Treatment Philosophy Research Articles

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

First-line Medications for the Outpatient Treatment of Alcohol Use Disorder: A Systematic Review of Perceived Barriers.

Alcohol use disorder (AUD) is a common illness with significant health and economic consequences. Although three pharmacotherapeutic agents have been shown to decrease heavy drinking days among individuals with AUD, they are vastly underutilized in clinical practice. The objective of this review was to elucidate barriers that may prevent patients from obtaining medication for addiction treatment (MAT) for AUD in an outpatient or residential setting. Electronic searches of Medline and EMBASE were conducted, and reference lists were hand-searched. All study designs which discussed the use of MAT for AUD in an outpatient or residential setting were eligible for inclusion. Two reviewers independently screened the search output to identify potentially eligible articles, the full texts of which were retrieved and assessed for inclusion. After eliminating duplicate citations and articles that did not meet eligibility criteria, 23 articles were included in the review. Perceived barriers to obtaining pharmacotherapy for the treatment of AUD in an outpatient or residential setting were grouped into 3 themes: lack of knowledge and concerns about efficacy and complexity of prescribing; treatment philosophy and stigma; medication accessibility including formulary restrictions, geographical and socioeconomic barriers. Although evidence-based pharmacotherapeutics have been approved for the treatment of AUD, our findings suggest patients continue to experience barriers to the use of these medications. Efforts should be made to increase rates of prescribing by providers and the use of medications by patients. More research is needed to further elucidate perceived barriers to MAT use, along with strategies to overcome them.

Wirksamkeit und Sicherheit von Home-Treatment in der Kinder- und Jugendpsychiatrie: Eine systematische Literaturübersicht

In child and adolescent psychiatry, home treatment is becoming increasingly important due to limited inpatient care capacities and changing treatment philosophies. This paper examines its effectiveness and safety. We did a systematic literature search and summarized the home treatment model characteristics as well as the evidence on its benefits and harms narratively. In the six identified studies, improvements in symptoms were found in both, home and institutionalized treatment. In the long-term, home treatment seems to be slightly superior and involves fewer hospital days. However, a best-practice model cannot be derived from the data available. Home treatment can be considered as an alternative to inpatient treatment, but requires coordination with other mental health care elements and further evaluation.

Transition of Failed Cement-Retained Prosthesis to Screw-Retained Implant Prosthesis

Prosthesis failures in cement-retained implant restorations can be managed by transforming the restorations into screw-retained prosthesis to meet the current implant treatment philosophies for large full-arch reconstructions. The challenges involved in this case report multiplied due to unavailability of components for older systems of implants and had to be managed with a framework which permits engagement of implant and abutment level connection simultaneously. The case report highlights the transition of failed cement-retained prosthesis to screw-retained prosthesis for predictable future retrievability and enhanced clinical performance.

Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach.

Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.

E-Health Literacy: A Skill Needed in the Coronavirus Outbreak Crisis

The article's abstract is not available.

Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness.

The majority of Palliative Care (PC) clinicians report recently caring for a person with a Substance Use Disorder (SUD). The impact of an untreated SUD is associated with significant suffering but many PC clinicians report a lack of confidence in managing this population. This paper aims to demonstrate existing PC skills that can be adapted to provide primary SUD treatment. A comprehensive literature review was conducted on quality PC domains and core SUD treatment principles. To demonstrate the shared philosophy and skills of PC clinicians and SUD treatment, the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and resources outlining core Addiction Medicine and Nursing Competencies were used. There is an abundance of overlapping domains in PC and SUD treatment. This paper focuses on the domains of communication, team-based care, quality of life considerations, addressing social determinants of health, and adherence to ethical principles. In each section, the shared domain in PC and SUD treatment is discussed and steps to expand PC clinician's skills are provided. PC clinicians may be among the last healthcare touchpoint for persons with SUD, by naming the shared skills required in PC and evidenced-based SUD treatment, we challenge the field to undertake primary SUD treatment as part of its constant pursuit to better serve people living with serious illness.

Swallowing and communication outcomes following primary transoral robotic surgery.

Heterogeneity within studies examining transoral robotic surgery (TORS) for oropharyngeal cancer (OPC) has made it challenging to make clear conclusions on functional outcomes. Infrequent use of instrumental swallow examinations compounds uncertainty surrounding the proposed functional advantage to TORS. A prospective cohort of 49 patients underwent speech and swallowing assessment 12 months following treatment for OPC. Patients were assessed using fibreoptic endoscopic evaluation of swallowing (FEES), clinician- and patient-reported outcomes. Participants were matched according to tumor site, T category, and age. Speech and swallowing outcomes were compared for those receiving TORS versus chemoradiation. When adjuvant radiotherapy to the primary site could be avoided, TORS demonstrated an advantage for feeding tube duration, secretion severity, penetration/aspiration, M. D. Anderson Dysphagia Inventory (MDADI), and airway protection. This explorative study suggests that a treatment philosophy of selecting patients for TORS where adjuvant therapy can be omitted or confined to the neck warrants further evaluation.

The Ethical Defensibility of Harm Reduction and Eating Disorders

Eating disorders are mental illnesses that can have a significant and persistent physical impact, especially for those who are not treated early in their disease trajectory. Although many persons with eating disorders may make a full recovery, some may not; this is especially the case when it comes to persons with severe and enduring anorexia nervosa (SEAN), namely, those who have had anorexia for between 6 and 12 years or more. Given that persons with SEAN are less likely to make a full recovery, a different treatment philosophy might be ethically warranted. One potential yet scarcely considered way to treat persons with SEAN is that of a harm reduction approach. A harm reduction philosophy is deemed widely defensible in certain contexts (e.g. in the substance use and addictions domain), and in this paper we argue that it may be similarly ethically defensible for treating persons with SEAN in some circumstances.

The role of local inpatient psychiatric units and general practitioner on continuity of care in Northern Norway: A case-register study.

ObjectivesThe general practitioners' (GP) role in the care of mental health patients has received increased attention. The literature underlines the need for integration of primary and specialist services, but cross‐boundary continuity for patients with severe conditions may be particularly poor. The aim of this study was to analyze the collaboration between primary care and different models of specialized psychiatric services for patients with severe conditions.MethodsWe compared a local and a centralized model of mental health care. Service utilization over a 5‐year period was studied.ResultsFindings suggest that a local institution‐based model of services positively affects the use of both GP and specialist outpatient care, with most inpatients utilizing both GP and specialist outpatient consultations. In the centralized model, a substantial proportion of inpatients only used GP outpatient care. Furthermore, inpatients that used both GP and specialist outpatient services received more of both services compared to those who did not enter specialist outpatient care at all.ConclusionLocal inpatient units may positively affect continuity of care and collaboration between general practitioners and specialist psychiatric services compared to more traditional hospital units, probably because better functional integration of services, better facilitation of clinical alliances/relationships, or a more network‐oriented treatment philosophy.

A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed.

Introduction: Humeral shaft fractures have traditionally been treated non-operatively due to their good union and low rate of functional impairment. In the recent years, upper extremity fractures and their operative treatment have increased in children. Nevertheless, the trends of humeral shaft fractures are not clear.Materials and Methods: All children aged <16 years, with a humeral shaft fracture in the geographical catchment area of Northern Finland Hospital District, with a yearly child population-at-risk of ~86 000 from the year 2001 until the end of 2015 were included. There were 88 cases, who comprised the study population. Radiographs were available of all. Injury, patient, and treatment characteristics were reviewed from hospital databases.Results: There was an increasing trend of surgical fixation of humeral shaft fractures during the 15 years' study period (β = 1.266, 95% CI 0.17 to 2.36, p = 0.035). However, we found no patient or fracture-related reasons that could have explained the increasing trend of surgical care. Comminuted fracture increased the risk of operative treatment 8-fold (Odds Ratio, OR 7.82, 95% CI 1.69 to 36.3, p = 0.009). Higher age, greater angular deformity or greater diameter of the humerus were not associated with the increased operation risk.Conclusions: The treatment philosophy concerning pediatric humeral shaft fractures has presented a shift from conservative care to surgical fixation. To authors' understanding there is not evidence supporting the increasing rate of osteosynthesis.

The landscape and flux of a minimum network motif, Wu Xing* *Project supported by the National Natural Science Foundation of China (Grant No. 21721003) and the Fund from the Ministry of Science and Technology of China (Grant No. 2016YFA0203200).

Wu-Xing theory is an ancient philosophy that serves as a guiding principle in the traditional Chinese medicine (TCM). It has been used to explain the unbalance among the TCM organ systems in disease states and provide treatment philosophy qualitatively. Until now, it is still a challenge to explore the Wu-Xing theory beyond its philosophical nature. In this study, we established a quantitative framework using the landscape and flux theory to characterize the nature of the Wu-Xing theory from a perspective of a minimal network motif and leave certain specific functional aspects of Wu-Xing theory for future exploration. We uncovered the irregular ring shape of projection landscape for the Wu-Xing network with several local basins and barriers. We found that the dynamics of the self-organized Wu-Xing system was determined by the underlying negative landscape gradient force and the nonequilibrium rotational flux. While the shape of the Wu-Xing landscape determines the stabilities of the states, the rotational flux guarantees the persistent periodic oscillation and the stability of the flow. This provides a physical and quantitative basis for Yin–Yang duality of the driving forces for determining the dynamics and behaviors of the living systems. Applying landscape and flux analysis, we can identify the key parameter for the dynamics/function of Wu-Xing network. These findings allow us to have a deeper understanding of the scientific merits of the ancient Wu-Xing theory from the network motif perspective.

Role of Platform Switching in Success of Dental Implants- A Meta-Analysis

Aim: To analyze through systematic review and meta-analysis of implant failure rates, marginal boneloss (MBL) in patients who received platform-switched implants and platform-matched implants and todetermine literature based evidence.Materials and Methods :Data: Search terms used in combination are dental implant, platform switch, platform mismatch, switchedplatform, implant – abutment design.Sources : An electronic search engine without time/ language restrictions was taken from Google Scholar,Pubmed.Clinical Significance: Platform switching for maintaining peri-implant bone levels has gained popularityover last few years. As philosophies of treatment alter over , a periodic review of different concepts arenecessary to refine techniques thereby forming a basis for optimum treatment.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

S1798 Composite Lymphomas in the Colon: Two Separate Entities, Treated as One

INTRODUCTION: Composite lymphoma (CL) is defined as two histologically distinct variants of malignant lymphoma occurring in the same organ or mass. Our case describes an asymptomatic patient with two extranodal B-Cell lymphomas discovered after routine colonoscopy. Further, we discuss pathogenesis and treatment philosophy of follicular lymphoma and marginal cell lymphoma. CASE DESCRIPTION/METHODS: A 62 year old Japanese female with multiple medical morbidities including cirrhosis and hypothyroidism presented for surveillance colonoscopy. On presentation, patient denied any fever, chills, night sweats, unintentional weight loss, hematochezia, or melena. Colonoscopy revealed multiple sessile polyps, 2−5 mm in size. H&E and immunohistochemical staining of specimens demonstrated grade 3A follicular lymphoma with 100% follicular pattern and positron emission tomography/computed tomography (PET/CT) demonstrating a prominent, isolated pericaval lymph node. Per NCCN guidelines for follicular lymphoma grade 3A, stage II (non-contiguous), observation with follow up PET/CT and colonoscopy was recommended. Repeat colonoscopy after 6 months revealed multiple polyps with demonstrating extranodal marginal zone b-cell lymphoma of Mucosa-Associated Lymphoid Tissue (MALT). The diagnosis of MALT type lymphoma was rendered based on histologic patterns of infiltration, the cellularity of the infiltrate, their locations, presence of clear cells, and immunostaining. Of note, repeat PET/CT was negative for lymphadenopathy. 6 months later, another colonoscopy was performed, and 6 more polyps were biopsied. Histological examination was consistent with tubular adenomas and follicular lymphoid proliferation. Given that she was clinically stable with minimal disease, plan was to continue monitoring with colonoscopy and PET/CT annually. DISCUSSION: CLs are defined as 2 or more morphologically and/or immunophenotypically different components in the same anatomic site. They can arise synchronously or metachronously. CLs are rare, with a frequency ranging from 1 to 4.7% of lymphoma cases. More rarely, CL has seldom been witnessed in the gastrointestinal tract. To our knowledge, this is the first case reporting composite follicular lymphoma and extranodal marginal zone b-cell lymphoma of MALT in the colon. Current literature suggests the components of CLs progress as separate entities and treatment should be focused on the component with the least favorable prognosis.

What You Didn't Know About the Sun: Infrared Radiation and Its Role in Photoaging.

Basia Michalski, BA, is a third-year medical student at the Medical College of Wisconsin, Wauwatosa, WI, with ambitions to pursue a career in Dermatology upon receiving her medical doctorate in the Spring of 2017. Basia is a St. Louis native who attended Washington University in St. Louis and graduated with a BS in French literature and Biology. Her dermatological interests lie in cutaneous oncology and autoimmune disorders of the skin. Edit Olasz, MD, PhD, is an associate professor of Dermatology at the Medical College of Wisconsin. She completed a fellowship at the Dermatology Branch at the National Cancer Institute. She is an expert of aesthetic dermatology, non-surgical facial rejuvenation, aesthetic and laser surgery. She has been invited to numerous national and international meetings to lecture on these topics. Dr Olasz also directs the dermatology resident aesthetic dermatology education. Her cosmetic treatment philosophy stands on four pillars; science, skills, sophistication and safety. Address correspondence to Edit Olasz, MD, PhD, Department of Dermatology, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226 (e-mail: [email protected]). Reprinted from Plastic Surgical Nursing, October-December 2016, vol. 36, no. 4, pp. 170-172. The authors report no conflicts of interest.

Saethre-Chotzen Syndrome: A Report of 7 Patients and Review of the Literature.

Saethre-Chotzen syndrome is a genetic condition characterized by craniofacial and limb anomalies, with craniosynostosis (mainly coronal) being the most frequent craniofacial finding. Cranial and facial deformities can be extremely variable requiring individualization of treatment strategies. We present our case series to highlight clinical findings, treatment philosophy, and challenges facing Saethre-Chotzen patients. A retrospective review was performed on records of patients given a diagnosis of Saethre-Chotzen syndrome at the University of California Los Angeles (UCLA) Craniofacial Clinic (n = 7) between 1980 and 2010. Patients with complete records were included in this study, and review of demographic data, clinical findings, surgical interventions and postoperative follow-up, and stability were performed. Seven patients (1 male and 6 female) were included in this study. The average age at which the patients were first seen was 6.5 years. Suture involvement was bicoronal (n = 6) and unicoronal (n = 1). There was 1 patient having superimposed metopic synostosis, and there was another patient having Kleeblattschädel deformity. Previous procedures performed for patients before establishing care at UCLA were strip craniectomy (n = 2) and fronto-orbital advancement (n = 2). All patients (n = 7) had fronto-orbital advancements at UCLA. Other skeletal operations included the following: redo forehead advancement and contouring (n = 3), monobloc advancement (n = 1), and LeFort III distraction (n = 1). Five patients reached skeletal maturity, and 2 patients received LeFort I advancement for class III malocclusion, one of which also required a bilateral sagittal split osteotomy of the mandible. Clinical presentation and severity of deformity in Saethre-Chotzen syndrome are variable. Our current report reviews our treatment strategies and illustrates the predominance of cranial and upper face deformities and frequent need for redo surgeries to address forehead asymmetry in this group of syndromic craniosynostosis patients.

Alarm Strategies and Surveillance for Mechanical Ventilation.

Clinical alarms, including those for mechanical ventilation, have been one of the leading causes of health technology hazards. It has been reported that < 15% of alarms studied rose to the level of being clinically relevant or actionable. Most alarms in health care, whether by default or intention, are set to a hypothetical average patient, which is essentially a one size fits most approach. A method of tuning to individual patient characteristics is possible, similar to the treatment philosophy of precision medicine. The excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events. All these factors come to bear on human perception and response to mechanical ventilation and clinical alarms. Observations of human response to stimuli suggest that response to alarms is closely matched to the perceived reliability and value of the alarm system. This paper provides a review examining vulnerabilities in the current management of mechanical ventilation alarms and summarizes best practices identified to help prevent patient injury. This review examines the factors that affect alarm utility and provides recommendations for applying research findings to improve safety for patients, clinician efficiency, and clinician well-being.

Violence rate dropped during a shift to individualized patient-oriented care in a high security forensic psychiatric ward

BackgroundContextual variables such as staff characteristics, treatment programs, assessment routines and administrative structures are found to influence patient violence rates in psychiatric forensic wards. The possible effects of current developments in treatment philosophy emphasizing patientsˈ perspective and treatment involvement upon violence rate have not yet been examined. The aim of this paper is to analyse associations between such developments and the occurrence of violent incidents among patients in a high security forensic psychiatric ward.MethodsDuring a 17-year period with stable ward conditions, incidents of violence were systematically collected together with diagnostic, risk assessment and demographic patient characteristics. Changes in care- and organizational related variables such as nursing staff characteristics, treatment and management routines were collected. Multilevel modelling was applied to estimate the relationship between these variables and changes in violent incidents.ResultsA substantial decline in the occurrence of violent incidents paralleled with changes in the ward during the middle phase of the study period. Most of the changes, such as implementation of new treatment and care routines and an increased proportion of female staff and higher education levels, were significantly related to a decrease in the occurrence of violent incidents in the ward.ConclusionsFindings in this study suggest that an increase in individualized, patient-oriented care strategies, delivered by well-educated nursing staff with an equally balanced gender distribution contribute to a low level of violence.

Determining the effectiveness of early intensive versus escalation approaches for the treatment of relapsing-remitting multiple sclerosis: The DELIVER-MS study protocol

Multiple Sclerosis (MS) is a common cause of neurological disability among young adults and has a high economic burden. Currently there are 18 disease modifying agents for relapsing MS, which were tested in clinical trials versus placebo or an active comparator in a pairwise manner. However, there is currently no consensus on the fundamental principles of treatment approach and initial therapy selection. These factors result in variable use of disease modifying therapies. Here we describe the study protocol for Determining the Effectiveness of earLy Intensive Versus Escalation approaches for the Treatment of Relapsing-remitting Multiple Sclerosis (DELIVER-MS). The main objective of the study is to determine whether an early highly effective treatment approach, defined as use of one of four monoclonal antibodies as initial therapy, is more effective than an escalation treatment approach (any other approved medication as initial therapy with subsequent escalation to higher efficacy treatments guided by radiological and clinical evaluation). The primary endpoint of the study is reduction in normalized brain volume loss from baseline visit to month 36 visit using MRI. Brain volume loss was selected as the best short-term predictor of long-term clinical disability. A total of 400 participants will be randomized 1:1 using minimization to account for age and sex by site, and 400 will be enrolled into a parallel observational cohort. The study results will help guide overall treatment philosophy and will have important implications for patient choice, clinical practice, and treatment access.