and 18-year-old adolescents in the city of Skierniewice in 2018

The aim of the study was to evaluate the results of the preventive and therapeutic programme addressed to adolescents aged 17 and 18, based on a comparison of the state of dentition prior to and after the completion of the programme. MATERIAL AND METHODS: All 44 adolescents from the City of Skierniewice and the surrounding area who applied for enrolment were included in the programme. Based on clinical examination, the prevalence of active caries, caries intensity expressed by mean values of the DMFT (decayed, missing, filled teeth) Index including D, M, and F components and the Dental Treatment (DT) Index F/(D + F) were assessed. All parameters were presented according to sex. RESULTS: Active caries was observed in 34 (77.3%) patients. Caries was more frequently detected in boys (82.6%) than in girls (71.4%). The value of the Caries Intensity Index, DMF, equalled 12.05 and was significantly higher (p<0.01) in boys than in girls: 13.73 ± 3.63 and 10.06 ± 3.42. In the examined group of 17- and 18-year-olds, the mean number of decayed teeth D (6.31) had the highest mean value, followed by the mean number of filled teeth F (4.26), the mean number of extracted (missing) teeth M (1.48) being the lowest. The values of the F Index were statistically significantly higher (t=2.570; p=0.0195) in boys as compared to girls (5.26 ± 2.69 vs. 3.13 ± 2.83). Mean value the Dental Treatment (DT) Index (F/D+F) appeared to be higher in the group of boys than in girls: 0.431 ± 0.182 and 0.358 ± 0.126, respectively. After the completion of the programme, all adolescents studied achieved the value of the Dental Treatment Index equalling 1. CONCLUSIONS: Dental examination qualifying 17- and 18-year old adolescents in Skierniewice to the preventive and therapeutic programme detected numerous foci of active caries. Implementation of the programme allowed to effectively treat the teeth of the adolescents participating in the project and to develop proper hygiene and dietary habits.