Background-Outpatient cardiac rehabilitation (CR) decreases mortality rates but is underutilized. Current median time from hospital discharge to enrollment is 35 days. We hypothesized that an appointment within 10 days would improve attendance at CR orientation. Methods and Results-At hospital discharge, 148 patients with a nonsurgical qualifying diagnosis for CR were randomized to receive a CR orientation appointment either within 10 days (early) or at 35 days (standard). The primary end point was attendance at CR orientation. Secondary outcome measures were attendance at ≥1 exercise session, the total number of exercise sessions attended, completion of CR, and change in exercise training workload while in CR. Average age was 60±12 years; 56% of participants were male and 49% were black, with balanced baseline characteristics between groups. Median time (95% confidence interval) to orientation was 8.5 (7-13) versus 42 (35 to NA [not applicable]) days for the early and standard appointment groups, respectively (P<0.001). Attendance rates at the orientation session were 77% (57/74) versus 59% (44/74) in the early and standard appointment groups, respectively, which demonstrates a significant 18% absolute and 56% relative improvement (relative risk, 1.56; 95% confidence interval, 1.03-2.37; P=0.022). The number needed to treat was 5.7. There was no difference (P>0.05) in any of the secondary outcome measures, but statistical power for these end points was low. Safety analysis demonstrated no difference between groups in CR-related adverse events. Conclusions-Early

Intermittent drug techniques refer to the "use of medication only during periods of incipient relapse or symptom exacerbation rather than continuously." The aim is to reduce the risk of adverse effects of antipsychotics by "reducing longterm medication exposure for patients who are receiving maintenance treatment while limiting risk of relapse," with a further goal of improving social functioning resulting from the reduction of antipsychotic-induced side effects. We reviewed the effects of different intermittent drug techniques compared with maintenance treatment in people with schizophrenia or related disorders. We searched The Cochrane Schizophrenia Group Trials register (april 2012) and supplemented this by contacting relevant study authors and manually searching reference lists. all relevant randomized controlled trials (rCTs) were included.of 241 records retrieved by the search, 17 trials were included. homogenous data demonstrated that instances of relapse were significantly higher in people receiving any intermittent drug treatment in the long term (n=436, 7 rCTs, rr=2.46, 95% CI=1.70-to 3.54). Intermittent treatment was shown to be more effective than placebo, however, and demonstrated that significantly less people receiving intermittent antipsychotics experienced full relapse by medium term (n=290, 2 rCTs, rr=0.37, 95% CI=0.24-0.58). Intermittent antipsychotic treatment is not as effective as continuous, maintained antipsychotic therapy for preventing relapse in people with schizophrenia. It does seem, however, significantly better than no treatment.

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Purpose For patients hospitalized for a cardiac event, an earlier appointment to outpatient cardiac rehabilitation (CR) increases participation. However, it is unknown what effect hastening CR enrollment might have among employed patients planning to return to work (RTW). Methods Using two complementary datasets [Henry Ford Hospital (HFH) and Mayo Clinic] we assessed when employed patients eligible for CR anticipated a RTW, the impact of an earlier appointment on CR enrollment, and the effect of employment status on the number of CR sessions attended. Patients at HFH attended CR at either 8 or 42 days (through randomization,) while Mayo Clinic patients attended 10 days after hospital discharge per standard routines. Results Among 148 patients at HFH, 65 (44%) were employed and planned to RTW. Of these, 67% desired to RTW within 1–2 weeks, while 28% anticipated a RTW within 1–3 days. Home financial strain predicted non-participation in CR (p<0.001) and was associated with an earlier planned RTW. Among 1,030 patients at Mayo Clinic, 393 (38%) were employed. Employed (vs. non-employed) patients enrolled in CR 3.3 days sooner (p < 0.001), but attended 1.6 fewer CR sessions (p = 0.04). In employed patients from both health systems, an earlier (vs. later) appointment to CR did not result in additional exercise sessions of CR. Conclusions Employed patients plan to RTW quickly, in part due to home finances. They also enroll earlier into CR than non-employed patients. Despite these findings, earlier appointments do not appear to favorably impact overall CR participation.