Number Of Treatment Interventions Research Articles

Adherence to a Hypoglycemia Protocol in Hospitalized Patients: A Retrospective Analysis.

Hypoglycemia can be a common occurrence in hospitalized patients, both those with and without diabetes. Hypoglycemia poses significant risks to hospitalized patients, including increased mortality. This was a retrospective pre-post study of hypoglycemic patients in an academic medical center of an intervention to improve timely staff nurse adherence to a hypoglycemia protocol. The number of mild and severe hypoglycemia events pre- and postintervention, timeliness of adherence to the hypoglycemia protocol, the number of treatment interventions, and time to return patients to euglycemia were analyzed. Data from hospitalizations of patients who experienced hypoglycemia (<70 mg/dl) and met inclusion criteria 1 year prior to intervention and 3 years postintervention were extracted, including demographics, glycemic control medications, diagnostic-related group, length of stay, and Charlson comorbidity index. For clarity and to determine if any significant change was sustained, the analysis compared data from 1 year prior to intervention to the second-year postintervention. A total of 7,895 unique hypoglycemic events in 3,819 patients experiencing 20,094 hypoglycemic measures were included in the analysis. Patients were primarily adult, female, and White. Only 58.7% of the sample had diabetes; the median Charlson comorbidity index was 6. Results demonstrated improvement postintervention to registered nurse hypoglycemia protocol adherence regardless of age category or hypoglycemia severity. There was a significant reduction in median time from the first hypoglycemia measure to the second measure. In addition, there was a significant difference in the number of treatment interventions and reduction in time from the first hypoglycemia measure to return of patient to a blood glucose of ≥70 mg/dl. These study results support that the use of a standardized hypoglycemia protocol and appropriate nurse workflows enables nurses to manage hypoglycemia promptly and effectively in most acute and critically ill hospitalized patients. Results also supported a differentiation in nurse workflow for patients with mild versus severe hypoglycemia. Implementing these interventions may result in avoidance or mitigation of the potential consequences of severe and/or sustained hypoglycemia.

Hippocampus subfield volumetry after microsurgical or endovascular treatment of intracranial aneurysms\u2014an explorative study

BackgroundTo study hippocampus subfield volumes in patients after microsurgical clipping (MC) and/or endovascular coiling (EC) of intracranial aneurysms.MethodsHippocampus subfield volumetry was performed using FreeSurfer v6.0 in 51 patients (35 females, mean age 54.9 ± 11.9 years, range 24–78 years). Visual inspection of image and segmentation quality was performed prior to statistical analyses. Multiple regression analysis, controlled for age, sex, and side of treatment, was used to assess the impact of prior MC and history of subarachnoid haemorrhage (SAH) on hippocampus subfield volumes (cornu ammonis (CA)-2/3, CA-4, subiculum). Partial correlation analyses were used to assess effect of multiple treatments on hippocampus subfield volumes.ResultsPrior MC was significantly associated with lower hippocampal subfield volumes in MC patients for right and left CA-2/3 (β = -22.32 [-40.18, -4.45]; p = 0.016 and β = -20.03 [-39.38, -0.68]; p = 0.043) and right CA-4 (β = -17.00 [-33.86, 0.12]; p = 0.048). History of SAH was not significantly associated with hippocampal subfield volumes. We observed a higher disease burden in the MC cohort. The number of aneurysms correlated with right-sided hippocampal subfield volumes while the number of treatment interventions did not.ConclusionIn this explorative study, we found that history of MC was significantly associated with lower volumes in distinct hippocampal subfields, which may be a consequence of a more extensive treatment. This could indicate specific atrophy of CA-2/3 after MC and should motivate hippocampal subfield assessment in larger cohorts.

Heart Transplantation for Hypertrophic Cardiomyopathy: The Tufts Experience

Background: Heart transplant has increasingly become an important treatment option for patients with a variety of end-stage cardiac diseases, including nonobstructive HCM. Details specifically related to the transplant experience in patients with HCM remain sparse, and current proposed allocation schemes may not adequately risk stratify this unique patient population. Therefore, we have evaluated our experience with heart transplantation in a large cohort of HCM patients. Methods: This analysis reviewed our 15-year experience with HCM patients evaluated for heart transplant, from 2002 to 2016, at the Tufts Medical Center, Hypertrophic Cardiomyopathy Institute and Cardiac Transplant Center. Results: Fifty-two patients underwent evaluation for transplant at 46 ± 13 years of age, 56% male, each in New York Heart Association functional class III/IV. Eleven of these 52 patients (21%) either declined or did not qualify, most commonly due to comorbidities that prohibited listing (n = 7). The remaining 41 patients were ultimately listed for transplant including 6 who did not meet traditional transplant criteria with peak VO2 > 14 ml/kg/min (and > 50% predicted for age and gender). Of the 41 patients, 6 (15%) died awaiting transplant due to heart failure, with 1- year mortality of 8.4%, 26 underwent heart transplantation, and 9 remain active on the transplant list. Extended survival to transplant in 28 patients (68%) was due to treatment interventions including ventricular assist devices (n = 7) or inotropic medications (n = 20), and 7 (of 33) with implanted defibrillators experienced appropriate device interventions for VT/VF (n = 7). Of the 6 patients listed with peak VO2 > 14 ml/kg/min, 4 required either inotropic medication (n = 3), or ventricular assist device (n = 1) for survival to transplant. Heart transplant was performed in 26, and 2 died within 30 days from primary allograft dysfunction, and 24 (92%) survived to 4.8 ± 3.4 years (range 6 months to 12 years). One patient died 9 years after transplant due to complications related to allograft vasculopathy, while the remaining 23 have survived to date, each in NYHA functional class I. Survival at both1 and 5 years post-transplant was 92%. Conclusions: Mortality in nonobstructive HCM patients listed for transplant is relatively high. A number of treatment interventions are necessary for HCM patients to survive to transplant including primary prevention ICDs and inotropic medications, and in select patients ventricular assist devices. Transplanted HCM patients have excellent short and long-term survival. In patients with nonobstructive HCM the severity of symptoms are not always supported by traditional heart transplant testing (i.e., peak VO2) and thereby the decision to offer transplant should be made on an individual patient basis.

Cumulative Number of Treatment Interventions Predicts Health-Related Quality of Life In Patients With Critical Limb Ischemia

Cumulative Number of Treatment Interventions Predicts Health-Related Quality of Life In Patients With Critical Limb Ischemia

Post-calving administration of uterine stimulants does not improve reproductive performance in dairy cows

The aim of this study was to evaluate the effects of administration of oxytocin, in combination with dinoprost or ergometrin, after parturition on the occurrence of clinical endometritis and subsequent reproductive performance in dairy cows. The cows, without retained foetal membranes, were assigned to one of three groups. No treatment was performed in the control group (Group C, n = 229). However, intramuscular administrations of oxytocin (30 IU) on Days 1 and 2 post partum, in combination with dinoprost (25 mg, Group D, = 123) or ergometrin (15 mg, Group E, n = 130) administered on Day 7 post partum, were performed in experimental groups. Vaginal discharge score (VDS, 1-5), uterine content score (UCS, 1-3) on Day14 to 21 post partum, number of treatment interventions (TI), proportion of non-treated cows (NT) because of endometritis, calving to first insemi - nation interval (CI), first insemination conception rate (CR), and proportion of pregnant cows by Day 150 post partum (PC), were compared among groups. There was no significant difference among groups for any parameter. Average values were 2.08, 2.24 and 2.06 (VDS); 1.49, 1.51 and 1.45 (UCS); 0.86, 0.93 and 0.74 (TI); 59.4, 54.2 and 54.7% (NT); 73.9 ± 15.2, 75.4 ± 17 and 74.2 ± 17 days (CI); 41.4, 38.9 and 44.3% (CR); and 75.4, 77.7 and 80.5% (PC) for Groups C, D and E, respectively. There was no significant benefit of preventive administration of oxy - tocin, in combination with dinoprost or ergometrin, after parturition on reproductive performance in dairy cows.

Understanding and Treating Procrastination: A Review of a Common Self-Regulatory Failure

Procrastination is a pervasive self-regulatory failure affecting approximately one-fifth of the adult population and half of the student population. It is defined as one’s voluntarily delay of an intended course of action despite being worse off as a result of that delay. Procrastination has a negative impact on performance and is associated with poorer mental health. Stress, worry, and feelings of guilt are common among those who procrastinate recurrently. In addition, procrastination is associated with fewer mental health-seeking behaviors and increased treatment delay, leading to greater distress and the exacerbation of illness. The current paper seeks to provide a theoretical and clinical understanding of procrastination by reviewing prior research. Procrastination can be understood using different motivational theories, learning theory, self-efficacy theory, as well as biases and heuristics. Temporal motivational theory is proposed as an integrated explanation for procrastination, consisting of the interaction of four different variables: expectancy, value, impulsiveness, and time, each of which affects the tendency to procrastinate. A general implication is that procrastination should be regarded as an idiosyncratic behavioral problem that requires a cognitive case conceptualization or a functional analysis in order to guide therapists in their work. A number of treatment interventions might be used in relation to procrastination—for example, efficacy performance spirals, automaticity, stimulus control, stimulus cues, learned industriousness, and cognitive restructuring. Furthermore, the current paper explores the evidence on using cognitive behavior therapy for procrastination, discussing the scarcity of randomized controlled trials and the lack of validated outcome measures, and highlighting the need for further research.

Management and treatment efficacy of drug and alcohol problems: what do doctors believe?

We conducted a survey of the attitudes of postgraduate medical trainees in Australia on the management of drug and alcohol problems and examined the medical practitioner's role in managing drug and alcohol problems, factors influencing prognosis and beliefs about the efficacy of a number of treatment interventions. Of 2461 trainees enrolled in specialty training programmes in internal medicine, psychiatry and general practice 1361 (55%) participated. There was a high level of acceptance of responsibility for management of alcohol and drug problems, with the strongest support observed among psychiatry trainees. However, views of the efficacy of various treatment interventions were less positive. Alcoholics Anonymous was considered to be an approach well supported by the research literature. Dynamic psychotherapy was less well supported, and there was considerable uncertainty about the evidence for brief advice and cognitive-behaviour therapies. The opinions expressed on treatment efficacy were in many cases in striking contrast to the research evidence. The implications for future training in drugs and alcohol in specialty programmes are discussed.

Relational Therapy for Personality Disorders

Back to table of contents Previous article Next article Book Forum: PsychotherapiesFull AccessRelational Therapy for Personality DisordersGLEN O. GABBARD, M.D., GLEN O. GABBARDSearch for more papers by this author, M.D., Topeka, Kan.Published Online:1 Feb 2001https://doi.org/10.1176/appi.ajp.158.2.334-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The unsuspecting reader may assume that the “relational therapy” referred to in the title of this book is a variant of relational psychoanalysis, the increasingly popular theoretical school deriving from the work of Stephen Mitchell, Lewis Aron, and others. However, Jeffrey Magnavita uses “relational therapy” to refer to integrative relational psychotherapy, a model of conceptual understanding and treatment that leans heavily on familiar theories of family systems. To his credit, Magnavita avoids the frequent problem of reductionism by fully acknowledging the necessity of thinking in biopsychosocial terms. Genetic factors and temperament are taken into account. He also values psychodynamic thinking in understanding how early attachment relationships create patterns of internal object relations that are played out within family systems. He reviews much of the existing literature on personality disorders in a scholarly fashion and comes up with his own classification of dysfunctional personological systems. The subtypes involved in this taxonomy take some getting used to. For example, the paranoid dysfunctional personological system is abbreviated as “Par Dps,” the somatic dysfunctional personological system is abbreviated “Som Dps,” and so forth.The author goes over a number of treatment interventions in a truly pluralistic manner, drawing from many different theoretical schools. Unfortunately, what readers gain in the breadth of the author’s coverage is not matched by the depth of case material. What is sorely lacking in the book is a detailed and extended clinical case that illustrates the author’s method in great detail. The clinical examples provided are quite sketchy and unsatisfying. So the reader is left with headlines but no details. The other major deficiency in the book is lack of any empirical evidence that the approach is useful. Even in the absence of systematic research, the author might have at least outlined a way to study the method that he is proposing.Psychiatrists and other mental health professionals who are interested in family approaches to personality disorders might find this book interesting and useful. However, much more testing of the method is needed before one can endorse broad use of the treatment described.By Jeffrey J. Magnavita. New York, John Wiley & Sons, 1999, 291 pp., $45.00. FiguresReferencesCited byDetailsCited byNone Volume 158Issue 2 February 2001Pages 334-a-335 Metrics History Published online 1 February 2001 Published in print 1 February 2001