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Does Combining Methadone with Psychotropics Further Increase the Risk of QTc Prolongation? Considerations for EKG monitoring.
Get PDFCo-occurring mental health and substance use disorders affect millions of American adults, with opioid use disorder (OUD) being a significant concern. Methadone Maintenance Treatment (MMT) is widely used for OUD, but both methadone and several psychotropic medications increase the risk of QTc prolongation, a precursor to life-threatening arrhythmias such as Torsades de pointes (TdP). Despite the potential risks, there are no definitive guidelines for EKG monitoring in individuals prescribed both methadone and psychotropics, leaving clinicians with an ethical dilemma regarding treatment decisions. This article reviews recent literature on the risk factors for QTc prolongation, focusing on the combined impact of methadone and psychotropic use. It also examines the evidence for EKG monitoring in this patient population and provides suggestions for evidence-based guidelines. While many patients on methadone have co-occurring mental health conditions requiring psychotropics, the additive effect of these medications on QTc prolongation is not fully understood. As such, individualized patient risk stratification is crucial in balancing the benefits of methadone treatment for OUD with the potential risks of arrhythmias. The article emphasizes the need for more robust research to establish the incidence of TdP in individuals taking QTc-prolonging medications to help inform clinical decision-making and ensure safer prescribing practices
Binge Eating Disorder: A Clinical Review
Get PDFBinge eating disorder (BED) is the most common eating disorder (ED) in the United States (U.S.) and is characterized by recurrent episodes of eating a larger than normal amount of food in a discrete period of time and includes a sense of loss of control over food intake. BED is often comorbid with serious somatic and psychiatric disorders and is associated with reduced quality of life and excess mortality. Some consider BED a public health concern due to frequent co-occurrence with obesity and worse outcomes in those populations. The diagnosis is often delayed due to shame and underreporting of symptoms and inadequate screening practices. BED is primarily managed with psychotherapy and pharmacotherapy, which are both focused on reducing binge-eating behavior to reduce medical and psychiatric complications. This clinical review aims to advance the clinician’s competence in proper evaluation and intervention with current evidence-based management strategies to reduce the mortality and morbidity associated with BED and restore functioning and quality of life for patients
The relationship between Lynchburg area OB-GYN physician exercise recommendations, physical activity status, and depression in postpartum women.
Get PDFIntroduction: Postpartum depression (PPD) significantly impacts maternal well-being and infant care, necessitating effective and accessible interventions. This study examines the role of physical activity as a potential therapeutic modality for PPD, focusing on whether OB-GYNs in the Lynchburg, VA area provide exercise recommendations to pregnant and postpartum patients, and how these recommendations relate to postpartum activity levels and mood. We hypothesize that OB-GYN recommendations on exercise will lead to a positive correlation between regular physical activity and reduced PPD symptoms, supporting the integration of exercise into standard postpartum care protocols. Methods: Data was collected through an anonymous Google-Form administered to postpartum women within 1 year of birth and treated within the Lynchburg area OB-GYN physician network. The survey gathered demographic data, self-reported physical activity, whether OB-GYNs instructed mothers to engage in physical activity, if OB-GYNs provided recommendations or guidance on how to exercise, and the stress levels using the Perceived Stress Scale - 10. Results: Fourteen participants (average age 28.4 +/- 4.7 years) completed the survey. The majority were White/Caucasian (78.6%) and lived in Lynchburg City (57.1%). Half reported receiving exercise instruction from their OB-GYN. Of these, 42.9% received recommendations, and 42.9% received specific guidance. However, only 21.4% reported meeting the 150 minutes/week of physical activity guidelines. There was a positive significant relationship between women who engaged in 150 minutes of physical activity per week and OB-GYNs who provided guidance on how to exercise based on a p-value of \u3c 0.001. There was a positive significant relationship between women who engaged in 150 minutes of physical activity per week and PSS-10 negative items based on a p-value of 0.002. There was a positive significant relationship between women who engaged in 150 minutes of physical activity per week and PSS-10 positive items based on a p-value of \u3c 0.001. Discussion: Results show that when OB-GYNs provided guidance on how to exercise, the women were more likely to exercise in comparison to just telling them to exercise or providing recommendations on how to exercise. Results also showed that women who exercised more had lower stress scores than women who did not engage in 150 minutes of exercise per week
Leading with a Doctorate: The Impact of Advanced Scholarship on Leadership Effectiveness
No full textABSTRACT
In an era marked by rapid change and complex challenges, the demand for effective leadership has never been more critical. This manuscript explores the transformative impact of doctoral-level education on leadership effectiveness across various sectors, including healthcare and education. Through a comprehensive review of recent literature, this study examines how advanced scholarship fosters critical thinking, ethical reasoning, and strategic insight, which are essential traits for successful leadership. The methodology involves a systematic review of peer-reviewed articles, books, and other scholarly resources published within the past decade, utilizing databases such as PubMed, Cochrane Database of Systematic Reviews, and Google Scholar. The findings reveal that doctoral education significantly enhances leadership capabilities, particularly in areas such as transformational leadership, ethical leadership, and emotional intelligence. The discussion highlights the implications of these findings for leadership development programs and offers recommendations for future research. This study underscores the importance of advanced education in cultivating visionary leaders who can drive meaningful change in their respective fields
A Comparison of Muscular Strength and Power Development in Unilateral and Bilateral Lower Body Exercises
No full textThe purpose of this study was to compare muscle strength and power development following training programs that involved unilateral and bilateral lower-body exercises. A randomized between-groups research design was used in which results from a pretest and posttest were compared across the unilateral and bilateral groups. Sled machine one repetition maximum (1-RM) testing was used as a measure of strength, and countermovement vertical jump (CMVJ) testing was used as a measure of absolute power. Total body bioelectrical impedance analysis testing was used to predict lean body mass in both the left and right legs. Six college-aged female students who were not physically active completed 12 exercise sessions over a four-week training period involving a variation of squats, sled machine pushes, a deadlift, and box step-ups utilizing one or both legs. The specific variation of exercises for each participant was determined by randomized placement into one of the two groups. Sets, repetitions, and loads were determined using percentages of individual 1-RM values that were associated with ACSM recommendations for strength and power development. There were no significant differences in the change in 1-RM values (p=0.18) between the two groups. There were no significant differences in the change in CMVJ values (p=0.15) between the two groups. This study demonstrates a lack of significant differences in muscular strength and power development using unilateral versus bilateral lower body exercises and suggests that other factors of exercise prescription, such as exercise intensity and frequency, may play a larger role in muscular adaptation than the use of one or both limbs
