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Mahler L. A Human Rights-Based Approach To Acute Mental Health Crisis Care. Eur Psychiatry 2022. [PMCID: PMC9566318 DOI: 10.1192/j.eurpsy.2022.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The United Nations Convention on the Rights of Persons with Disabilities as well as the new guidance on community mental health services recently published by the World Health Organization formulate clear goals for the future of psychiatry and psychosocial support. Innovative concepts of psychiatric care that focus on full participation, recovery-orientation and the prevention of coercion play an important role in achieving these goals. Implementing and scientifically evaluating the effects of such models in mental health services needs to be prioritized in national mental health planning and budgeting decisions. In this lecture, Dr. Lieselotte Mahler will address the requirements of psychiatric concepts, specifically on acute psychiatric wards, to enable participation and prevent coercion. Using practical examples and evaluated models (e.g. Weddinger Modell, standardized post-coercion review sessions), she will make suggestions on how a psychiatry oriented towards human rights can also be implemented within existing clinical structures. Dr. Lieselotte Mahler will discuss, based on the current state of research as well as practical experience, which challenges exist with regard to patient autonomy and prevention of coercion in clinical practice and how these can be addressed from a human rights perspective.
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Wullschleger A, Vandamme A, Mielau J, Stoll L, Heinz A, Bermpohl F, Bechdolf A, Stelzig M, Hardt O, Hauth I, Holthoff-Detto V, Mahler L, Montag C. Effect of standardized post-coercion review on subjective coercion: Results of a randomized-controlled trial. Eur Psychiatry 2021; 64:e78. [PMID: 34872630 PMCID: PMC8715283 DOI: 10.1192/j.eurpsy.2021.2256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Post-coercion review has been increasingly regarded as a useful intervention in
psychiatric inpatient setting. However, little is known about its effect on perceived
coercion. Methods A multicenter, two-armed, randomized controlled trial was conducted, aiming at
analyzing the effect of post-coercion review on perceived coercion. People with severe
mental disorders, who experienced at least one coercive measure during inpatient
treatment, were randomized using Zelen’s design to an intervention group receiving
standardized post-coercion review, or a control group treated as usual. The MacArthur
admission experience scale (AES) and the coercion ladder (CL) were used to assess
perceived coercion during inpatient treatment. The coercion experience scale (CES)
measured experienced coercion during the coercive intervention. Analyses of covariance
were performed to determine group differences. Results Of 422 randomized participants, n = 109 consented to participate in
the trial. A restricted intention-to-treat analysis of all individuals who consented
revealed no significant effect of the intervention on perceived coercion. A significant
interaction effect between the factors gender and intervention on the AES scores was
found. Sensitivity analysis revealed significant effects of the intervention on both AES
and CL scores and an interaction effect between intervention and gender, indicating a
higher efficacy in women. No effect of the intervention on CES scores was found. Conclusions Standardized post-coercion review sessions did not alleviate the subjective perception
of coercion in the total sample. However, post hoc analysis revealed a significant
effect of the intervention in women. Results indicate the need to further address
gender-specific issues related to coercion.
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Affiliation(s)
- A Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Thônex, Switzerland
| | - A Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - J Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - L Stoll
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Am Urban and Vivantes Hospital im Friedrichshain/Charité Medicine Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - M Stelzig
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Wenckebach Clinic, Berlin, Germany
| | - O Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinic Neukölln, Berlin, Germany
| | - I Hauth
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Joseph Hospital Berlin-Weissensee, Berlin, Germany
| | - V Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Kliniken Berlin, Berlin, Germany.,Medical Faculty, University of Technology, Dresden, Germany
| | - L Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - C Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Xu F, Delmonico MJ, Lofgren IE, Uy KM, Maris SA, Quintanilla D, Taetzsch AG, Letendre J, Mahler L. Effect of a Combined Tai Chi, Resistance Training and Dietary Intervention on Cognitive Function in Obese Older Women. J Frailty Aging 2018; 6:167-171. [PMID: 28721435 DOI: 10.14283/jfa.2017.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cognitive decline in older adults is a major public health problem and can compromise independence and quality of life. Exercise and diet have been studied independently and have shown to be beneficial for cognitive function, however, a combined Tai Chi, resistance training, and diet intervention and its influence on cognitive function has not been undertaken. The current study used a 12-week non-randomized research design with experiment and control groups to examine the effect of a combined Tai Chi, resistance training, and diet intervention on cognitive function in 25 older obese women. Results revealed improvements in domain specific cognitive function in our sample. Baseline cognitive function was correlated with changes in dietary quality. These findings suggest that Tai Chi and resistance training combined with diet intervention might be beneficial for community-based programs aiming to improve cognitive function.
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Affiliation(s)
- F Xu
- Furong Xu, Department of Kinesiology, The University of Rhode Island, 25 West Independence Way, Suite P, Kingston, RI 02881, (401)874-2412 (office), (401)874-4215 (fax),
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Mahler L, DiBlasi R, Perez A, Gaspard J, McCauley D. On-Body Injector: An Administration Device for Pegfilgrastim. Clin J Oncol Nurs 2017; 21:121-122. [DOI: 10.1188/17.cjon.121-122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cohen J, Junghaenel DU, Schneider S, Mahler L, Stone A, Broderick J. Abstract P6-08-06: Use of an NIH PROMIS® instrument to identify predictors of fatigue in breast cancer patients receiving adjuvant chemotherapy. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Fatigue is one of the most common side effects of treatment for breast cancer (BC). This study used a daily diary approach to investigate the course of fatigue in BC patients receiving adjuvant chemotherapy. We examined clinical (BSA, menopausal status, stage, hemoglobin levels) and self-reported biopsychosocial factors (anxiety, depression, pain, physical and social functioning) as predictors of fatigue after chemotherapy infusion.
Methods: We enrolled 28 stage I (39%), II (50%), and III (11%) BC patients (mean age = 48.9 years, SD = 9.7) receiving standard adjuvant chemotherapy. Fatigue was assessed over 14 consecutive days (day −2 to +11) using a modified version of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) fatigue short-form. Putative predictors of fatigue were assessed in the week prior to infusion. Anxiety and depression were measured with computerized adaptive testing. Pain, physical functioning, and social functioning were assessed using PROMIS global health items. Clinical variables were abstracted from patients' medical records. Analyses used individual growth curve modeling to examine overall levels of post-infusion fatigue and rates of change (amplitude) in daily fatigue over a 14-day period prior to the next infusion.
Results: Daily fatigue varied considerably over the 14 day study period, following a sinusoidal pattern. Fatigue T-scores increased from near-normal values (mean = 53) by about 1 SD (p < .001) during the first 3 days post-infusion (mean = 62), peaked on days 3–6, and decreased to near-normal (mean = 53) by day 11. Higher baseline anxiety, depression, pain and problems with physical functioning independently predicted higher overall fatigue levels during the post-infusion period (p < .001). In addition, baseline pain and physical functioning predicted distinct patterns of change in fatigue scores (p < .05). Fatigue showed a steep rise and fall in patients with less pain and better physical functioning at baseline, rapidly returning to pre-infusion levels. Fatigue was more constant in patients with greater pain and worse physical functioning at baseline. These patients reported higher fatigue scores prior to infusion but experienced fewer dynamic changes in response to chemotherapy. Medical variables and social functioning were not associated with baseline fatigue levels or changes in fatigue.
Conclusions: This study demonstrates that BC patients with greater anxiety, depression, pain or poor physical functioning at baseline are at risk for prolonged and severe fatigue during treatment with chemotherapy. Patients with low pain and high physical functioning experience sharper changes in fatigue after infusion with quick return to baseline. The NIH PROMIS questionnaire provides a powerful quantitative method to identify predictors of chemotherapy-related fatigue. Identification of these predictors is critical for effective management of patient expectations and the development of targeted interventions to improve tolerance and functioning during adjuvant chemotherapy for breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-06.
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Affiliation(s)
- J Cohen
- Stony Brook University, Stony Brook, NY
| | | | | | - L Mahler
- Stony Brook University, Stony Brook, NY
| | - A Stone
- Stony Brook University, Stony Brook, NY
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Hensley JM, Montoya J, Allen MG, Xu J, Mahler L, Tredicucci A, Beere HE, Ritchie DA. Spectral behavior of a terahertz quantum-cascade laser. Opt Express 2009; 17:20476-20483. [PMID: 19997276 DOI: 10.1364/oe.17.020476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this paper, the spectral behavior of two terahertz (THz) quantum cascade lasers (QCLs) operating both pulsed and cw is characterized using a heterodyne technique. Both lasers emitting around 2.5 THz are combined onto a whisker contact Schottky diode mixer mounted in a corner cube reflector. The resulting difference frequency beatnote is recorded in both the time and frequency domain. From the frequency domain data, we measure the effective laser linewidth and the tuning rates as a function of both temperature and injection current and show that the current tuning behavior cannot be explained by temperature tuning mechanisms alone. From the time domain data, we characterize the intrapulse frequency tuning behavior, which limits the effective linewidth to approximately 5 MHz.
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Affiliation(s)
- J M Hensley
- Physical Sciences Inc, 20 New England Business Center, Andover, Massachusetts 01810-1077, USA.
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Mahler L, Thornval A. Sitzungsberichte der Dänischen Oto-laryngo-logischen Gesellschaft. Acta Otolaryngol 2009. [DOI: 10.3109/00016482009123109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Richter H, Semenov AD, Pavlov SG, Mahler L, Tredicucci A, Beere HE, Ritchie DA, Ortolani M, Schade U, Il'in KS, Siegel M, Hübers HW. Development of a THz heterodyne receiver with quantum cascade laser and hot electron bolometer mixer for standoff detection of explosive material. ACTA ACUST UNITED AC 2009. [DOI: 10.1117/12.818134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hübers HW, Pavlov S, Semenov A, Köhler R, Mahler L, Tredicucci A, Beere H, Ritchie D, Linfield E. Terahertz quantum cascade laser as local oscillator in a heterodyne receiver. Opt Express 2005; 13:5890-5896. [PMID: 19498595 DOI: 10.1364/opex.13.005890] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Terahertz quantum cascade lasers have been investigated with respect to their performance as a local oscillator in a heterodyne receiver. The beam profile has been measured and transformed in to a close to Gaussian profile resulting in a good matching between the field patterns of the quantum cascade laser and the antenna of a superconducting hot electron bolometric mixer. Noise temperature measurements with the hot electron bolometer and a 2.5 THz quantum cascade laser yielded the same result as with a gas laser as local oscillator.
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Pearl ML, Frandina M, Mahler L, Valea FA, DiSilvestro PA, Chalas E. A randomized controlled trial of a regular diet as the first meal in gynecologic oncology patients undergoing intraabdominal surgery. Obstet Gynecol 2002; 100:230-4. [PMID: 12151142 DOI: 10.1016/s0029-7844(02)02067-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To prospectively evaluate the safety and efficacy of a regular diet as the first meal after intraabdominal surgery in gynecologic oncology patients. METHODS During a 20-month period, 254 gynecologic oncology patients undergoing intraabdominal surgery were enrolled in a randomized controlled trial of a clear liquid diet compared with a regular diet as the first postoperative meal. All patients received their first meal on the first postoperative day in the absence of nausea, vomiting, or symptomatic abdominal distension. Standard criteria for discharge were used for all study patients. RESULTS The clear liquid and the regular diet groups were similar in age, disease, surgical procedure distribution, surgery length, and estimated blood loss. The incidence of nausea, vomiting, abdominal distention, frequency and duration of nasogastric tube use, passage of flatus before discharge, and percentage of patients who tolerated their diets on the first attempt were comparable for both groups. For those patients who were intolerant of the first attempt at either a clear liquid or regular diet, the time to tolerance was comparable for both groups. The time to development of bowel sounds, passage of flatus, and hospital stay were comparable for both groups. Febrile morbidity, pneumonia, wound complications, and atelectasis occurred equally in both groups. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematologic indices and electrolytes were comparable in both groups. CONCLUSION A regular diet as the first meal after intraabdominal surgery in gynecologic oncology patients is safe and efficacious.
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Affiliation(s)
- Michael L Pearl
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook, New York, USA.
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Pearl ML, McCauley DL, Thompson J, Mahler L, Valea FA, Chalas E. A randomized controlled trial of early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery. Obstet Gynecol 2002; 99:704-8. [PMID: 11978276 DOI: 10.1016/s0029-7844(02)01956-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of early oral analgesia after intra-abdominal surgery in gynecologic oncology patients. METHODS Over a 2.5-year period, 227 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early oral versus traditional parenteral analgesia. All patients initially received parenteral morphine via a patient-controlled analgesia (PCA) pump with a basal dose of 0.5 mg/h and a PCA dose of 1 mg with a 10-minute lockout. On the first postoperative day, all patients began a clear liquid diet, which was advanced as tolerated. Patients allocated to early oral analgesia were switched from parenteral to oral morphine. They received a scheduled dose of 20 mg every 4 hours with an additional dose of 10 mg every 2 hours as needed for breakthrough pain. Patients allocated to traditional parenteral analgesia continued to receive parenteral morphine via a PCA pump with basal and PCA doses. On the second postoperative day, the scheduled oral and basal parenteral doses were discontinued. The oral and parenteral PCA doses were continued until 24 hours before discharge, at which time the patient was switched to oxycodone 5 mg/acetaminophen 325 mg. RESULTS There were no significant differences among the groups in any demographic or clinical indices, including age, case distribution, surgery length, blood loss, time to return of bowel function, length of hospital stay, pain, sedation, and satisfaction scores, and incidence of nausea, vomiting, or major postoperative complications. CONCLUSIONS Early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery is safe and efficacious.
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Affiliation(s)
- Michael L Pearl
- Departments of Obstetrics, Gynecology, Division of Gynecologic Oncology, State University of New York at Stony Brook, Stony Brook, New York, USA.
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Pearl ML, Valea FA, Fischer M, Mahler L, Chalas E. A randomized controlled trial of early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery. Obstet Gynecol 1998; 92:94-7. [PMID: 9649101 DOI: 10.1016/s0029-7844(98)00114-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of early oral feeding after intra-abdominal surgery in gynecologic oncology patients. METHODS During a 1-year period, 200 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early compared with traditional oral postoperative feeding. Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative day and then advanced to a regular diet as tolerated. Patients allocated to traditional postoperative oral feeding received nothing by mouth until return of bowel function (defined as the passage of flatus in the absence of vomiting or abdominal distention), then began a clear liquid diet, and advanced to a regular diet as tolerated. RESULTS Age, case distribution, surgery length, blood loss, and first passage of flatus were similar in the early and traditional feeding groups. Significantly more patients in the early group developed nausea. Despite this, the incidence of vomiting, abdominal distention, incidence and duration of nasogastric tube use, and percentage of patients who tolerated clear liquid and regular diets on the first attempt were comparable in both groups. Time to development of bowel sounds, time to initiation of clear liquid and regular diets, and hospital stay were significantly longer in the traditional group. Major complications (eg, pneumonia, atelectasis, and wound complications) and febrile morbidity occurred equally in both groups. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematologic indices and electrolytes were comparable in both groups. CONCLUSION Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated.
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Affiliation(s)
- M L Pearl
- Department of Obstetrics, Gynecology and Reproductive Medicine, State University of New York at Stony Brook, USA
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