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Cognitive Behavioral Therapy Approaches for Chronic Suicidality.
No full textThis review provides an overview of research evidence from the past 5 years concerning cognitive behavioral therapy for suicide prevention. The authors then discuss the clinical implementation of this approach in patients with chronic suicidal behavior
Analysis of Analgesics and Adjuvant Medications on Psychiatric Comorbidities in Patients With Complex Regional Pain Syndrome 1.
No full textComplex regional pain syndrome (CRPS) is a chronic pain disorder characterized by severe, disproportionate pain relative to an inciting event. The disorder\u27s pathophysiology is complex, involving both central and peripheral nervous system alterations, alongside genetic, inflammatory, and psychological factors. Using data from TriNetX, this study investigated the impact of analgesic and adjuvant therapies on psychiatric outcomes in CRPS patients. The analysis included 1,029 patients treated with non-opioid versus opioid analgesics and those using antidepressants versus anticonvulsants. Results revealed no significant differences in major depressive disorder (MDD), anxiety, suicidal ideation, or post-traumatic stress disorder (PTSD) between opioid and non-opioid analgesic groups. However, opioid analgesic was associated with a lower risk of behavioral disorders due to psychoactive substance use disorder (0.732; 95% confidence interval [CI] 0.555-0.899). Anticonvulsants, compared to antidepressants, were linked to significantly higher odds and hazards of psychiatric comorbidities: depression (odds ratio [OR] 5.475), anxiety (OR 1.87), PTSD (OR 1.551), and suicidal ideation (OR 2.718). Hazard ratios also showed higher risks for antidepressants in depression, anxiety, and PTSD. These findings highlight the risks and benefits associated with opioid analgesics and the potential therapeutic effects of antidepressants in patients with CRPS. Treatment should consider physiological and psychiatric symptoms, as both are impactful on pain management
Multilevel factors affecting food choices among families with low incomes during the COVID-19 crisis
Get PDFBetter Late than Never: Identification of a Duodenal Web in a 14-Year-Old Male with Trisomy 21
Get PDFAdolescent Bariatric Surgery Programs: Progress in Pennsylvania
No full textLisa Baro Douglassville PA1, Gunnar Wolfe Corona CA2, Stephan Myers Sinking Spring PA3, Renee Riddle Wyomissing PA3, Vesta Salehi philadelphia PA4Tower Health Weight Loss Surgery and Wellness Center1Tower Health Weight Loss Surgery and Wel2Reading Hospital Weight Loss Surgery and3 St. Christopher\u27s Hospital for Children4 Objective: In 2019 the American Academy of Pediatrics (AAP) called for increased access to Metabolic and Bariatric Surgery (MBS). To understand adolescent weight loss programs offering MBS in Pennsylvania, a survey was completed. Methods: Adolescent weight loss centers in Pennsylvania offering MBS were identified using the American Society for Metabolic and Bariatric Surgery (ASMBS) on-line directory and Google search. Phone interviews were conducted with the director of each program. Results: Eight programs were identified. Operations were performed in seven adult hospitals. Six had Comprehensive Adolescent Accreditation through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). A total of 92 adolescents were operated on in the year from June 2021 to July 2022 which is an 84% increase from the preceding year. Ninety patients received a sleeve gastrectomy. Adult bariatric surgeons were involved in all operations. Six of the programs were led by diplomates of the American Board of Obesity Medicine. Each clinic had a psychologist. No program had all eight of the health care professionals recommended by the authors, but two programs had seven of the eight. In addition, three included a social worker, two an exercise physiologist and two had pediatric subspecialists incorporated into the clinic. Two programs had the operating surgeon caring for patients in the multidisciplinary clinic. Conclusion: This survey of programs across Pennsylvania shows an increase in the number of bariatric operations. More progress is necessary to improve access to this service and improve the quality of programs in Pennsylvania
Postoperative Mortality Following Metabolic and Bariatric Surgery for Obesity in Individuals with Prader-Willi Syndrome
No full textStephan Myers Sinking Spring PA1, Gunnar Wolfe Corona CA2, Aaron Hechtman Wyomissing PA3, Robert Dillard3, Renee Riddle Wyomissing PA3, Vesta Salehi philadelphia PA4, John Fam Wyomissing PA3 St. Chrristopher\u27s Hospital for Children1 University of California, Riverside2Tower Health3 St. Christopher\u27s Hospital for Children4 Background: The risk of postoperative mortality after metabolic and bariatric surgery (MBS) is often considered to be too high for individuals with Prader-Willi Syndrome (PWS) Objectives: Determine the rate of postoperative mortality following initial MBS for the treatment of obesity in PWS. Methods: A systematic review of articles in the English language of MBS in PWS was performed using PubMed, Embase and Cochrane Central identifying 254 citations extending from 1974 to July 2022. Twenty-eight articles in the English language were identified that reported on a total of 103 patients having a primary MBS operation. Results: There were 3 deaths reported within 12 months following 103 MBS operations performed for obesity on PWS individuals for a postoperative mortality rate of 2.9%. Two reported in 1985 following a jejunoileal bypass which is no longer performed, and one reported in 1996 following a gastric band placement. There has been no postoperative mortality recorded in the 71 individuals with PWS that had MBS since 1996. No postoperative mortality was reported any of the individuals with PWS (87) that had a primary laparoscopic gastric sleeve (n=34), gastric bypass (n=23) or biliopancreatic diversion with or without duodenal switch (n=30). Conclusion: There has been no postoperative mortality reported in a primary laparoscopic gastric sleeve, gastric bypass or biliopancreatic bypass with or without a duodenal switch. Therefore, individuals with PWS who suffer from severe obesity should not be excluded from being evaluated for MBS
An Innovative Method to Debrief Critical Events.
No full textPURPOSE: To explore if cold debriefing, which by definition, occurs days to weeks following the critical event, addresses identified barriers to routine debriefing and results in instituting debriefing as standard practice in the perianesthesia division at the site hospital.
DESIGN: A qualitative descriptive design using case study reviews METHODS: Seven critical events, meeting the criteria of a preproject list, were debriefed by the patient\u27s primary nurse using a cold debriefing method. Following the debriefing session, the nurse outlining the event, and the staff in attendance were asked to complete a short survey. Knowledge gained or education needed, suggestions for process improvements, and perceived safety of the environment, and feeling safe to provide feedback were assessed.
FINDINGS: Identified barriers were reduced with the institution of cold debriefing. An average of 33% of the working staff were able to attend at least one debriefing session, indicating the barrier of time may be diminished by using cold debriefing. Most staff and debriefers also felt the environment was safe, and feedback provided during the debriefing sessions resulted in identified needed education and process improvement measures.
CONCLUSIONS: Implementation of cold debriefing to share and examine information following a critical event may address common barriers, result in process improvement measures, and identify educational needs required by the perianesthesia staff
Multidisciplinary expert consensus statements and recommendations for use of hypochlorous acid as a solution for negative pressure wound therapy with instillation.
No full textBACKGROUND: HOCl (eg, pHAp) preserved solutions have antimicrobial properties and are considered safe and effective for wound management. NPWTi-d (or NPWTi) is an established adjunctive wound modality for a variety of wound etiologies in various anatomic locations in which an instillate solution dwells on the surface of the wound to assist in wound bed preparation. A variety of solutions have been used, including 0.9% normal saline wound cleansers and antiseptics. pHAp is growing in popularity as the solution of choice for NPWTi-d.
OBJECTIVE: To evaluate consensus statements on the use of NPWTi-d with pHAp.
METHODS: A 15-member multidisciplinary panel of expert clinicians in the United States, Canada, and France convened in person in April 2023 in Washington, D.C. and/or corresponded later to discuss 10 statements on the use of pHAp with NPWTi-d. The panelists then replied agree or disagree to each statement and had the option to provide comments.
RESULTS: Ten consensus statements are presented, along with the proportion of agreement or disagreement and summary comments. Although agreement with the statements on NPWTi-d with pHAp varied, the statements appear to reflect individual preferences for use rather than concerns about safety or efficacy.
CONCLUSION: The consensus indicates that NPWTi-d with pHAp can have a beneficial effect in wound care
