bluuebunny/crossref_metadata_2025 huggingface dataset:
Supervision and case management in low intensity interventions
Authors: Curry Vicki , French Lesley
Published: August 2022

Frequent good-quality supervision is essential for effective delivery of low intensity interventions. There is a wealth of research and literature which informs good practice and the consequent training of supervisors for low intensity practitioners. Implications of this for supervisory practice have been set out, and it is hoped the development of training programmes for supervisors, such as those that exist in the UK, will embed best practice in time. Support for diversifying the child mental health workforce and addressing cultural difference in the supervision process are key areas of focus. It is important that these new roles and trainings are embedded in national delivery and recognized career structures, which is not yet the case in some countries. The ambition of expansion of a trained workforce in England and elsewhere is dependent on sufficient supervisors supporting these new practitioners.
Service organizations: stepped care
Authors: McLellan Lauren F. , Schniering Carolyn , Wuthrich Viviana
Published: August 2022

Stepped care has been widely embraced as an ideal model of service delivery; however, as a healthcare approach for children and adolescents with mental illness, the field is in its infancy and substantial further development and research is required. A growing body of evidence suggests that under controlled conditions in university settings, stepped models are as efficacious as standard care and are likely to use less therapist time; however, the clinical and cost-effectiveness of stepped care models in real-world settings has been minimally evaluated. There is currently no gold standard model of stepped care, and the ideal combination of steps will depend on the unique features of both the patient and the service delivery site. Service organization will be central to the effective delivery of low intensity interventions to youth in primary mental health settings. The successful implementation of stepped care models will require a healthcare framework that includes high-level policy specifications, effective governance of service elements including assessment and risk management, engagement of various stakeholders, implementation via a workforce-readiness campaign, and ongoing monitoring, evaluation, and modification. Finally, preliminary evidence on the cost-effectiveness of this approach for childhood emotional disorders has been mixed, and further economic evaluations across multiple settings are recommended.
Postoperative Myocardial Ischemia Complicated by Cardiogenic Shock
Authors: Milian Ricardo Diaz , Castresana Manuel R.
Published: August 2022

Postoperative myocardial ischemia hinders the recovery of some patients after surgery. When it is complicated by cardiogenic shock, mortality rises significantly. Among surgical patients, those undergoing vascular procedures are considered to be at the highest risk. Quick diagnosis and prompt treatment minimizes injury and improves outcomes. A high index of suspicion is required since a typical complaint of chest pain may be absent in the postoperative period. Emergency revascularization is indicated when myocardial ischemia is complicated by cardiogenic shock. Assist devices can be utilized to support the affected myocardium in this situation; however, this strategy has failed to show an improvement in mortality.
Abdominal Pain Following a Motor Vehicle Crash
Authors: Leiendecker Eric , Ketzler Jonathan , Coursin Douglas
Published: August 2022

According to the Centers for Disease Control and Prevention, roughly 32,000 people are killed each year and over 2 million others are injured in motor vehicle crashes yearly. This common presentation to trauma centers requires rapid diagnosis and management of life-threatening injuries necessitating immediate intervention by a cohesive trauma team made of surgeons, emergency medicine specialists, and anesthesiology physicians. The recognition of common presentations and use of bedside ultrasonography have allowed for more rapid and accurate diagnosis. In turn, this reduces time to intervention and allows for more tailored interventions.
Preeclampsia and HELLP Syndrome in the Parturient
Authors: Romanelli Erik , Ring Laurence
Published: August 2022

Preeclampsia is a multisystemic disorder of pregnancy defined by the presence of hypertension after 20-weeks gestational age in combination with either proteinuria or new onset of 1 of 5 findings (thrombocytopenia, renal insufficiency, pulmonary edema, cerebral or visual symptoms, and impaired liver function). It affects approximately 3% to 4% of pregnant women and ranks among the leading causes of maternal mortality. Although the exact pathophysiology of preeclampsia is not completely understood, its development is likely a consequence of abnormalities in placental growth and implantation leading to vascular hyperreactivity and widespread endothelial dysfunction. Delay in diagnosis can result in intracranial hemorrhage, pulmonary edema, placental abruption, renal failure, and even death. Treatment is largely centered around achieving blood pressure control with antihypertensive therapies, seizure prophylaxis with magnesium sulfate infusion, and expeditious delivery in more severe cases.
LVAD Complicated by RV Failure
Authors: Mittel Aaron M. , Wagener Gebhard
Published: August 2022

Right ventricular (RV) failure is defined as a persistently elevated central venous pressure and low cardiac output in the absence of left-sided cardiac dysfunction, usually requiring pharmacologic support to maintain adequate flow. It is a clinical diagnosis and is a common complication following left ventricular assist device (LVAD) insertion. It is associated with poor outcomes, including prolonged hospitalization, increases in end-organ failure rates, and increased mortality rates. Perioperative clinicians must have a high suspicion for its presence, particularly in patients with pre-existing RV impairment or extra-cardiac comorbidities. Pathophysiologically, it is caused by a decrease in interventricular dependence following left ventricular decompression, a reduction in septal contribution to RV performance, and an inability to compensate for increased venous return that accompanies LVAD insertion. Treatment is focused on optimizing preload and afterload to the RV. Typical treatment strategies consist of inotropes, pulmonary vasodilators, diuretics, and possibly mechanical circulatory support devices.
Loss and Grief
Authors: Klein Linda
Published: August 2022

Loss and Grief: Personal Stories of Doctors and Other Healthcare Professionals, is a unique collection of personal narratives that chronicle the journeys of doctors and other healthcare professionals who have been personally impacted by life-altering losses. Edited by internationally recognized practitioners of supportive care medicine and grief counseling, these are unflinching, first-person narratives of authors walking in their own shoes. The narratives reveal losses of cherished loved ones, integrity, dreams, naïve views of colleagues, and the lack of institutional support for these inevitable experiences. Although the narrators are well-established leaders in their fields, serious loss brought each back to the exposed core of their most basic selves. They learned that the professional veneer was too thin to be instructive or protective. Readers might resonate with their own painful experiences and memories, and others might wonder how they will imagine their own future, when these inevitable aspects of being human—loss and grief—strike them, too. In Loss and Grief, the authors’ hope that such openly shared feelings of isolation and suffering will humanize the loss experience, ignite prospective discussions, and illuminate opportunities for education, research, and interventions to prepare us for multiple loss experiences endemic to life.
Thinking and Treating Beyond the Tremor
Authors: Shukla Aparna Wagle
Published: August 2022

Tremor is the most prevalent movement disorder that affects millions of people worldwide. Tremor can present is isolation or can present in combination with other neurological, psychiatric, and systemic features such as ataxia, cognitive impairment, parkinsonism, dystonia, anxiety, and depression. These features may contribute to tremor disabilities and thus clinicians should think of considerations beyond the pure motor presentation in their practice. This chapter will discuss the importance of these co-occurring features as they have a definite albeit indirect role in determining the treatment outcomes. While the focus will be mainly in the context of essential tremor, their implications for Parkinson disease, dystonia, and orthostatic tremor will be discussed under “other tremor disorders.”
Tremor: Emerging and Investigational Treatments
Authors: Ondo William
Published: August 2022

Better understanding of tremor pathophysiology is facilitating investigation into a number of pharmacologic, surgical, and peripheral electronic and mechanical devices to improve tremor. Oral pharmacological agents undergoing major trials for essential tremor include the T-type calcium antagonists CX-8998/JZP-385 and PRAX-944, the SK Channel Positive Allosteric Modulator CAD-1883, and the GABA positive allosteric modulator Sage 324. Smaller recent trials have evaluated novel alcohols, the AMPA antagonist perampanel, and injections of botulinum toxins. Improvements in deep brain stimulation and brain lesioning, specifically focused ultrasound continue. Peripheral nerve electrical stimulation devices, and mechanical treatments including gyroscope gloves, counter-weight dampening systems, and accelerometry guided assistance devises are also recently available.
Eating Disorders
Authors: McNaught Elizabeth , Treasure Janet , Pollard Nick
Published: August 2022

Eating disorders affect 1.25 million people in the UK, and the incidence is rising. The DSM-5 specifies diagnostic criteria for eight types of eating disorder, with anorexia nervosa, bulimia nervosa, and binge eating disorder accounting for the majority of cases. This title covers the aetiology, epidemiology, risk factors, and diagnostic criteria for all forms of eating disorders, alongside patient management within the community and inpatient settings. Also featuring chapters on emerging eating disorders, such as orthorexia and muscle dysmorphia, medicolegal issues surrounding involuntary hospitalisation and nasogastric feeding, and acute emergency care, each chapter is accompanied by case stories drawn from real-life examples, taking the reader through from initial presentation to treatment, and the key need-to-know facts and current evidence-based treatments.
Geopsychiatry and social psychiatry
Authors: Valsraj Koravangattu , Persaud Albert , Pemberton Max , Bhavsar Vishal
Published: August 2022

Geopsychiatry focuses on the influence of geopolitical factors, such as globalization, foreign policy, collective violence and regional conflict, climate change, natural and man-made public health crises, and transnational migration, on mental health and mental illness. Despite their impact on all aspects of our lives, the importance of geopolitical factors to health has been under-recognized, including within social psychiatry. The COVID-19 pandemic has made evident the pressing need to consider the geopolitical determinants of mental health, in the context of shifting geopolitical challenges. We argue that geopolitical factors are key drivers of population mental health, including through their influence on the traditional social determinants, which may be considered downstream of geopolitical factors. Therefore, geopolitical determinants need to be more clearly addressed in research and policy in mental health. Social psychiatry, a discipline concerned with the relation between social determinants and mental health, should attend more clearly to the geopolitical context within which social determinants are experienced.
Poverty and social psychiatry
Authors: Ayonrinde Oyedeji A. , Mngoma Nomusa F.
Published: August 2022

Poverty has a complex, and in some places direct, relationship with well-being, and physical and mental health. The impact can be lasting, with consequences felt over several generations. Intertwined with social determinants of health and through multiple health inequalities, poverty can precipitate and perpetuate mental disorders, help-seeking, and prognosis. This is visible in the impact on childhood and households, as well as in the impact on the trajectory of mood disorders, psychosis, trauma, substance misuse, and personality disorders. Furthermore, the global and multidimensional consequences of poverty can manifest in both wealthy and low- and middle-income countries, as well as in the rural and urban divide. Against this backdrop, Sustainable Development Goals are geared towards the reduction of poverty across regions and nation states; however, catastrophic events such as climate change and the COVID-19 pandemic highlight how vulnerable these can be to disruption. By illustrating the bidirectional relationship between poverty and mental health, this chapter stresses the importance of poverty alleviation as a critical social, economic, and mental health policy priority in all nations.
Homelessness and mental health
Authors: Castaldelli-Maia João Mauricio , Ventriglio Antonio , Bhugra Dinesh
Published: August 2022

There is considerable research evidence indicating that rates of psychiatric disorders are higher in homeless individuals, although, in some cases, psychiatric illnesses may lead to homelessness. It is likely that in spite of high rates of illness, individuals who are homeless or are in insecure housing may be more reluctant to seek help. Thus, it is of paramount importance to enable homeless people with mental illness to access mental health services easily, which is a worldwide challenge. Homelessness and psychiatric disorders are both strongly affected by other social determinants and thus may feed into each other. A significant improvement in the health of these persons can be through outreach programmes leading to early detection of psychiatric disorders. In view of the great vulnerability to which the homeless are exposed, the special psychological treatments they may need are obvious, but interventions require joined up thinking between health, housing, employment, education, justice, and other ministries. Each nation may need to develop optimal models of social care and rehabilitation that rely on the particular research-driven needs of homeless people with mental illnesses. In order to improve the availability of services to the homeless, it is also important to consider and value their experiences and opinions. Many underprivileged groups such as refugees and migrants, adolescents, those with intellectual and developmental disabilities, LGBTIQ, and homeless individuals may need extra input. The well-recognized association between homelessness and mental illness needs to be addressed at multiple levels in any society.
Psychosis
Authors: Craig Tom J.
Published: August 2022

Evidence for a causal role for social conditions in psychosis is slowly accumulating. Three overlapping associations stand out. Firstly, a dose–response relationship with growing up in urban environments and evidence that changing this urban exposure, for example by moving to a more rural location decreases risk. Secondly, belonging to a minority group (e.g. black ethnicity), especially when resident in neighbourhoods where minorities form a small proportion of the population. Thirdly, exposure to sexual and other abuse in childhood and adolescence and to intrusive experiences in adulthood. These causal pathways overlap and interact, affecting perceptions of risk and the trustworthiness of other people, with clear implications for the delivery of psychiatric services.
Common mental disorders
Authors: Nataraj Manamohan , Kumble Chaitra Nagaraj , Ganjekar Sundarnag , Desai Geetha
Published: August 2022

Common mental disorders (CMDs) are group of psychiatric disorders that are highly prevalent and associated with impairment in the functioning and quality of life of the individual. Depression and anxiety disorders are often considered as CMDs with a high occurrence in women. Clinicians working in primary care and general hospital settings need to be aware of CMDs and make appropriate assessments and interventions. This chapter on CMDs explains the conceptual framework of disorders under its definition and describes the clinical features, epidemiology, probable aetiology and pathogenesis, course, and outcome. It also includes a section on pathways to care and management.
Social aspects of depression
Authors: Ventriglio Antonio , Castaldelli-Maia João Mauricio , Torales Julio , Chumakov Egor , De Berardis Domenico
Published: August 2022

Depression is a common and disabling mental disorder, affecting more than 200 million people worldwide. The social impact of illness is relevant in terms of frequency, severity and disability, comorbidity, costs, and impact on family life. Its aetiopathogenesis includes biological, psychological, and social factors, as integrated in the biopsychosocial model. In fact, several social risk factors have been identified for mood disorders and a relevant number of clinical disorders are sub-syndromal and mostly related to social maladjustment. The concept of depressive threshold is debated in the international literature. In addition, culture is a relevant factor influencing the explanatory model of illness, as well as its presentation and outcome. Depression heavily affects individual social functioning, and a set of psychological and social interventions are needed to address the social disability properly and family burden. The chapter concludes that the understanding and treatment of depression should be routinely based on a social medicine approach.
Eating disorders
Authors: Nicholls Dasha , Nagularaj Lidushi
Published: August 2022

Over recent decades there has been a shift away from cultural and interpersonal towards genetic, metabolic, and neurobiological understandings of eating disorders (EDs). This has gone some way to redress the tendency to minimize and trivialize this group of serious mental illnesses in research, clinical practice, and society. Over the same period, however, new sociocultural influences that play a potential role in aetiology and maintenance have emerged, resulting in changes in epidemiology, classification, and understanding, and providing new theories of gene–environment interaction. These include an increase in EDs in men and sexual minorities, recognition of EDs in a range of ethnicities and cultures, increases in obesity at a population level and public health efforts to address it, which impact on EDs, and the role of globalization and social media on the Westernization of cultures previously unexposed to the thin ideal. In this chapter, how these, as well as intra-familial and interpersonal factors, interplay in the onset of EDs are examined, and further research in low- and middle-income countries, in marginalized populations such as children or older people, and of epigenetic phenomena, is called for to help further our understanding of how biological and social risk factors interact in the causation, prevention, treatment, and outcome of EDs.
Social determinants of child psychopathology
Authors: Palmer Melanie , Scott Stephen
Published: August 2022

Social conditions play an important role in how children develop. As a high proportion of adult mental health problems have roots in childhood, it is important to understand how the environment affects child psychopathology. These factors include the immediate family environment in which children grow up, their school, and peers, as well as the wider community and cultural context. They interact with genetic and biological factors, and there is an increasing understanding of when they combine to lead to resilience and success and under what conditions poorer outcomes are more likely. Knowing which social conditions in childhood are associated with which patterns of psychopathology enables understanding of how early intervention may reduce suffering, improve outcomes in childhood, and prevent the development of disorders in adulthood.
Managing children and young people
Authors: Debelle Alice , Dogra Nisha
Published: August 2022

It is well recognized that three-quarters of psychiatric disorders in adulthood start before the age of 24 years and half do so below the age of 15 years. Thus, a focus on children and young people is key to preventing the emergence and progression of psychiatric disorder. There is no doubt that biological and genetic factors influence a child’s development. Equally important are cultural and social contexts. These include the family, peer group, school, communities, sports clubs, social media use, broader cultural contexts, and governmental polices. Young people also experience multiple life stage transitions such as starting school and puberty, which can affect them in a number of ways. Hence, it is crucial that social interventions are identified to make sure that development is as smooth as possible.
Atmiyata
Authors: Joag Kaustubh , Kalha Jasmine , Shields-Zeeman Laura , Kumar Sonali , Pathare Soumitra
Published: August 2022

This chapter describes a community-led, rural mental health programme that was scaled-up in villages across the district of Gujarat, India, from 2016 to 2019. Mental health disorders are largely unaddressed in rural India owing to a lack of specialized providers, stigma, and inadequate public health services. Atmiyata employed a tiered model of care in which community volunteers were trained to identify common and severe mental disorders, deliver evidence-based counselling and referrals to psychiatric services, facilitate access to social benefits, and raise awareness through narrow-casting educational films. Atmiyata is a feasible and acceptable intervention that harnesses community networks to deliver mental health care effectively within the public health system. Key challenges such as motivation and attrition of volunteers were addressed through consistent training, mentoring, and supervision. This chapter aims to provide an in-depth look at the implementation of Atmiyata such that it could be applied in similar environments in other low- and middle-income countries.
Lessons from the English Improving Access to Psychological Therapies programme in delivering primary care psychotherapy
Authors: Wright Ben
Published: August 2022

The UK National Health Service (NHS) programme to improve access to psychological therapies (Improving Access to Psychological Therapies) has created talking therapy services in every locality in England. The programme delivers high-speed access to evidence-based psychological treatments for depression and anxiety disorders, delivered at scale with over 1.6 million referrals and 606,192 treatment episodes in 2019/20. Over 99% of patients have outcome measurement, and national summary data show that over 51% make a recovery from their condition. This delivers a return of over six times the investment. Key ingredients to this success include centrally agreed outcome measures, useable clinical information systems, a semi-stratified stepped-care pathway, a comprehensive training programme to ensure a cohort of staff with sufficient capacity and capability, and adherence to evidence-based treatments. Ongoing challenges include maintaining staff well-being; access for hard-to-reach groups; maintaining both outcome and volume; managing demand, complexity, and boundaries; and achieving equitable recovery.
The deinstitutionalization of the mentally ill
Authors: Lanzotti Pierluigi , De Luca Ilaria , Janiri Luigi
Published: August 2022

Law 180, also called ‘Basaglia’s law’, after Franco Basaglia, who inspired and promoted the revolution of mental health care in Italy. It was the result of a strong antipsychiatry movement and involved macroscopic changes in the management of the psychiatric patients. This was followed across borders, being widely studied by researchers in UK and USA. The main objective of the reform was to create a psychiatry movement, with a community-based perspective of care and therapeutic interventions. Contrary to what its detractors argued, deinstitutionalization was not linked to an increase in mandatory psychiatric admissions or suicide attempts, and it did not increase the number of crimes. In recent years, this process has also involved forensic psychiatry, considering a patient to be rehabilitated rather than an individual to be punished or incarcerated. This chapter provides an overview of the historical account of Basaglia’s reforms and their impact on psychiatric care in Italy.
Human rights and the United Nations Convention on the Rights of Persons with Disabilities and Psychiatry—on a collision course?
Authors: Pathare Soumitra , Kapoor Arjun
Published: August 2022

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) marks an inflection point in the history of psychiatry’s strained relationship with the human rights movement. It ensures a radical departure from the status quo by establishing a gold standard for the treatment and care of persons with psychosocial disability and compelling us to reimagine and transform societal structures, including psychiatry’s established practices and methods. The CRPD enforces a rights-based approach to disability thus shifting the onus to governments, medical professionals, families, caregivers, and other duty bearers to ensure that the rights of persons with disabilities are protected and fulfilled. The CRPD’s legal framework has been subject to multiple interpretations from both the standpoint of human rights and psychiatry, spurring crucial debates on the legality and clinical benefits of involuntary treatments, substitute decision-making, and other forms of non-consensual interventions for persons with psychosocial disability. This also opens questions about the contested relationship between psychiatry and human rights, and whether the same can be resolved to ultimately fulfil the CRPD’s radical vision. In this chapter these debates are considered in light of the CRPD’s provisions, authoritative interpretations of the same, and their implications for psychiatry and persons with psychosocial disability.
Challenges to mental health in Europe
Authors: Ruggeri Mirella , Martinelli Alessandra
Published: August 2022

The Mental Health Declaration for Europe (2005) laid the foundations to innovate the challenges of social psychiatry in Europe, where cultural, economic, social, and political differences correspond to significant inequalities in the mental health development within and between countries. Most countries have mental health policies and legislation, and many are implementing Community Mental Health Services (CMHS). Some countries (low- to middle-income) still fight to finance mental health care, while in high-income areas, models of psychiatry are focused on quality outcomes or the maintenance of traditional institutional settings. Only a minority of patients receive appropriate and effective mental health treatment, even though quality standards are provided. Opportunities for promotion and prevention in mental health are highly variable, with different starting points for action. In this context, a common challenge for Europe is to unify the continent under common principles, organizations, and initiatives towards mental health, while respecting each country’s autonomy.
Mental health in low- and middle-income countries
Authors: Ojagbemi Akin , Gureje Oye
Published: August 2022

Inhabited by over 85% of the world’s population, low- and middle-income countries (LMICs) consist of countries with diverse social, cultural, linguistic, and racial profiles. Nevertheless, they share a commonality of being, compared to high-income countries, economically less resourced. Many of these countries are also undergoing rapid social transitions characterized by epidemiological shifts, rapid urbanization, and a reorganization of family and community structures. Along with global climate change, some of these changes are associated with increasing poverty, armed conflicts, and forced migration, especially of young people. These features have major impacts on the mental health of populations. Globally, about 80% of all people living with a mental health disorder reside in LMICs. While the features and profiles of mental disorders among the populations of LMICs are broadly similar to those of populations in high-income countries, the treatment gap that exists for these disorders is far larger in LMICs as a consequence of resource constraints. Innovative ways that attend to the social determinants of health by drawing on traditional and cultural networks and leveraging on the burgeoning growth of modern technology hold the promise of addressing the expanding need for mental health services.
Training in social psychiatry
Authors: Ahmed Saeed , Ayub Shahana
Published: August 2022

While the theories of social psychiatry are far from new, psychiatry in general has evolved far beyond the narrow lens of the topic first proposed by early proponents of the field. These early negative attitudes often led to the institutionalization of people with mental illnesses and a loss of basic human rights. After largely recovering from those stigmas, the closure of asylums and a move towards community psychiatry have involved the science of social psychiatry with the advent of medications. Therefore, further integration of the biopsychosocial model of mental illness into research and clinical practice has emerged across communities and has led to advancing the everyday practice of modern psychiatry by collaborating across biological and social paradigms into clinical practice. While a few early initiatives have involved the training of psychiatric residents in this field, to date a holistic approach involving the educational requirements necessary to be competent in social psychiatry has not been thoroughly explored. In this chapter, the practice of social psychiatry is placed in historical context before a proposal of which areas of community psychiatry and cultural psychiatry are needed for a successful core curriculum in medical schools and psychiatric residency programmes that will advance this field of study for the psychiatrists of the future.
Reduction in Risk of Death Among Patients Admitted With COVID-19 Between the First and Second Epidemic Waves in New York City
Authors: Bowen Anthony , Zucker Jason , Shen Yanhan , Huang Simian , Yan Qiheng , Annavajhala Medini K , Uhlemann Anne-Catrin , Kuhn Louise , Sobieszczyk Magdalena , Castor Delivette
Published: August 2022

Background

Many regions have experienced successive epidemic waves of coronavirus disease 2019 (COVID-19) since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with heterogeneous differences in mortality. Elucidating factors differentially associated with mortality between epidemic waves may inform clinical and public health strategies.

Methods

We examined clinical and demographic data among patients admitted with COVID-19 during the first (March–August 2020) and second (August 2020–March 2021) epidemic waves at an academic medical center in New York City.

Results

Hospitalized patients (n = 4631) had lower overall and 30-day in-hospital mortality, defined as death or discharge to hospice, during the second wave (14% and 11%) than the first (22% and 21%). The wave 2 in-hospital mortality decrease persisted after adjusting for several potential confounders. Adjusting for the volume of COVID-19 admissions, a measure of health system strain, accounted for the mortality difference between waves. Several demographic and clinical patient factors were associated with an increased risk of mortality independent of wave: SARS-CoV-2 cycle threshold, do-not-intubate status, oxygen requirement, and intensive care unit admission.

Conclusions

This work suggests that the increased in-hospital mortality rates observed during the first epidemic wave were partly due to strain on hospital resources. Preparations for future epidemics should prioritize evidence-based patient risks, treatment paradigms, and approaches to augment hospital capacity.
Unusual and Severe Complications of Acute Schistosomiasis in Travelers
Authors: Biber Asaf , Petersil Neta , Naaman Efrat , Neuberger Ami , Schwartz Eli
Published: August 2022

Acute schistosomiasis (ASC) is a hypersensitivity reaction seen mostly in nonimmune travelers and manifests mainly with fever, urticaria, and respiratory symptoms. We describe unusual severe presentations of ASC in 3 patients, including hip-monoarthritis, peri-myocarditis, and optic neuritis. In all 3 patients, clinical symptoms appeared or worsened after praziquantel administration.
Extending weeknight sleep of delayed adolescents using weekend morning bright light and evening time management
Authors: Crowley Stephanie J , Velez Sabrina L , Killen Logan G , Cvengros Jamie A , Fogg Louis F , Eastman Charmane I
Published: August 2022

Study Objectives

Shift sleep onset earlier and extend school-night sleep duration of adolescents.

Methods

Forty-six adolescents (14.5–17.9 years; 24 females) with habitual short sleep (≤7 h) and late bedtimes (≥23:00) on school nights slept as usual for 2 weeks (baseline). Then, there were three weekends and two sets of five weekdays in between. Circadian phase (Dim Light Melatonin Onset, DLMO) was measured in the laboratory on the first and third weekend. On weekdays, the “Intervention” group gradually advanced school-night bedtime (1 h earlier than baseline during week 1; 2 h earlier than baseline during week 2). Individualized evening time management plans (“Sleep RouTeen”) were developed to facilitate earlier bedtimes. On the second weekend, Intervention participants received bright light (~6000 lux; 2.5 h) on both mornings. A control group completed the first and third weekend but not the second. They slept as usual and had no evening time management plan. Weekday sleep onset time and duration were derived from actigraphy.

Results

Dim light melatonin onset (DLMO) advanced more in the Intervention (0.6 ± 0.8 h) compared to the Control (−0.1 ± 0.8 h) group. By week 2, the Intervention group fell asleep 1.5 ± 0.7 h earlier and sleep duration increased by 1.2 ± 0.7 h; sleep did not systematically change in the Control group.

Conclusions

This multi-pronged circadian-based intervention effectively increased school-night sleep duration for adolescents reporting chronic sleep restriction. Adolescents with early circadian phases may only need a time management plan, whereas those with later phases probably need both time management and morning bright light.

Clinical Trials

Teen School-Night Sleep Extension: An Intervention Targeting the Circadian System (#NCT04087603): https://clinicaltrials.gov/ct2/show/NCT04087603
The development of the Religious Health Interventions in Behavioural Science (RHIBS) Taxonomy: a scientific classification of religious practices in health
Authors: Patel Riya , Jong Jonathan , Worthington Everett L , Lycett Deborah
Published: August 2022

The development and delivery of religiously integrated health interventions is increasing, however lack of nomenclature to specify the religious components presents barriers to replication, implementation, and evidence synthesis. We describe the development of the “Religious Health Interventions in Behavioural Sciences (RHIBS)” Taxonomy, the first scientific classification of religious intervention components to be used globally by chaplains, healthcare providers, and researchers interested in the scientific study of religion, spirituality, and health. We developed a taxonomy of empirically used religious intervention components in health, sought international cross-disciplinary consensus for definitions and tested its usability. Study 1: systematic review of intervention studies to identify religious components tested within healthcare; development of taxonomy nomenclature, definitions, and categories. Study 2: Delphi exercise with 19 international, cross-disciplinary experts from a variety of religions. Study 3: “think aloud” study and usability testing with 10 end-users. Study 1: 12,337 papers identified from search, 167 intervention studies included, plus an additional 74 from hand-searching 14 systematic reviews. A taxonomy of 191 religious components, grouped into 27 categories resulted. Study 2: two Delphi rounds resulted in international and cross-disciplinary consensus of a revised taxonomy of 81 religious components grouped into 23 categories. Study 3: usability testing by participants (range of disciplines, geography, and religions) led to a final taxonomy comprising 82 religious components grouped into 22 categories and supported by online training. The “RHIBS Taxonomy,” is the first multidisciplinary, global shared language within religion, spirituality, and health, ushering in a new era for religious interventions to be precisely defined, developed, and tested; shaping the evidence-base for future healthcare research/practice.
Galectin‐1 deletion in mice causes bone loss via impaired osteogenic differentiation potential of BMSCs
Authors: Chen Yu , Liu Yanbin , Zhang Yangyang , Yu Jiangming , Tang Liang
Published: August 2022

Bone formation is dependent on the osteoblasts which are differentiated from bone marrow stromal cells (BMSCs). In addition to potent proliferation, self‐renewal, and pluripotent differentiation, BMSCs have been extensively studied due to their low immunogenicity and immunomodulatory effects. Recently, galectin‐1 (Gal‐1) has been proposed as a potent mediator of immunomodulatory properties of BMSCs. Previous study demonstrated that Gal‐1 showed age‐related decline in mice serum and serum Gal‐1 was positively associated with bone mass in mice. The current study makes attempts to elucidate the functional role of Gal‐1 in skeletal system by investigating the regulation of Gal‐1 expression during BMSCs osteogenic differentiation and the molecular mechanisms underlying the effects of Gal‐1 on BMSCs osteogenic differentiation. In Gal‐1 null (−/−) mice, bone loss was observed due to bone formation attenuation. In in vitro experiments, Gal‐1 supported the osteogenic differentiation of BMSCs by binding to CD146 to activate Lrp5 expression and Wnt/β‐catenin signaling pathway. Meanwhile, there was positive feedback regulation via Wnt/β‐catenin signaling to maintain Gal‐1 high‐level expression during osteogenic differentiation of BMSCs. More importantly, Gal‐1 down‐regulation in BMSCs and attenuation of osteogenic differentiation potential of BMSCs were observed in aged mice compared with young mice. Gal‐1 over‐expression could enhance osteogenic differentiation potential of aged BMSCs. Our study will benefit not only for deeper insights into the functional role of Gal‐1 but also for finding new targets to modulate BMSCs osteogenic differentiation.
Meeting the complex healthcare needs of veterans
Authors: Zychowicz Michael E. , Jeter Ertha , Koerper Emma C. , Naimoli Vanessa M. , Reynolds Annie M.
Published: August 2022

More than half of US veterans seek care outside of the Veterans Health Administration. Physical and mental healthcare needs can be complicated by experiences during military service. Community clinicians can deliver more holistic and comprehensive care to veterans through understanding the unique needs of the veteran population.
Preexposure prophylaxis for HIV prevention
Authors: Mayeux Jack J. , Ng Yeow Chye
Published: August 2022

The prevention of HIV is continually evolving with the development of new resources and the adaptation of older resources in new regimens. Ideally, these new and updated methods of prevention will allow easier implementation and continuation as well as reduced costs in the fight to prevent HIV infections.
Policy advocacy and health equity
Authors: Phillips Janice
Published: August 2022

Advanced practice nurses are key partners in achieving health equity and are encouraged to use their advocacy skills and policy acumen in doing so. While conducting social determinants of health screenings and providing referrals are important elements in our quest to achieve health equity, meaningful advancements in this area are dependent on the enactment of public policies that yield equitable solutions.
Informed refusal
Authors: Peterson Kathleen
Published: August 2022

This article discusses the principles of informed consent and informed refusal (IR) in the context of patient-centered care and evidence-based practice, the right of patients to refuse care when properly informed, and the implications of IR for nursing practice.
Promoting a culture of clinical inquiry in nursing
Authors: McIntosh Kimberly , Collins Jody , Mick Joann
Published: August 2022

Evidence-based nursing practice supports the provision of high-quality patient care. This article shares how a contest at a community hospital promoted a culture of clinical inquiry and engaged nurses in evidence-based practice.
Reducing nurse burnout when caring for patients with substance use disorder
Authors: Ward Cynthia W. , Mitchell Tammy
Published: August 2022

Caring for patients with substance use disorder (SUD) can be challenging. Lack of knowledge of SUD treatment may add to nurses' feelings of burnout and intent to leave the workplace. This article describes a novel program for patients with SUD admitted for long-term antibiotic treatment and its impact on the nurses' work environment, particularly burnout.
Blood, Cellular, and Tissular Calcineurin Inhibitors Pharmacokinetic–Pharmacodynamic Relationship in Heart Transplant Recipients: The INTRACAR Study
Authors: Coste Gwendal , Chabanne Céline , Tron Camille , Lelong Bernard , Verdier Marie-Clémence , Roussel Mikael , Le Gall François , Turlin Bruno , Desille-Dugast Mireille , Flécher Erwan , Laviolle Bruno , Lemaitre Florian
Published: August 2022

Background:

After heart transplantation, calcineurin inhibitors (CNI) (cyclosporin A and tacrolimus) are key immunosuppressive drugs to prevent graft rejection. Whole-blood concentration (Cblood)-guided therapeutic drug monitoring (TDM) is systematically performed to improve graft outcomes. However, some patients will still experience graft rejection and/or adverse events despite CNI Cblood within the therapeutic range. Other pharmacokinetic parameters, such as the intragraft, or intracellular concentration at the CNI site of action could refine their TDM. Nonetheless, these remain to be explored. The objective of the INTRACAR study was to describe the relationship between whole blood, intragraft, and intracellular CNI concentrations as well as their efficacy in heart transplant recipients (HTR).

Methods:

In a cohort of HTR, protocol endomyocardial biopsies (EMB) were collected to assess rejection by anatomopathological analysis. Part of the EMB was used to measure the intragraft concentrations of CNI (CEMB). Cblood and the concentration inside peripheral blood mononuclear cells, (CPBMC), a cellular fraction enriched with lymphocytes, were also monitored. Concentrations in the 3 matrices were compared between patients with and without biopsy-proven acute rejection (BPAR).

Results:

Thirty-four HTR were included, representing nearly 100 pharmacokinetic (PK) samples for each CNI. Cblood, CEMB, and CPBMC correlated for both CNI. BPAR was observed in 74 biopsies (39.6%) from 26 patients (76.5%), all except one was of low grade. None of the PK parameters (Cblood, CEMB, CPBMC, CEMB/blood, and CPBMC/blood) was associated with BPAR.

Conclusions:

In this cohort of well-immunosuppressed patients, no association was observed for any of the PK parameters, including Cblood, with the occurrence of BPAR. However, a trend was noticed for the CEMB and CEMB/blood of cyclosporin A. Further studies in higher-risk patients may help optimize the use of CEMB and CPBMC for CNI TDM in HTR.
Development and Evaluation of a Novel Software Program, SAKURA-TDM, for Area Under the Concentration-Time Curve–Guided Vancomycin Dosing: A Short Communication
Authors: Horita Yasuhiro , Asaoka Minami , Iida Moeko , Kato Hideki , Wachino Chiharu , Mitamura Kana , Ohashi Kazuki , Mimura Yoshihisa , Hotta Yuji , Kataoka Tomoya , Nakamura Atsushi , Kimura Kazunori
Published: August 2022

Background:

The area under the concentration-time curve (AUC)–guided dosing of vancomycin has been introduced in Japan; however, the optimal dosing method remains controversial. Here, a novel software program was developed for AUC-guided vancomycin dosing and to estimate the theoretical threshold of the steady-state AUC24 that could reduce the risk of renal injury.

Methods:

A single-center, retrospective, observational study was conducted to develop a novel software program (SAKURA-TDM ver.1.0) for AUC-guided dosing. The estimation accuracy of pharmacokinetic parameters determined using SAKURA-TDM was compared with that of clinically available software programs and assessed with Bland–Altman analysis. In addition, theoretical cutoff points of the steady-state AUC24 and the predicted trough values were estimated using Youden J statistic approach.

Results:

The estimation accuracy of pharmacokinetic parameters and AUC determined using SAKURA-TDM was comparable to that of other TDM software programs. Of note, despite a good relationship between the predicted AUC24 and trough values, the correlation between the predicted AUC24 and measured trough values was not strong. The cutoff values of the steady-state AUC24 and the predicted trough value for reducing the probability of a measured trough value of >20 mcg/mL were 513.1 mg·h/L and 15.6 mcg/mL, respectively.

Conclusions:

We demonstrated the equivalence of the estimated PK parameters between SAKURA-TDM and other TDM software programs available in Japan. Considering the threshold of both trough values and the steady-state AUC and monitoring of the AUC in a non–steady state, it would be possible to reduce the risk of vancomycin-associated renal injury.
Lean Body Mass and Total Body Weight Versus Body Surface Area as a Determinant of Docetaxel Pharmacokinetics and Toxicity
Authors: Hoge Rien H. L. , Detert Oude Weme Suzan E. H. , Vervenne Walter L. , van Berlo-van de Laar Inge R. F. , van Herpen Carla M. L. , Roorda Laurens , Mathôt Ron A. A. , Jacobs Maartje S. , van Erp Nielka P. , Jansman Frank G. A.
Published: August 2022

Aim:

This study examined whether anthropometric and body composition parameters such as body surface area (BSA), lean body mass (LBM), and total body weight (TBW) are correlated with docetaxel clearance and exposure by analyzing area under the curve. In addition, LBM, TBW, and a fixed dose were compared with BSA as dosing parameters for dose individualization of docetaxel.

Methods:

Thirty-six patients receiving docetaxel chemotherapy for breast or metastatic castration-resistant prostate carcinoma were included. Before treatment, LBM was measured using a dual-energy X-ray absorptiometry scanner. Blood samples were collected up to 180 minutes after dosing to analyze docetaxel concentrations and determine individual pharmacokinetic parameters.

Results:

No significant correlations were found between docetaxel clearance and the anthropometric and body composition variables (BSA, LBM, and TBW). The area under the curve was significantly but poorly correlated with BSA [r = 0.452 (P = 0.016)] and TBW [r = 0.476 (P = 0.011)]. The mean absolute percentage error and mean error of simulated dosing based on LBM and fixed dosing were not significantly different from those of BSA. For TBW, only mean absolute percentage error was significantly higher compared with dosing based on BSA (24.1 versus 17.1, P = 0.001).

Conclusions:

There was no clinically relevant correlation between docetaxel pharmacokinetics and the anthropometric and body composition variables BSA, LBM, and TBW. Therefore, dose individualization of docetaxel based on LBM, TBW, or fixed dosing cannot be recommended over BSA-based dosing.