Episode 1.144 Full Movie Free Download
Kenneth Calimlim
Client data used in this study represented 139,516 treatment episodes collected from July 1, 2006, to December 30, 2011. We limited the analysis to outpatient programs because they represent the most common treatment option in Los Angeles County, accounting for more than 70 % of all admissions [34]. Only clients who were admitted and discharged within the same year were included to obtain accurate estimates, due to data coding issues with clients who stayed beyond one calendar year.
The revised version includes all the readmission episodes for all the patients. We have included burn patients in the analysis and updated the results. We have added APACHE II illness severity to the revised manuscript. We have reported on the incidence of ICU readmission, the risk factors associated with ICU readmission, the characteristics of the patients, the care processes delivered in ICU, organ support, resource utilisation, timings of ICU discharge and the ICU outcomes.
ICU length of stay (LOS) is listed as outcome. Does this refer to the original LOS for all patients (if so it should not be considered as an outcome of the study since this occurs before the readmission episode, or dose this refer to the LOS of the readmission episode? If the former it is still important to report and should be considered as a potential predictor of readmission.
The whole paper should have a proof read to provide more clarity when the authors are referring to ICU admission episodes, ICU readmission episode or patients. It is difficult to follow sometimes when authors are referring to characteristics of the patient as opposed to characteristics of the ICU episode. E.g.
The authors should be clearer about the outcomes they are examining. ICU length of stay (LOS) is listed as outcome. Does this refer to the original LOS for all patients (if so it should not be considered as an outcome of the study since this occurs before the readmission episode, or dose this refer to the LOS of the readmission episode? If the former it is still important to report and should be considered as a potential predictor of readmission.
The definition of PMD originated from a Kraepelinian dichotomous view. Since DSM-II stated that psychotic depressive reactions referred to severe depressive episodes in response to one or more identifiable stressor, depressed patients with mood-incongruent delusions were regarded as a subtype of schizophrenia or of schizoaffective disorder. In DSM-III and DSM-III-R, the specifier "with psychotic features" reflected the presence of delusion or hallucination, and thought disorders were regarded as reflecting the severity of a depressive disorder rather than a distinctive feature. The "severity-psychosis" hypothesis stipulates that severe levels of depression result in psychotic symptoms, and this view is generally accepted in contemporary psychiatric nosology or taxonomy. In both ICD-10 and DSM-IV, PMD is currently classified as a subtype of severe depression, or a severe variant of depression.6,7,8 Thus, the presence of delusion or hallucination has been conceptualized as the hallmark of PMD distinguishing it from non-psychotic major depression (NPMD). Furthermore depressive symptoms,9,10 psychomotor disturbances9,11 and guilt9,12,13 have been suggested as accessory features separating PMD and NPMD. On the other hand, several psychiatrists have insisted that PMD is a clinical syndrome distinct from PMD, based on a large body of findings of clinical and translational studies.6,7 Thus, there has been a longstanding debate about whether PMD is merely a subtype of depression distinguished by its severity, or is a distinctive diagnostic entity.
Diagnostic evaluation and retrospective reporting of the medical history and/or psychiatric illness and treatment took place at baseline. Clinical data collected in the study included outpatient/inpatient enrollment, history of depressive episodes, age at onset of first depressive episode, family history of depression, and history of suicide attempts. The section concerning concurrent physical disorders had questions on the presence or absence of 33 listed physical disorders, including hypertension, cancer, diabetes, angina, cerebrovascular disease, thyroid disease, osteoporosis, hyperlipidemia, Cushing's disease, uremia, gastroduodenal ulcer, inflammatory bowel disease, and others. As treatment status and severity of physical disorders were also recorded, patients with a concurrent medical or neurological illness that was severe enough to interfere with study participation were excluded.
Several socioeconomic factors including marital status, current employment, and monthly income did not differ between PMD and NPMD subjects in our study. No consistent differences with respect to age at baseline, educational attainment, and economic status have been found between patients with PMD and NPMD.32 We found that PMD subjects had a higher rate of inpatient enrollment than those with NPMD. As mentioned above, inpatients diagnosed with MDD tended to have higher rates of psychotic features than those with NPMD.5,32 It is possible that PMD patients are less likely to seek treatment in outpatient settings.36 PMD subjects also tended to be more likely to have a history of suicidal attempt (41.7% vs. 22.1%), although the difference was not significant. Previous studies have found that PMD patients were 2 to 5 times more likely to have attempted suicide than those with NPMD.33,37 In a study of 183 PMD patients, Schaffer et al.38 found that 21% of these patients had attempted suicide and that the lifetime risk of suicide attempts was negatively associated with advancing age. Thus, it can be said that higher rates of suicide attempts is consistent with findings from previous studies. However, several clinical factors including age at onset of first depressive episode, history of depressive episodes, family history of depression and concomitant physical illnesses did not differ between PMD and NPMD subjects in our study. Some investigations have found that presence of psychotic features was negatively associated with age at onset for patients with affective disorders.39,40 Since age at onset is usually regarded as a useful factor for dissecting the phenotypic and genotypic heterogeneity of MDD,40 further investigations are needed. In earlier studies, patients with PMD tended to have an increased likelihood of recurrence of depression and an increased risk of family prevalence of unipolar major depression42,43 and bipolar affective disorder.42 The differences between those findings and that of this study may be explained by differences in clinical characteristics of PMD subjects studied.
In addition, PMD subjects scored higher on many of the individual items of the BPRS compared to NPMD subjects. Not only positive symptoms (suspiciousness and hallucinations) but also negative symptoms (emotional withdrawal and blunted affect), guilt feelings, tension and somatic concern were more severe in PMD subjects than in those with NPMD. It has been suggested that psychotic features are sufficient but not necessary for identifying PMD.44 In an epidemiological survey, more than 10% of subjects who had feelings of worthlessness or guilt and suicidal ideation had delusions; that survey also indicated that 9.7% of patients who presented feelings of worthlessness or guilt had hallucinations and that 4.5% had combinations of hallucination and delusions.3 Based on these findings, feelings of worthlessness or guilt have been suggested as good indicators for the presence of psychotic features during depressive episodes. Also, Parker and colleagues13 have suggested that PMD patients are distinguishable from those with NPMD by psychomotor disturbance, depressive content, diurnal variation, and constipation. Furthermore, a number of psychiatric symptoms other than depressive symptoms (including anxiety, paranoia and hypochondriasis) were more severe in PMD patients than in those with NPMD.45
National Health Insurance Service data are materials for a health insurance claim to be submitted to the National Health Insurance Service by medical institutions after the institutions provide medical service. Data of daily outpatients of medical clinics in 16 cities and provinces were collected on three codes: allergic rhinitis (J30), asthma (J45), and atopic dermatitis (L20). The concept of episode was used in order to research incidence rate through daily outpatients' documents [13]. Each episode was measured for 1 month and outpatients visited within 1 month were considered one episode.
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