Consultation Team Research Articles

Risk management in dialectical behavior therapy: Treating life-threatening behaviors as problems to be solved.

Dialectical behavior therapy (DBT) is an empirically supported behavioral treatment for individuals with borderline personality disorder who frequently exhibit life-threatening behavior, such as suicide attempts, nonsuicidal self-injury urges and actions, and suicidal ideation. We provide an overview of the theoretical framework by which DBT conceptualizes these life-threatening behaviors and the principles by which safety planning measures are implemented and maintained throughout treatment. The importance of orienting clients to treatment and obtaining their commitment to decrease life-threatening behavior is reviewed. Relevant strategies associated with risk management and assessment, such as the diary card, chain analysis, solution analysis, phone coaching, and consultation team, are described. The overview concludes with a case example to illustrate the application of these techniques with a DBT client with a long-standing history of engaging in life-threatening behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

We need a broader debate on the sustainability of blockchain

Alexander Rieger is a postdoctoral researcher at the Interdisciplinary Centre for Security, Reliability and Trust (SnT) at the University of Luxembourg. His research interests include innovative digital technologies such as blockchain, decentralized digital identities, and artificial intelligence. Alex leads the scientific advisory team for the FLORA blockchain project of Germany's Federal Office for Migration and Refugees and acts as advisor to the European Blockchain Partnership and various public and private sector partners in Germany and Luxembourg. Tamara Roth is a postdoctoral researcher at the Interdisciplinary Centre for Security, Reliability and Trust (SnT) at the University of Luxembourg. Her research interests include the interplay of innovative technologies such as blockchain and decentralized digital identities with sociocultural and socioethical constructs in public administration and healthcare. Moreover, she investigates technology adoption and implications of technologies for sustainable development from a psychological and neurobiological perspective. Johannes Sedlmeir is a researcher on information systems at the FIM Research Center, University of Bayreuth. In his research, he focuses on the energy consumption and performance benchmarking of different blockchains, the application of cryptographic methods such as zero-knowledge proofs for scalable and privacy-oriented blockchain solutions in different sectors, and decentralized digital identities. He received his M.Sc. in theoretical and mathematical physics. Gilbert Fridgen is professor and PayPal-FNR PEARL chair in digital financial services at the Interdisciplinary Centre for Security, Reliability and Trust (SnT) at the University of Luxembourg. In his research, he analyzes the transformative effects of digital technologies on individual organizations and on the relationship between organizations. He addresses potentially disruptive technologies like blockchain, decentralized digital identities, artificial intelligence, or the Internet of Things. His research involves information systems engineering and IT strategy and (risk) management, as well as regulatory compliance. In his projects and partnerships, he collaborates with partners in financial services, energy, mobility, manufacturing, and consulting, as well as with public bodies and governments.

Integration of geriatric assessment in cancer care for senior adults during COVID-19 pandemic.

e24027 Background: Older patients with cancer are particularly vulnerable, and the risk of mortality and morbidity during this pandemic is high. Comprehensive geriatric assessment (CGA) helps in predicating toxicity and improve outcomes. SAOP3 is validated geriatric screening tool that can efficiently identify deficits in different GA domains. It was developed to determine when a multidisciplinary team consultation with GA-intervention is required. Methods: We performed a retrospective review of institutional cancer registry. We compared 2 groups of cancer patients ≥ 70 years old who completed SAOP3 questionnaire in the pre-COVID (9/1/2019- 3/10/2020) and during the pandemic period (3/11/2020-12/31/2020). Fisher’s exact test was used to statistical analysis. Analytical models were adjusted for age, cancer histology, stage, therapy type, and GA variables. Results: 951 patients were included (499 prepandemic,452 during pandemic). Median age was 76.6 yrs. (range = 71-86). A 50.7% male, 48.3% female and 34% (323) have metastatic disease. The capture and completion rate of SAOP3 were 82% (779) and 86% (817) respectively. There was a significant psychosocial impairment during the pandemic. More patients were feeling depressed 26% (118) during Vs. 3% (15) prior pandemic (P < 0.001). The caregiver availability was different with 47% (212) during pandemic compared to 52% (259) in pre-pandemic (P = 0.0013). There was a statistically significant difference in the fall history with 4% (20) in pre-, in contrast to 10% (45) during pandemic (P = 0.003). There was a numerical difference in the cognitive impairment during the pandemic in compared to the pre-COVID [34% (171), 52% (235) respectively], but it was not statistically significant (P = 0.154). There was no difference observed in nutritional domains between the two groups. Conclusions: Data regarding patients’ domains of a CGA are crucial for optimal care. Screening with the SAOP3 questionnaire captured significant changes in CGA domains associated with the pandemic. These findings also suggest that Integration of high-yield brief geriatric screening tools such as SAOP3 is feasible in busy practice during the pandemic. It can help identify specific impairment of older cancer patients and trigger appropriate interventions to improve the quality of life and clinical outcomes.

Partnering with immigrant families to promote language justice and equity in education.

Despite USfederal legislation mandates institutions to provide meaningful access and participation to students and families in educational settings, culturally and linguistically diverse (CLD) families and caregivers of children in special education experience cultural and linguistic barriers. A Community Advisory Team (CAT) of parents, advocates, community interpreters and translators, researchers, and teachers explored CLD families' experiences and advocacy efforts. Critical bifocality and circuits of dispossession, privilege, and resistance informed the documentation of inequities and resistance to understand the linkages of structural arrangements of power. Focus groups with families (n = 21) speakers of Spanish, Portuguese, and Cantonese were conducted. Findings indicate perceived discrimination, poor and inadequate interpretation and translation services impact children's access to special education services, hinder family's communication with schools and reduce the perceptions of schools as trustworthy institutions. Families advocate relentlessly for their children and recommend schools listen to families and hire culturally and linguistically competent interpreters and translators. Community psychologists can make significant contributions to promote language justice in education settings through participatory approaches to inquiry that value CLD families' knowledge and expertise.

Clinical Impact of Heart Team Decisions for Patients With Complex Valvular Heart Disease: A Large, Single-Center Experience.

BackgroundA multidisciplinary approach might be pivotal for the management of patients with valvular heart disease (VHD), but clinical outcome data are lacking.Methods and ResultsAt our institution, since 2014, internal guidelines recommended heart team consultations for patients with VHD. The clinical/echocardiographic characteristics, treatment recommendations, performed treatment, and early clinical outcomes of consecutive, hospitalized patients with VHD undergoing heart team evaluation were collected. Surgical risk was prospectively assessed by the EuroSCORE II and STS‐PROM. The primary end point of the study was early mortality. A total of 1004 patients with VHD with high clinical complexity (mean age, 75 years; mean EuroSCORE II, 9.4%; mean STS‐PROM, 5.6%; 48% ischemic heart disease; 29% chronic kidney disease, 9% oncologic/hematologic diseases) were enrolled. The heart team recommended an interventional treatment for 807 (80%) patients and conservative management for 197 (20%) patients. Management crossovers occurred in only 5% of patients. The recommended intervention was cardiac surgery for 230 (23%) patients, percutaneous treatment in 516 (51%) patients, and hybrid treatment in 61 (6%) patients. Early mortality occurred in 24 patients (2.4%) and was independently predicted by aortic stenosis, left ventricular ejection fraction, pulmonary artery systolic pressure, and conservative management recommendation. In patients referred to treatment, observed early mortality (1.7%) was significantly lower (P<0.001) than expected on the bases of both the STS‐PROM (5.2%) and EuroSCORE II (9.7%).ConclusionsWithin the limitations of its single‐center and observational design, the present study suggests that heart team–based management of patients with complex VHD is feasible and allows referral to a wide spectrum of interventions with promising early clinical results.

Pilot Remote Video Restorative Consultation Clinics at the Eastman Dental Hospital – An Evaluation of User Experiences

Hospital-based face-to-face patient consultations in dentistry have traditionally been undertaken with patients traveling to the hospital. Digital technology has revolutionized patient care by improving access bringing benefits to patients. This pilot project evaluated the effectiveness of using digital platforms for dental patient consultations for patients referred to the Eastman Dental Hospital. Eleven general dental practitioners (GDPs) took part in the pilot which ran for 6 months. Two clinics using Attend Anywhere where patients were seen for consultation and Microsoft Teams where the patient referral was used for a second opinion discussion with the GDP. All patients and GDPs consented to participate and had their data shared with the other GDPs in the second clinic. Predesigned feedback questionnaires were sent to the GDPs, consultant team, and patient feedback was sought via a structured telephone conversation after the clinic. Fifteen patients participated with six being seen in the first clinic and nine in the second clinic. The feedback was positive from all patients and GDPs who participated in both clinics with consultant feedback stating that there were no issues with providing a diagnosis and treatment plan to the patient and GDP. Within the limitations of this pilot, the positive feedback from all users suggests that a digital platform for patient consultation and second opinion is effective in conducting consultations. This new way of working would reduce waiting times, expedite the start of treatment, and improve user access to care by improving GDPs confidence in managing patients.

Survey of sarcoma surgery principles among orthopaedic oncologists

BackgroundSurgical principles and techniques used during primary sarcoma excision focus on acquiring negative margins, reducing the risk of local recurrence, and minimizing contamination. These principles and techniques within orthopaedic oncology are not well documented in the literature. No standardized surgical hand-off or approach to education across disciplines on orthopaedic oncology principles and techniques has been published. Currently, education on intraoperative approaches is passed down by oral tradition. ObjectivesOur objective was to survey members of the Musculoskeletal Tumor Society (MSTS) to identify their core principles and practices in orthopaedic oncology. We aimed to 1) provide descriptive analyses of surgeon technique patterns; 2) determine correlations between individual practice patterns; and 3) identify distinct clusters of surgeons on the basis of common practice tendencies. MethodsA web-based, 16-question survey regarding orthopaedic oncology intraoperative principles and techniques was distributed online to all 349 members of the MSTS in 2021. There were 137 (39%) unique respondents, all of whom completed the entire survey. The 16 survey questions were grouped into 4 key aspects of sarcoma excision: pre-incision, exposure of the mass, delivery of the mass, and closure. The questions inquired about respondent preference on draping, back table setup, instrument use, and intraoperative decision making. These questions were selected on the basis of existing reports, as well as the senior author's experience. We analyzed the responses using 3 methods: 1) descriptive statistics, 2) correlations between question responses, and 3) clustering analysis. We used an artificial intelligence–based clustering algorithm to cluster respondents according to their practice patterns. The results of our correlation analyses are reported as Spearman's rho (ρ) correlation coefficients. ResultsMost respondents (mean, 71%; standard deviation, 22%) reported using the described surgical techniques “most of the time” or “in all cases.” A strong positive correlation was found between respondents who answered “yes” to both of the following questions: “Do you change your surgical gloves after passing off the tumor specimen?” and “Does your entire surgical team change their gloves after passing off the tumor specimen?” (ρ = 0.88). A moderate positive correlation was found between those who answered “yes” to both of the following questions: “Do you change your surgical gloves after passing off the tumor specimen (i.e., prior to closure)?” and “Do you use new and/or unused surgical instruments for the final closure?” (ρ = 0.60). The cluster analysis identified 3 distinct clusters of respondents. The conservative technique cluster (N = 42) was more likely to answer “yes” to 9 of the 10 questions regarding incision management, consultant team communication, gloving, and instrument use, whereas the permissive technique cluster (N = 41) was more likely to answer “no” to questions regarding gloving, draping, and instrument use. ConclusionsOur findings indicate that most respondents perform the surveyed techniques, and there is homogeneity in the practice patterns of members of the MSTS; however, we identified distinct clusters of respondents who were significantly more likely to perform certain techniques. These results support establishing a standardized set of intraoperative techniques and formal surgical education regarding intraoperative principles and techniques in orthopaedic oncology.

Improving individualized prescription in patients with multimorbidity through medication review

BackgroundOlder patients tend to have multimorbidity, represented by multiple chronic diseases or geriatric conditions, which leads to a growing number of prescribed medications. As a result, pharmacological prescription has become a major concern because of the increased difficulties to ensure appropriate prescription in older adults. The study’s main objectives were to characterize a cohort of older adults with multimorbidity, carry out a medication review and compare the pharmacological data before and after the medication review globally and according to the frailty index.MethodsThis was a quasi-experimental (uncontrolled pre-post) study with a cohort of patients ≥ 65 years old with multimorbidity. Data were collected from June 2019 to October 2020. Variables assessed included demographic, clinical, and pharmacological data, degree of frailty (Frail-VIG index), medication regimen complexity index, anticholinergic and or sedative burden index, and monthly drug expenditure. Finally, a medication review was carried out by an interdisciplinary team (primary care team and a consultant team with a geriatrician and a clinical pharmacist) by applying the Patient-Centered Prescription model to align the treatment with care goals.ResultsFour hundred twenty-eight patients were recruited [66.6% women; mean age 85.5 (SD 7.67)]. The mean frail index was 0.39 (SD 0.13), corresponding with moderate frailty. Up to 90% of patients presented at least one inappropriate prescription, and the mean of inappropriate prescriptions per patient was 3.14 (SD 2.27). At the three-month follow-up [mortality of 17.7% (n = 76)], the mean chronic medications per patient decreased by 17.96%, varying from 8.13 (SD 3.87) to 6.67 (SD 3.72) (p < 0.001). The medication regimen complexity index decreased by 19.03%, from 31.0 (SD 16.2) to 25.1 (SD 15.1), and the drug burden index mean decreased by 8.40%, from 1.19 (SD 0.82) to 1.09 (SD 0.82) (p < 0.001). A decrease in polypharmacy, medication regimen complexity index, and drug burden index was more frequent among frail patients, especially those with severe frailty (p < 0.001).ConclusionsAn individualized medication review in frail older patients, applying the Patient-Centered Prescription model, decreases pharmacological parameters related to adverse drug effects, such as polypharmacy, therapeutical complexity, and anticholinergic and, or sedative burden. The benefits are for patients with frailty.

A Pilot Study of the Effects on an Inpatient Geriatric Consultation Team on Geriatric Syndrome Patients.

PurposeTo evaluate the effect of comprehensive geriatric assessment performed by an inpatient aging consultation team on older patients with geriatric syndromes.MethodsFifty-nine patients with ≧65 years, Barthel Index score ≦60, at least one geriatric syndrome, and admitted to non-geriatric wards were enrolled. By their preference, 16 were in the intervention group with comprehensive geriatric assessment and instructions from the consultation team. And 43 were in the control group, receiving standard care from non-geriatric-specialist physicians. Outcomes were readmission and mortality within one year after discharge.ResultsThe mean age of the intervention and control groups was 78.35 (8.54) and 80.23 (6.36) years (p = 0.36), with female of 62.5% and 60.5%, respectively. Compared to control, intervention is not significantly associated with attenuated risk for readmission (adjusted hazard ratio (aHR): 0.256, 95% confidence interval (CI): 0.12–1.78, p = 0.256) and mortality (aHR: 2.13, 95% CI: 0.29–15.7, p = 0.457) within one year after discharge. Multivariate analysis showed that patients with a fall history ≧1 in the past one year had a lower risk of readmission (aHR: 0.28, 0.07–0.6, p = 0.004) or mortality (aHR: 0.11, 95% CI: 0.01–0.97, p = 0.047), and disability is associated with mortality (aHR: 5.37, 95% CI: 0.87–33.12, p = 0.07).ConclusionIntervention is not significantly associated with outcomes in our pilot study. But fall history ≧1 in the recent one year is associated with a lower risk of readmission and mortality among all included patients. More participants and longer follow-up are needed for better elucidation.

Effects of a Problem-Solving Team Consultation on the Problem-Solving Process: An Evaluation of Concept Knowledge, Implementation Integrity, and Student Outcomes

ABSTRACT We examined the outcomes of elementary school-based problem-solving teams (PSTs) who participated in a multi-component consultation focused on enhancing systematic problem solving. Consultation provided to each PST included training in the use of a problem-solving protocol (i.e., Outcomes: Planning Monitoring, and Evaluating [Outcomes: PME]) and subsequent performance feedback and training regarding team use of the protocol. A train-the-trainer model was used whereby researchers trained school psychologists to deliver the intervention and serve as coaches on the PSTs. At baseline, all three PSTs demonstrated low (i.e., <50%) problem-solving procedural integrity (i.e., the degree to which critical components of the problem-solving process were implemented), often scoring lowest for problem-solving components related to data collection and analysis (e.g., treatment integrity, progress monitoring, and pre-post intervention data). Each PST demonstrated increased problem-solving integrity following implementation of the first intervention component, problem-solving information and Outcomes: PME training. Procedural integrity also increased for the two PSTs that received the second intervention component, performance feedback. An increase in procedural integrity was not found for one PST that received the third intervention component, targeted consulting; however, data collection was incomplete. Results are discussed in terms of future research priorities to examine consultation that promotes the use of quality team problem-solving components.

Donald Edward Moggridge (1943–2021)

Donald Edward Moggridge (1943–2021)

Implementation of diabetes care and educational program via telemedicine in patients with COVID-19 in home isolation in Thailand: A real-worldexperience.

BackgroundThe coronavirus disease (COVID‐19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self‐management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home‐isolated patients with COVID‐19 infection.MethodsA retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed.ResultsA volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high‐risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same‐day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE® platform) to assess the patient's clinical status and need. Real‐time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin‐naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home.ConclusionDiabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID‐19 pandemic was safe and effective.

Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO): process of adapting collaborative care for co-occurring opioid use and mental disorders

BackgroundOpioid use disorders (OUD), co-occurring with either depression and/or PTSD, are prevalent, burdensome, and often receive little or low-quality care. Collaborative care is a service delivery intervention that uses a team-based model to improve treatment access, quality, and outcomes in primary care patients, but has not been evaluated for co-occurring OUD and mental health disorders. To address this treatment and quality gap, we adapted collaborative care for co-occurring OUD and mental health disorders.MethodsOur adapted model is called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO). We used the five-step Map of Adaptation Process (McKleroy in AIDS Educ Prev 18:59–73, 2006) to develop the model. For each step, our stakeholder team of research and clinical experts, primary care partners, and patients provided input into adaptation processes (e.g., adaptation team meetings, clinic partner feedback, patient interviews and beta-testing). To document each adaptation and our decision-making process, we used the Framework for Reporting Adaptations and Modifications-Enhanced (Wiltsey Stirman in Implement Sci 14:1–10, 2019).ResultsWe documented 12 planned fidelity-consistent adaptations to collaborative care, including a mix of content, context, and training/evaluation modifications intended to improve fit with the patient population (co-occurring disorders) or the New Mexico setting (low-resource clinics in health professional shortage areas). Examples of documented adaptations include use of community health workers as care coordinators; an expanded consultant team to support task-shifting to community health workers; modified training protocols for Problem-Solving Therapy and Written Exposure Therapy to incorporate examples of treating patients for depression or PTSD with co-occurring OUD; and having care coordinators screen for patients’ social needs.ConclusionsWe completed the first three steps of the Map of Adaptation Process, resulting in a variety of adaptations that we believe will make collaborative care more acceptable and feasible in treating co-occurring OUD and mental health disorders. Future steps include evaluating the effectiveness of CLARO and documenting reactive and/or planned adaptations to the model that occur during its implementation and delivery.Trial registration NCT04559893, NCT04634279. Registered 08 September 2020, https://clinicaltrials.gov/ct2/show/NCT04559893

Multidisciplinary Consulting Team for Complicated Cases of Neurodevelopmental and Neurobehavioral Disorders: Assessing the Opportunities and Challenges of Integrating Pharmacogenomics into a Team Setting.

Neurodevelopmental disorders have steadily increased in incidence in the United States. Over the past decade, there have been significant changes in clinical diagnoses and treatments some of which are due to the increasing adoption of pharmacogenomics (PGx) by clinicians. In this pilot study, a multidisciplinary team at the Arkansas Children’s Hospital North West consulted on 27 patients referred for difficult-to-manage neurodevelopmental and/or neurobehavioral disorders. The 27 patients were evaluated by the team using records review, team discussion, and pharmacogenetic testing. OneOme RightMed® (Minneapolis, MN, USA) and the Arkansas Children’s Hospital comprehensive PGx test were used for drug prescribing guidance. Of the 27 patients’ predicted phenotypes, the normal metabolizer was 11 (40.8%) for CYP2C19 and 16 (59.3%) for CYP2D6. For the neurodevelopmental disorders, the most common comorbid conditions included attention-deficit hyperactivity disorder (66.7%), anxiety disorder (59.3%), and autism (40.7%). Following the team assessment and PGx testing, 66.7% of the patients had actionable medication recommendations. This included continuing current therapy, suggesting an appropriate alternative medication, starting a new therapy, or adding adjunct therapy (based on their current medication use). Moreover, 25.9% of patients phenoconverted to a CYP2D6 poor metabolizer. This retrospective chart review pilot study highlights the value of a multidisciplinary treatment approach to deliver precision healthcare by improving physician clinical decisions and potentially impacting patient outcomes. It also shows the feasibility to implement PGx testing in neurodevelopmental/neurobehavioral disorders.

Three-dimensional QCA-based vessel fractional flow reserve (vFFR) in Heart Team decision-making: a multicentre, retrospective, cohort study

ObjectivesTo evaluate the feasibility of three-vessel three-dimensional (3D) quantitative coronary angiography (QCA)-based fractional flow reserve (FFR) computation in patients discussed within the Heart Team in whom the treatment decision was...

Bioabsorbable polymer drug-eluting stents with 4-month dual antiplatelet therapy versus durable polymer drug-eluting stents with 12-month dual antiplatelet therapy in patients with left main coronary artery disease: the IDEAL-LM randomised trial.

Improvements in drug-eluting stent design have led to a reduced frequency of repeat revascularisation and new biodegradable polymer coatings may allow a shorter duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). The Improved Drug-Eluting stent for All-comers Left Main (IDEAL-LM) study aims to investigate long-term clinical outcomes after implantation of a biodegradable polymer platinum-chromium everolimus-eluting stent (BP-PtCr-EES) followed by 4 months DAPT compared to a durable polymer cobalt-chromium everolimus-eluting stent (DP-CoCr-EES) followed by 12 months DAPT in patients undergoing PCI of unprotected left main coronary artery (LMCA) disease. This is a multicentre randomised clinical trial study in patients with an indication for coronary artery revascularisation who have been accepted for PCI for LMCA disease after Heart Team consultation. Patients were randomly assigned in a 1:1 ratio to receive either the BP-PtCr-EES or the DP-CoCr-EES. The primary endpoint was a non-inferiority comparison of the rate of major adverse cardiovascular events (MACE), defined as all-cause death, myocardial infarction, or ischaemia-driven target vessel revascularisation at 2 years. Between December 2014 and October 2016, 818 patients (410 BP-PtCr-EES and 408 DP-CoCr-EES) were enrolled at 29 centres in Europe. At 2 years, the primary endpoint of MACE occurred in 59 patients (14.6%) in the BP-PtCr-EES group and 45 patients (11.4%) in the DP-CoCr-EES group; 1-sided upper 95% confidence interval (CI) 7.18%; p=0.04 for non-inferiority; p=0.17 for superiority. The secondary endpoint event of BARC 3 or 5 bleeding occurred in 11 patients (2.7%) in the BP-PtCr-EES group and 2 patients (0.5%) in the DP-CoCr-EES group (p=0.02). In patients undergoing PCI of LMCA disease, after two years of follow-up, the use of a BP-PtCr-EES with 4 months of DAPT was non-inferior to a DP-CoCr-EES with 12 months of DAPT with respect to the composite endpoint of all-cause death, myocardial infarction or ischaemia-driven target vessel revascularisation.

Reflections on the guidelines proposed by the American Psychoanalytic Association Covid-19 Advisory Team on returning to in-person treatment

This essay reflects on the guidelines proposed by the American Psychoanalytic Association Covid-19 Advisory team on returning to in-person clinical practice, the implications of the guidelines for the practice of psychoanalysis during the pandemic and beyond, as well as what is at stake when psychoanalysts become compliant with the authority of established norms. (Author&#8217;s own translation)

758 Constant evolution: Early experiences treating COVID-19 in a burn center

IntroductionThe COVID-19 pandemic came as an unexpected challenge to many healthcare systems around the world. Many centers struggled to provide COVID-19 ICU-level care while also maintaining adequate care for non-COVID-19-related conditions, especially in critical care specialty units like trauma and burn. We present a case series of our early experiences treating COVID-19 in a burn center.MethodsWe present a case.ResultsSee Table 1. Though one case was admitted prior to initiation of universal testing, routine infection-control protocols limited exposure to personnel and prevented transmission to staff. In May 2020, we implemented the use of N95 mask and eye protection during all aerosolizing procedures, N95 mask use in all ORs, and universal surgical mask use in all rooms regardless of COVID-19 status. An in-house risk-stratification system was used to screen patients based on symptoms and exposure. Burn-center admissions were screened at a lower threshold than throughout the institution given the unique nature of burn injury. Eventually, because of increasing community spread, all admissions to the hospital were universally screened with RT-PCR prior to admission. To minimize exposure to non-COVID patients and Burn Center staff, COVID-19 positive burn admissions were assessed on a case-by-case basis. High acuity patients were admitted to the Burn Center and followed by the COVID consult team. Lower acuity patients were admitted to the Burn Center but were treated on the medical COVID unit and followed by the burn consult service.ConclusionsThe COVID 19 pandemic has strained healthcare systems worldwide. Development and implementation of universal screening, testing, infection-control precautions, and triage strategies are critical elements of burn care during the COVID-19 pandemic. As we prepare for future surges due to more transmissible variants, implementation of standard protocols enables continued provision of quality care, preservation of the healthcare workforce, and efficient use of resources.

Perceptions on handling of opioids: focus COVID-19 : A survey among anesthesiologists via the specialist societies DGAI/BDA

HintergrundOpioide gehören zum Klinikalltag in Anästhesiologie, Intensivmedizin und Palliativmedizin. Hinsichtlich der Behandlung von Dyspnoe mit Opioiden finden sich in Leitlinien jedoch unterschiedliche Gewichtungen. Dies kann zu Unsicherheiten bezüglich Indikationsstellung und ethischer Implikationen im Umgang mit Opioiden – auch bei COVID-19 – führen.Ziel der ArbeitErfassung der Wahrnehmung bezüglich Umgang mit Morphin/Opioiden (M/O) zur Symptomkontrolle inner- und außerhalb der Palliativmedizin, auch bei COVID-19-Erkrankten.Material und MethodenMittels SurveyMonkey® (Momentive Inc., San Mateo, CA, USA) wurden Mitglieder der Deutschen Gesellschaft für Anästhesiologie (DGAI) und des Berufsverbands Deutscher Anästhesisten (BDA) im Oktober 2020 anonymisiert nach ihrer eigenen Wahrnehmung zum Umgang mit M/O zur Symptomkontrolle befragt.Ergebnisse und DiskussionVon N = 1365 teilnehmenden Anästhesist:innen beschrieben 88 % den Umgang mit M/O innerhalb der Palliativmedizin als „sicher und vertraut“ bzw. 85 % als „klar geregelt“, während dies für die Bereiche außerhalb der Palliativmedizin deutlich seltener angegeben wurde (77 %/63 %). Bei der Betreuung COVID-19-Erkrankter wurde der Umgang mit M/O außerhalb der Palliativmedizin noch seltener als „sicher und vertraut“ (40 %) oder „klar geregelt“ (29 %) wahrgenommen. Dyspnoe (95 %/75 %), Erleichterung des Sterbeprozesses (84 %/51 %), Unruhe (59 %/27 %) und Angst/Panik (61 %/33 %) wurden häufiger innerhalb als außerhalb der Palliativmedizin als allgemeine Indikationen genannt. Von den Befragten wünschten sich 85 % die Einbindung eines palliativmedizinischen Konsilteams.FazitAnästhesist:innen nahmen deutliche Unsicherheiten im Umgang mit M/O wahr, insbesondere außerhalb der Palliativmedizin. Einheitliche, interdisziplinäre Leitlinien zur Symptomkontrolle etwa bei Dyspnoe, mehr Lehre und die Einbindung eines palliativmedizinischen Konsilteams sollten zukünftig intensiver bedacht werden.

A critique of the EIA Report selected from the East African region, taking into consideration what is required in an ideal of EIA Report

At present, every country strives to realize development for its people. Therefore, to achieve this requires the construction of various projects for the realization of a country's socio-economic and political development. However, the development of the projects is associated with various ecological challenges that can have an impact on society as a whole and the environment. Therefore, there is a need to conduct an environmental impact assessment (EIA), a tool that can be used to determine the environmental, social and economic impacts of a project before making a decision. The EIA process is linked to the detailed report containing all possible environmental, social and health impacts after, during and after the project. Therefore, this paper aims to deliver the critique of one of the EIA reports in the East African region. To achieve this, EIA legislation and guidelines for preparing and verifying EIA reports in the East African region will be examined. The critique contains the issues that include the advisory team (environmental and social impact assessment team), an executive or non-technical summary, a description of the proposed project, a description of the development, the local environment and initial conditions, the political, legal and administrative framework, and public participation/stakeholder analysis in the EIA process.