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Older Psychodynamic Psychiatrists: Practice Metrics and Subjective Observations
No full textA survey of 20 older psychodynamic psychiatrists was conducted to determine practice metrics, venues of clinical care, and clinician’s subjective observations. The post-pandemic normalization of teletherapy, societal acceptance of psychoactive medication into the practice of psychotherapy, significant advances in medical care for older persons, and increased utility of computer technology have enabled clinicians to work into their later years. The integration of supportive therapeutic techniques with psychoanalytic principles coupled with long-term weekly or biweekly treatment has largely replaced intensive formal psychoanalytic therapy of an earlier era. How aging may impact the therapeutic relationship and matters of health and mortality may need to enter the therapeutic dialogue. Minor deficits in cognitive function may be offset by note-taking and session reviews. The benefits of wisdom and experience often unburdened by the demands of earning a livelihood or furthering professional ambitions may render care by secure older psychodynamic psychiatrists effective
Time to Acute Treatment in Intracerebral Hemorrhage Lags Significantly Behind Ischemic Stroke: A Multicenter, Observational Retrospective Study
No full textBACKGROUND: Time-to-treatment goals for acute ischemic stroke (AIS) have substantially improved outcomes, yet similar metrics have not been studied in patients with intracerebral hemorrhage (ICH), where mortality rates are much higher. METHODS: Multicenter, observational retrospective study of patients with ICH and AIS between January 1, 2017, and December 31, 2022, in 11 comprehensive stroke centers across the United States participating in Get With The Guidelines. We included patients with ICH who received antihypertensive therapy and anticoagulation reversal, and patients with AIS requiring intravenous thrombolytic and mechanical thrombectomy. The coprimary outcomes included (1) time-to-treatment and (2) the percentage of patients meeting current national time interval goals. Multivariable logistic regression models controlling for age, sex, race and ethnicity, time to arrival, National Institutes of Health Stroke Scale score, arrival systolic blood pressure, and admission international normalized ratio were constructed to assess the likelihood of patients with ICH being treated within goal compared with patients with AIS. Multivariable logistic regression models were constructed to assess the impact of treatment time on mortality or discharge disposition in patients with ICH. RESULTS: A total of 28180 patients were identified, of which 7003 patients were included: n=1972 ICH (mean age, 67; 43% female) and n=5031 AIS (mean age, 69; 49% female). The median door-to-first medication was 52 (28–157) minutes for patients with ICH and 42 (30–63) minutes for patients with AIS (P\u3c0.001). Fifty-three percent of patients with ICH received antihypertensive medications in ≤60 minutes from arrival compared with 74% of patients with AIS who received intravenous thrombolytic ≤60 minutes (P\u3c0.001). Thirty-seven percent of patients with ICH received anticoagulation reversal ≤90 minutes from arrival compared with 47% of patients with AIS with door-to-puncture times ≤90 minutes (P\u3c0.001). The adjusted odds of timely treatment in patients with ICH compared with patients with AIS are less than three-fourths (adjusted odds ratio, 0.74 [95% CI, 0.61–0.89]; P\u3c0.01). Patients with ICH who received antihypertensive treatment ≤60 minutes from arrival had a higher likelihood of discharge to home or acute rehab unit (adjusted odds ratio, 7.48 [95% CI, 1.99–28.09]; P\u3c0.01) compared with those treated in \u3e60 minutes. CONCLUSIONS: Time-to-treatment for patients with ICH is significantly longer than for patients with AIS. Faster antihypertensive treatment times are associated with better discharge outcomes in patients with ICH. GRAPHIC ABSTRACT: A graphic abstract is available for this article
Assessment of First-Year Medical Student Perceptions in the Development of Self-Directed Learning Skills in a Single Medical School Course
No full textSelf-directed learning (SDL) is a form of education in which learners take charge of their own learning process, with an active role in knowledge, skill and attitude acquisition. Developing SDL skills is essential to becoming a lifelong learner, which is necessary in the current climate of rapidly expanding medical knowledge. Students must also develop the ability to reflect on their own strengths and weaknesses in SDL-related skills, allowing them to set appropriate learning goals and identify areas that require further improvement. Critical Reasoning Exercises (CREs), a student-driven, problem-based learning course, was introduced for first year medical students at New York Medical College School of Medicine to ensure all steps of the SDL cycle were covered in a comprehensive and standardized way. As part of the formative assessment process for CREs, we developed and validated a five-item self-reporting rubric of SDL competency to aid students’ self-assessment of their acquisition of SDL skills. The increase in student self-assessed total score from midpoint to endpoint of CREs was statistically significant (p \u3c.001), indicating students’ perceived increase in SDL competency by the end of the CRE course. In addition to the total score, there was a significant perceived increase in competency for four of the five component skills of SDL (p \u3c.05). Interestingly, there was also a statistically significant difference in student self-assessment total scores among facilitator groups at the midpoint of the CRE course. Integration of CREs into the curriculum demonstrated potential as an effective educational intervention for medical student development of competency in SDL
A Single-Dose, Randomized, Open-Label, Parallel Design Study to Characterize the Pharmacokinetics of an Investigational Olanzapine Intranasal Spray Compared to a Reference Dose of Olanzapine Intramuscular Injection in Healthy Adult Males
No full textObjective: Injectable olanzapine for acute agitation in psychiatric disorders is limited to delivery by health care professionals in supervised settings. Intranasal (IN) administration offers a potential needle free route of delivery with favorable pharmacokinetics and patient experience, including the possibility of self-administration in community settings. Two IN formulations of olanzapine containing the permeation enhancer dodecyl maltoside (DDM) were assessed, with intramuscular (IM) olanzapine as a reference. Methods: In this randomized phase 1 trial (conducted October 2023), healthy volunteers (N =24) were randomized 1:1: 1 to receive 1 dose of IN olanzapine 7.5 mg+0.25% DDM, IN olanzapine 7.5 mg+0.50% DDM, or olanzapine 7.5 mg IM. Plasma olanzapine concentrations were measured over time, and safety and tolerability were assessed. Results: Mean peak plasma olanzapine concentrations were 31.5, 32.3, and 20.5 ng/mL for 0.25% and 0.50% DDM sprays and IM dosing, respectively. Median times to peak plasma concentration were 4.8, 10.2, and 37.8 minutes. After a single dose of the 0.25% and 0.50% DDM formulations, bioavailability was 88.8% and 83.3% of a single IM dose. All reported treatment emergent adverse events were mild, transient, and deemed possibly related to the study drug, with the most frequent being sedation (n = 24) and nasal discomfort lasting seconds (n = 16, IN treatments). Nasal irritation scores were grade 0 (no sign of nasal irritation or mucosal erosion), and suicide risk assessment was negative for all time points. Conclusion: Two novel investigational IN formulations of olanzapine containing the permeation enhancer DDM showed favorable pharmacokinetics and an acceptable safety profile presenting no unexpected signals in healthy adults. Continued study is warranted. Trial Registration: ClinicalTrials.gov identifier: NCT06600477
Split-Face Histomorphological Study of Radiofrequency Microneedling versus Fractionated Ablative 2940 Nm Er:YAG Laser Resurfacing for Perioral Skin Rejuvenation
No full textSolid Tumors, Liquid Challenges: The Impact of Coagulation Disorders
No full textCoagulation disorders are increasingly recognized as significant complications in patients with solid tumors, affecting morbidity and mortality outcomes. Solid tumors can provoke a hypercoagulable state through the release of pro-coagulant factors, endothelial activation, and inflammation, leading to a heightened risk of coagulation disorders. These coagulation disorders may manifest as venous thromboembolism, arterial thromboembolism, thrombotic microangiopathy, or disseminated intravascular coagulation. These disorders can complicate surgical interventions and impact treatments, including chemotherapy and immunotherapy efficacy, leading to poor outcomes. Understanding the implications of coagulation disorders in solid tumors is essential for optimizing patient management, including identifying high-risk patients, implementing prophylactic measures, elucidating biomarkers for clinical outcomes, and exploring novel therapeutic agents. This review aims to provide insights into the current knowledge surrounding coagulation disorders in solid tumors and their clinical implications
Emergency Priorities in the Treatment of Cerebral Hemorrhage: Code-Intracerebral Hemorrhage
No full textThe HOX Gene Family’s Role as Prognostic and Diagnostic Biomarkers in Hematological and Solid Tumors
No full textThe HOX gene family encodes for regulatory transcription factors that play a crucial role in embryogenesis and differentiation of adult cells. This highly conserved family of genes consists of thirty-nine genes in humans that are located in four clusters, A–D, on different chromosomes. While early studies on the HOX gene family have been focused on embryonic development and its related disorders, research has shifted to examine aberrant expression of HOX genes and the subsequent implication in cancer prediction and progression. Due to their role of encoding master regulatory transcription factors, the abnormal expression of HOX genes has been shown to affect all stages of tumorigenesis and metastasis. This review highlights the novel role of the HOX family’s clinical relevance as both prognostic and diagnostic biomarkers in hematological and solid tumors
Botulinum Toxin: A Potential Cardiovascular Agent?
No full textBotulinum neurotoxin (BoNT) is a toxin with a wide repertoire of well-known applications in cosmetics and medicine, such as treating migraine headaches, spasticity, and achalasia, and it has generally been shown to be safe and well-tolerated. In addition to its current successes in clinical practice, studies have also demonstrated the potential of BoNT to be used as a therapeutic agent for many cardiovascular conditions. Prior investigations, as well as trials currently underway, have showcased the safety and potential efficacy of BoNT in applications such as treating ischemia-reperfusion injury, hypertension, atrial fibrillation, and heart failure. While further study in humans, as well as improved statistical power in efficacy studies, are needed before its prospective use as a treatment for the aforementioned conditions, one might consider BoNT a potential cardiovascular agent
