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Temporal trends of inpatient C. difficile infections within the Veterans Health Administration hospitals: An analysis of the effect of molecular testing, time to testing, and mandatory reporting
- Zarchi E. Sumon, Alan J. Lesse, John A. Sellick, Sheldon Tetewsky, Kari A. Mergenhagen
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue 1 / January 2020
- Published online by Cambridge University Press:
- 11 November 2019, pp. 44-51
- Print publication:
- January 2020
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Background:
Clostridium difficile infection (CDI) is a reportable hospital metric associated with significant healthcare expenditures. The epidemiology of CDI is pivotal to the implementation of preventative measures.
Objective:To portray temporal CDI trends in Veterans Health Administration (VA) hospitals.
Design:A retrospective analysis of veterans who had stool testing for C. difficile.
Setting:VA acute-care hospitals within the continental United States.
Methods:Data were mined from the VA’s Corporate Data Warehouse. CDI is reported per 10,000 patient days.
Results:From 2006 to 2016, 472,346 patients had C. difficile testing. Overall, decreases in incidence of total CDI (16.81 to 13.66) and hospital-onset healthcare facility-associated (HO-HCFA) CDI (10.87 to 6.41) were observed. Temporal increases in the incidence of total and HO-HCFA CDI were associated with the increased use of molecular testing (P < .0001). Decreased use of fluoroquinolones (P < .0001), clindamycin (P = .0006), and third-generation cephalosporins (P = .0002) correlated with decreased rates of CDI, but VA mandatory reporting did not influence CDI rates (P = .24). The overall crude 30-day mortality of patients with CDI decreased from 2.17 deaths per 10,000 patient days in 2006 to 1.41 in 2016. The frequency of International Classification of Disease, Ninth/Tenth Revision (ICD-9/10) discharge diagnosis for CDI was 73.3%.
Conclusion:Molecular testing was associated with increased incidence of CDI. Controlling CDI is likely multifactorial. Although the VA initiative to report cases of hospital-acquired CDI was not significant in our model, the advent of stewardship programs throughout the VA and reductions in the use of third-generation cephalosporins, fluoroquinolones, and clindamycin were significantly associated with reduced rates of CDI.
Influence of Adjuvants and Bromoxynil on Absorption of Clethodim
- A. Stanley Culpepper, David L. Jordan, Alan C. York, Frederick T. Corbin, Yvonna Sheldon
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- Journal:
- Weed Technology / Volume 13 / Issue 3 / September 1999
- Published online by Cambridge University Press:
- 12 June 2017, pp. 536-541
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The effect of nonionic surfactant, crop oil concentrate, organosilicone surfactant, methylated seed oil, and a blend of organosilicone surfactant and methylated seed oil on absorption of 14C-clethodim was evaluated in barnyardgrass (Echinochloa crus-galli). Absorption of 14C-label was greatest during the first 40 min after application when 14C-clethodim was applied with methylated seed oil or a blend of methylated seed oil and organosilicone surfactant. These adjuvants increased the rate of absorption more than crop oil concentrate, organosilicone surfactant, or nonionic surfactant. Crop oil concentrate was more effective than organosilicone or nonionic surfactant in increasing absorption, with nonionic surfactant being more effective than organosilicone surfactant. These results generally agreed with the order of increasing efficacy of clethodim on barnyardgrass as affected by adjuvants in field experiments. Another study was conducted to determine the effect of bromoxynil on absorption and translocation of 14C-clethodim in yellow foxtail (Setaria glauca). Bromoxynil reduced absorption of 14C–clethodim 4, 8, and 24 h after application and also reduced the amount of 14C-label translocated from the treated leaf. These data suggest that antagonism of clethodim control of yellow foxtail by bromoxynil observed in previous research can be attributed partially to decreased absorption and translocation of clethodim.
Basis for Antagonism in Mixtures of Bromoxynil Plus Quizalofop-P Applied to Yellow Foxtail (Setaria glauca)
- A. Stanley Culpepper, Alan C. York, David L. Jordan, Frederick T. Corbin, Yvonna S. Sheldon
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- Journal:
- Weed Technology / Volume 13 / Issue 3 / September 1999
- Published online by Cambridge University Press:
- 12 June 2017, pp. 515-519
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Antagonism of quizalofop-P efficacy on annual grasses by bromoxynil has been noted in both the field and greenhouse. Laboratory experiments were conducted on yellow foxtail (Setaria glauca) to determine the effect of mixing bromoxynil with the ethyl ester of quizalofop-P on absorption, translocation, and metabolism of 14C-quizalofop-P Applying bromoxynil in mixture with quizalofop-P reduced 14C-label absorption from 63 to 51%, 73 to 52%, 77 to 68%, and 90 to 80% at 4, 8, 24, and 96 h after treatment, respectively. Translocation of 14C-label from the treated leaf into the shoot above or shoot below was unaffected by bromoxynil. However, translocation into the roots was reduced from 0.9 to 0.4% and 1.0 to 0.5% at 4 and 8 h after treatment, respectively, but differences were not noted at 0.5, 1, 24, and 96 h after treatment. Bromoxynil increased deesterification of quizalofop-P-ethyl into quizalofop-P acid from 45 to 60% in the shoot above the treated leaf. However, bromoxynil did not affect metabolism of quizalofop-P in the treated leaf or shoot below the treated leaf. These results suggest that antagonism of quizalofop-P activity by bromoxynil is primarily due to decreased absorption of quizalofop-P, whereas effects on translocation and metabolism were minor.
Influence of Selected Fungicides on Efficacy of Clethodim and Sethoxydim
- Sarah H. Lancaster, David L. Jordan, Alan C. York, Ian C. Burke, Frederick T. Corbin, Yvonna S. Sheldon, John W. Wilcut, David W. Monks
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- Journal:
- Weed Technology / Volume 19 / Issue 2 / June 2005
- Published online by Cambridge University Press:
- 20 January 2017, pp. 397-403
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Field experiments were conducted to compare large crabgrass control by clethodim or sethoxydim applied alone and with selected fungicides registered for use in peanut. Fluazinam, propiconazole plus trifloxystrobin, or tebuconazole did not affect efficacy of clethodim or sethoxydim. Azoxystrobin, boscalid, chlorothalonil, and pyraclostrobin reduced efficacy of clethodim and sethoxydim in some experiments. Increasing the herbicide rate increased large crabgrass control regardless of the addition of chlorothalonil. In laboratory experiments, 14C absorption was less when 14C-clethodim or 14C-sethoxydim was applied with chlorothalonil. Pyraclostrobin and tebuconazole did not affect absorption of 14C-clethodim or 14C-sethoxydim.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Epidemic Serratia marcescens in a Neonatal Intensive Care Unit: Importance of the Gastrointestinal Tract as a Reservoir
- Gordon D. Christensen, Sheldon B. Korones, Louise Reed, Roderick Bulley, B. McLaughlin, Alan L. Bisno
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 3 / Issue 2 / March/April 1982
- Published online by Cambridge University Press:
- 02 January 2015, pp. 127-133
- Print publication:
- March/April 1982
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Between March and December of 1979, an outbreak of infections due to multiply antibiotic resistant Serratia marcescens took place in a 50-bed neonatal intensive care unit. Fifteen neonates suffered major infections (sepsis, meningitis and pneumonia) with one death, and 20 suffered minor infections (conjunctivitis, cystitis, wound infections). Epidemiologic investigation failed to reveal a common source; S. marcescens, however, was isolated from an employee's hand, emollient skin cleanser, suction tubing, and three in-use manual infant resuscitation bags. The skin cleanser and equipment-cleaning agents were ineffective against S. marcescens. Asymptomatic, colonized infants were the major reservoir of S. marcescens. These infants were identified by daily cultures of the nose, umbilicus and rectum. The rectal swab most commonly (76%) yielded first-positive cultures in previously uncolonized infants, and was ultimately positive in 92% of colonized infants. A control program was begun by: 1) removing all inanimate sources of S. marcescens; and 2) cohorting patients and staff into a S. marcescens-exposed group and a new patient group. The new patient group of infants was surveyed by daily triple-site cultures for colonization and subsequent transfer to the S. marcescens-exposed group. After four months, the epidemic was controlled and the organism eradicated from the neonatal intensive care unit.
Contributors
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- By Lenard A. Adler, Pinky Agarwal, Rehan Ahmed, Jagga Rao Alluri, Fawaz Al-Mufti, Samuel Alperin, Michael Amoashiy, Michael Andary, David J. Anschel, Padmaja Aradhya, Vandana Aspen, Esther Baldinger, Jee Bang, George D. Baquis, John J. Barry, Jason J. S. Barton, Julius Bazan, Amanda R. Bedford, Marlene Behrmann, Lourdes Bello-Espinosa, Ajay Berdia, Alan R. Berger, Mark Beyer, Don C. Bienfang, Kevin M. Biglan, Thomas M. Boes, Paul W. Brazis, Jonathan L. Brisman, Jeffrey A. Brown, Scott E. Brown, Ryan R. Byrne, Rina Caprarella, Casey A. Chamberlain, Wan-Tsu W. Chang, Grace M. Charles, Jasvinder Chawla, David Clark, Todd J. Cohen, Joe Colombo, Howard Crystal, Vladimir Dadashev, Sarita B. Dave, Jean Robert Desrouleaux, Richard L. Doty, Robert Duarte, Jeffrey S. Durmer, Christyn M. Edmundson, Eric R. Eggenberger, Steven Ender, Noam Epstein, Alberto J. Espay, Alan B. Ettinger, Niloofar (Nelly) Faghani, Amtul Farheen, Edward Firouztale, Rod Foroozan, Anne L. Foundas, David Elliot Friedman, Deborah I. Friedman, Steven J. Frucht, Oded Gerber, Tal Gilboa, Martin Gizzi, Teneille G. Gofton, Louis J. Goodrich, Malcolm H. Gottesman, Varda Gross-Tsur, Deepak Grover, David A. Gudis, John J. Halperin, Maxim D. Hammer, Andrew R. Harrison, L. Anne Hayman, Galen V. Henderson, Steven Herskovitz, Caitlin Hoffman, Laryssa A. Huryn, Andres M. Kanner, Gary P. Kaplan, Bashar Katirji, Kenneth R. Kaufman, Annie Killoran, Nina Kirz, Gad E. Klein, Danielle G. Koby, Christopher P. Kogut, W. Curt LaFrance, Patrick J.M. Lavin, Susan W. Law, James L. Levenson, Richard B. Lipton, Glenn Lopate, Daniel J. Luciano, Reema Maindiratta, Robert M. Mallery, Georgios Manousakis, Alan Mazurek, Luis J. Mejico, Dragana Micic, Ali Mokhtarzadeh, Walter J. Molofsky, Heather E. Moss, Mark L. Moster, Manpreet Multani, Siddhartha Nadkarni, George C. Newman, Rolla Nuoman, Paul A. Nyquist, Gaia Donata Oggioni, Odi Oguh, Denis Ostrovskiy, Kristina Y. Pao, Juwen Park, Anastas F. Pass, Victoria S. Pelak, Jeffrey Peterson, John Pile-Spellman, Misha L. Pless, Gregory M. Pontone, Aparna M. Prabhu, Michael T. Pulley, Philip Ragone, Prajwal Rajappa, Venkat Ramani, Sindhu Ramchandren, Ritesh A. Ramdhani, Ramses Ribot, Heidi D. Riney, Diana Rojas-Soto, Michael Ronthal, Daniel M. Rosenbaum, David B. Rosenfield, Durga Roy, Michael J. Ruckenstein, Max C. Rudansky, Eva Sahay, Friedhelm Sandbrink, Jade S. Schiffman, Angela Scicutella, Maroun T. Semaan, Robert C. Sergott, Aashit K. Shah, David M. Shaw, Amit M. Shelat, Claire A. Sheldon, Anant M. Shenoy, Yelizaveta Sher, Jessica A. Shields, Tanya Simuni, Rajpaul Singh, Eric E. Smouha, David Solomon, Mehri Songhorian, Steven A. Sparr, Egilius L. H. Spierings, Eve G. Spratt, Beth Stein, S.H. Subramony, Rosa Ana Tang, Cara Tannenbaum, Hakan Tekeli, Amanda J. Thompson, Michael J. Thorpy, Matthew J. Thurtell, Pedro J. Torrico, Ira M. Turner, Scott Uretsky, Ruth H. Walker, Deborah M. Weisbrot, Michael A. Williams, Jacques Winter, Randall J. Wright, Jay Elliot Yasen, Shicong Ye, G. Bryan Young, Huiying Yu, Ryan J. Zehnder
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp xi-xx
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Contributors
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- By Leslie Citrome, Alan J. Cross, Judith Dunn, Kenneth R. Evans, Douglas E. Feltner, Philip D. Harvey, Amir Kalali, Richard S. E. Keefe, Michael Krams, Joseph Kwentus, Matthew Macaluso, Craig H. Mallinckrodt, Geert Molenberghs, Nuala Murphy, Ginette Nachman, Sheldon Preskorn, William R. Prucka, Penny Randall, Frank D. Yocca, Gwen L. Zornberg
- Edited by Amir Kalali, University of California, San Diego, Sheldon Preskorn, Joseph Kwentus, University of Mississippi, Stephen M. Stahl, University of California, San Diego
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- Book:
- Essential CNS Drug Development
- Published online:
- 05 July 2012
- Print publication:
- 07 June 2012, pp vi-viii
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Maintenance in the Community: A Study of Psychiatric After-care and Rehospitalization
- Alan Sheldon, Kenneth J. Jones
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- Journal:
- The British Journal of Psychiatry / Volume 113 / Issue 502 / September 1967
- Published online by Cambridge University Press:
- 29 January 2018, pp. 1009-1012
- Print publication:
- September 1967
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An initial report on this study (Sheldon, 1964) demonstrated a significant positive relationship between psychiatric after-care and reduction of readmissions to mental hospital in the six months following hospital discharge when patients were randomly allocated to psychiatric after-care or to the general practitioner. The present paper demonstrates that this effect, although diminished, is still apparent for a similar group of patients allocated to after-care by their discharging psychiatrist and followed up for three years. It attempts to clarify the factors operating in psychiatric selection for after-care, and to explore the relative importance of after-care and of the nature and severity of illness in determining outcome, at least as measured by the number, duration, and time after discharge of rehospitalizations.
An Evaluation of Psychiatric After-care
- Alan Sheldon
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- Journal:
- The British Journal of Psychiatry / Volume 110 / Issue 468 / September 1964
- Published online by Cambridge University Press:
- 29 January 2018, pp. 662-667
- Print publication:
- September 1964
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Current planning in the field of the community mental health services places considerable emphasis on the after-care of patients discharged from hospital. This is partly in response to the high re-admission rates experienced as a result of the “revolving door” policy, partly to a scepticism about the present state of knowledge regarding factors amenable to primary prevention techniques, and partly to a belief that keeping the patient in the community is in itself beneficial both to the patient and to the community. The benefits of such a policy are felt to lie in avoidance of institutionalization and furthering of rehabilitation, and in preventing a re-distribution of roles within the family to exclude the patient. The primary purpose of the policy is not necessarily to cut short the illness of the patient, at least as measured by time under treatment, and evidence will be given below to suggest that in fact time in treatment is prolonged. This study focusses on one issue. Can aftercare in fact prevent re-admission to hospital to any significant extent? In view of the complex nature of the decision to select which patients are to receive after-care and which not, a factor in itself likely to prejudice any results, successive discharges from a psychiatric hospital falling within selected categories were randomly allocated to psychiatric after-care and to their general practitioner, and followed for a six-month period. A null hypothesis was set up that the re-admission rate during the follow-up period would not significantly differ in the two groups.