bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPLORING RELATEDNESS AS SOUGHT BY ADOLESCENTS AND YOUNG ADULTS IN AN ONLINE INSTAGRAM INFLAMMATORY BOWEL DISEASE SUPPORT COMMUNITY
Authors: Malloy Caeli , Mravec Michelle , Miller Wendy
Published: January 2023

INTRODUCTION

Individuals with chronic conditions have flocked to social media as a source of information, connection, and support. Online social groups are particularly salient for individuals with isolating or stigmatized conditions such as inflammatory bowel disease (IBD). IBD self-management is complex, ongoing, and highly individualized. Adolescents and young adults (AYAs) often struggle with IBD self-management, resulting in increased risk for poor health outcomes. AYAs with IBD are active on social media sites, but little is known about the possible drivers of motivation for AYAs to engage in online support communities.

Self-Determination Theory proposes that behavior is intrinsically motivated by an individual’s need for autonomy, competence, and relatedness. Relatedness has been defined as a sense of group belonging and has been theorized as a key component of behavior change. However, little is known about the way in which online communities may fulfill the need for relatedness for people with chronic conditions. In this study, we aim to explore the way AYAs with IBD find relatedness in an Instagram IBD support community.

METHODS

We extracted public Instagram posts published between January and December 2019 in a popular IBD support group. In this group, Instagram users sent questions about IBD to the group account owner via direct message. The owner screenshotted user messages and posted these anonymous screenshots to the group, allowing other users to leave comments. We extracted posts about IBD self-management from users who indicated that they had IBD and that they were 13-24 years old or in middle school, high school, or college. Eighty-three posts were included. Then, we screenshotted and transcribed comments under each post, resulting in 1,110 unique comments. Using thematic analysis, three investigators have begun familiarizing themselves with the data, independently coding comments, and identifying emerging themes. Themes will continue to be refined through an iterative process.

RESULTS

From preliminary analysis, five themes have emerged: Validation, Autonomy Support, Well Wishes, Shared Identity, and Connection Within and Beyond Illness. Instagram users connected with AYAs with IBD in a variety of ways by validating their concerns, supporting their autonomy in making self-management decisions, providing online human connection, and uplifting them in their illness journeys.

CONCLUSION

Relatedness is a critical component of behavioral interventions, but is poorly understood in reference to self-management support in AYAs with IBD. As AYAs seek relatedness online, it is crucial to understand this population’s needs for relatedness in developing future interventions that are effective, sustainable, and tailored to the self-management needs of AYAs with IBD.
ESRD IN PATIENTS WITH IBD: AN ANALYSIS OF THE NATIONAL INPATIENT SAMPLE 2015-2019
Authors: Chhoun Christopher , Blair Brian , Joo Lucy , Khalid Yaser , Dasu Neethi , Patel Rahul
Published: January 2023

BACKGROUND

Inflammatory Bowel Disease (IBD) can have numerous complications involving all systems of the body. There are limited data investigating the effect of renal disease on outcomes in patients with IBD . The aim of our study was to examine the impact of End-Stage Renal Disease (ESRD) on the outcomes of patients with IBD.

METHODS

The Nationwide Inpatient Sample (NIS) database encompasses approximately 7 million inpatient hospitalizations annually in the United States. Data were extracted from the National Inpatient Sample (NIS) Database for the years 2015-2019. Patients aged 18 years and above with diagnoses of IBD and ESRD were identified using ICD codes. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges using STATA 17. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.

RESULTS

We identified 226,264 patients with IBD of which 44,340 patients were matched to those with diagnoses of ESRD. Average age was 60.4 years. There was a significant increase in inpatient mortality (OR 2.22, CI 1.629486-3.018497, p<0.0001), total cost of hospitalization ($31,461.41, CI 21,365.89 - 41,556.94, p<0.0001), and hospital length of stay (2.03 days, CI 1.392255-2.674399, p<0.0001) in patients with IBD with a concurrent diagnosis of ESRD when compared to IBD patients without ESRD. On multivariate analysis, positive predictors of mortality were sepsis (OR: 6.828519 p-value: <0.001; 95% CI: 5.809829 8.025826), aspiration events,(OR: 3.78247 p-value: <0.001; 95% CI: 2.939117- 4.867815), and malnourishment (OR: 2.919507 p-value: <0.001; 95% CI: 2.447496- 3.482547).

LOS was increased in patients with hospitalizations complicated by sepsis (OR 3.282481; p-value: <0.001; 95% CI: 2.96-3.60), malnutrition (OR 5.60; p-value: <0.001; CI: 5.11- 6.08), and aspiration events (OR 3.58; p-value:<0.001;CI: 2.74-4.42).

Total hospital charges were increased in patients with hospitalizations complicated by sepsis ( $45,351.03; p-value: <0.001; 95% CI: 39,370.62-51,331.44), malnutrition ($63,326.1; p-value: <0.001; CI: 52,921.92-73,730.27), and aspiration events($ 57,778.34; p-value: <0.001; CI: 40,777.18-74,779.5).

CONCLUSIONS

Our study demonstrates the presence of ESRD in hospitalized patients with IBD is associated with poor outcomes in terms of mortality, length of stay, and total hospital charges. Furthermore concurrent aspiration events, malnutrition, and sepsis are also associated with worsened outcomes.

Our study is novel because there are minimal data that investigate the clinical outcomes associated with IBD patients with ESRD. Our study demonstrates that the presence of ESRD poses a significant mortality risk in these patients, among other factors.
INTESTINAL PERFORATIONS IN PATIENTS WITH IBD: AN ANALYSIS OF THE NATIONAL INPATIENT SAMPLE 2015-2019
Authors: Chhoun Christopher , Joo Lucy , Blair Brian , Khalid Yaser , Dasu Neethi , Patel Rahul
Published: January 2023

BACKGROUND

Inflammatory Bowel Disease results in numerous complications due to inflammatory damage to the intestinal mucosa. One complication of IBD is perforation of the intestines. The aim of our study was to study the impact of IBD on clinical outcomes in patients with intestinal perforation.

METHODS

The Nationwide Inpatient Sample (NIS) database encompasses approximately 7 million inpatient hospitalizations annually in the United States. Data were extracted from the National Inpatient Sample (NIS) Database for the years 2015-2019. Patients aged 18 years and above with diagnoses of IBD and intestinal perforation were identified using ICD codes. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges using STATA 17. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.

RESULTS

We identified 221,820 patients with IBD of which 43,509 patients were matched to those with intestinal perforations. Average age was 56.61 years. There was a significant increase in inpatient mortality (OR 3.10, CI 2.06-4.67, p<0.0001), total cost of hospitalization ($140,391, CI 108,576.3 - 172,205.9, p<0.0001), and hospital length of stay (9.42 days, CI 7.67 - 11.2, p<0.0001) in patients with IBD with a concurrent diagnosis of intestinal perforation when compared to IBD patients without intestinal perforations. On multivariate analysis, positive predictors of mortality were Acute Kidney Injury (AKI) (OR: 3.734811 p-value: <0.001; 95% CI: 3.159078 - 4.41547) and sepsis (OR: 5.616263 p-value: <0.001; 95% CI: 4.777288- 6.602577). LOS was increased in patients with hospitalizations complicated by AKI (OR 2.577361; p-value: <0.001; 95% CI: 2.327294-2.827427) and sepsis (OR 3.096738; p-value: <0.001; CI: 2.754462- 3.439013). Total hospital charges were increased in patients with hospitalizations complicated by sepsis ($41,685.55; p-value: <0.001; 95% CI: 35,262.58-48,108.52) and AKI ($34,990.15; p-value: <0.001; CI: $30,215.96-39,764.34).

CONCLUSIONS

Our study demonstrates the presence of intestinal perforations in hospitalized patients with IBD is associated with poor outcomes in terms of mortality, length of stay, and total hospital charges. Furthermore it was found that the presence of both sepsis and AKI are also associated with worsened outcomes.

Our study is novel because there are minimal data that investigate the clinical outcomes associated with IBD patients with intestinal perforations. Our study demonstrates that the presence of intestinal perforations poses a significant mortality risk in these patients, along with concurrent sepsis and AKI.Further studies would be beneficial to identify further risk factors contributing to worsening outcomes.
GUT-BIOME MODULATION WITH HUMAN MILK OLIGOSACCHARIDE (HMO) BASED SYNBIOTIC FOR A COMPLETE AND DEEP REMISSION IN CROHN’S DISEASE: A CASE STUDY
Authors: Tummala Sai , Palle Sirish Kumar , Devalaraja Matt
Published: January 2023

BACKGROUND

Gut microbiome plays a crucial role in modulation of inflammatory and immune pathways. Diverse bacterial species from gut microbiota feed on specific prebiotics (non-digestible dietary fibers) producing metabolites, such as short chain fatty acids (SCFA). These metabolites beneficially affect the intestinal mucosa with their role in metabolic and immunologic homeostasis, and gut barrier integrity. Recently gut-biome modulation and use of metabolites gained interest as potential targets for therapeutic development, for instance in Inflammatory Bowel Disease (IBD) which includes Crohn’s disease (CD) and ulcerative colitis (UC).

HYPOTHESIS

Nourishing the gut-biome thru synbiotic formulation can enhance the interspecies synergy with production of metabolites and improved gut barrier integrity more naturally. This is a superior and holistic approach to reduce gut-inflammation.

METHODS (CLINICAL CASE)

An 11 year old male with refractory iron deficiency anemia, fecal calprotectin at 1375 µg/g, on video capsule endoscopy showed discrete linear and serpiginous ulcers with surrounding erythema in duodenum and proximal jejunum. Biopsy of colon showed multiple granulomas in terminal ileum and entire colon suggesting CD (Inflammatory phenotype). Exclusive Enteral Nutrition (EEN) with polymeric formula proved unsustainable. To nourish the gut-biome and its ecosystem a synbiotic formulation (Gastrosyn) that has a blend of specific prebiotics with HMO and complimentary probiotic blend with strains of Lactobacilli and Bifidobacterium was administered and followed for 20 weeks. Formulation also contained powerful antioxidant for synergistic effect in reducing inflammation.

RESULTS

After 4 weeks on synbiotic, fecal calprotectin dropped to 665ug/g which further dropped to 110 ug/g by week 12. Complete and deep remission was observed by 15 weeks as analyzed by endoscopy/colonoscopy (images), histology and lab tests results repeated several times (Calprotectin 65ug/g by week 15). Anemia also improved significantly, and patient continued to tolerate solid foods with no relapse even after 1year.

CONCLUSIONS

Synbiotics utilizing prebiotics that are specific to probiotic strains used is crucial for successful engraftment and biome modulation as established in recent literature. HMO based Synbiotic formulation has proven to nurture the ecosystem, and foster interspecies interactions, cross feeding, and generation of metabolites (SCFAs), providing a holistic and superior approach for remission in IBD.
PCBP1 acts as a regulator of CCL2 expression in macrophages to induce recruitment of monocyte-derived macrophages into the inflamed colon
Authors: Yang Xinquan , Yabe-Wada Toshiki , Han Jia , Saito Fumiji , Ogasawara Chie , Yamada Sohsuke , Onai Nobuyuki
Published: January 2023

Intestinal macrophages with functional plasticity play essential roles in gut immune responses by increasing chemokines and cytokines, thereby contributing to the pathogenesis of inflammatory bowel disease (IBD). Poly(rC)-binding protein 1 (PCBP1), which is widely expressed in immune cells, binds to nucleic acids in mRNA processing, stabilization, translation and transcription. However, little is known about the influence of PCBP1 on macrophages and its specific mechanism in inflamed intestines. In this study, conditional depletion of Pcbp1 in macrophages protected mice from progression of dextran sulfate sodium induced colitis and resulted in significant alleviation of colitis. Pcbp1 deficiency markedly decreased C-C motif chemokine ligand 2 (CCL2) production by colonic CX3C motif chemokine receptor 1+ (CX3CR1+) macrophages and reduced accumulation of pro-inflammatory macrophages and production of pro-inflammatory cytokines, such as IL-6 and TNF-α, in the inflamed colon. RNA-immunoprecipitation analysis indicated that PCBP1 might interact with Ccl2 mRNA and regulate its expression in macrophages. PCBP1 expression in inflamed intestines also correlated significantly with IBD severity in patients, suggesting a critical involvement of PCBP1 in intestinal inflammation. We anticipate that our findings will facilitate the development of novel therapeutic approaches for IBD by targeting the specific function of immune cells in the local microenvironment, thereby helping to reduce adverse effects.
Awareness of antibiotic resistance: a tool for measurement among human and animal health care professionals in LMICs and UMICs
Authors: Pinto Jimenez Chris , Pearson Maddy , Hennessey Mathew , Nkereuwem Esin , Crocker Chloe , Egbujo Uzoamaka , Hendriks Jolijn , Smith Sarah , Whanpuch Phakha , Manongi Rachel , Thi Hoa Ngo , Chandler Clare I R
Published: January 2023

Background

Raising awareness of antimicrobial resistance is a cornerstone of action plans to tackle this global One Health challenge. Tools that can reliably assess levels of awareness of antibiotic resistance (ABR) among human or animal healthcare professionals (HCPs) are required to guide and evaluate interventions.

Methods

We designed and tested an ABR awareness scale, a self-administered questionnaire completed by human and animal HCPs trained to prescribe and dispense antibiotics in six countries—Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru. Questionnaires also elicited demographic, practice, and contextual information. Psychometric analysis for the scale followed Rasch Measurement Theory. Bivariate analysis was carried out to identify factors associated with awareness scores.

Results

Overall, 941 HCPs (625 human and 316 animal) from Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru were included in the study. The 23-item ABR awareness scale had high-reliability coefficients (0.88 for human and 0.90 for animal HCPs) but performed better within countries than across countries. Median ABR awareness scores were 54.6–63.5 for human HCPs and 55.2–63.8 for animal HCPs (scale of 0–100). Physicians and veterinarians scored higher than other HCPs in every country tested. HCPs in this study reported working in contexts with limited laboratory infrastructures. More than 95% of HCPs were interested in receiving information or training on ABR and antimicrobial stewardship.

Conclusion

HCPs’ awareness of ABR can be reliably assessed with this validated 23-item scale within the countries tested. Using the scale alongside context questions and objective measurement of practices is recommended to inform interventions to improve antibiotic use.
The primary pharmacology of ceftazidime/avibactam: resistancein vitro
Authors: Nichols Wright W , Lahiri Sushmita D , Bradford Patricia A , Stone Gregory G
Published: January 2023

This article reviews resistance to ceftazidime/avibactam as an aspect of its primary pharmacology, linked thematically with recent reviews of the basic in vitro and in vivo translational biology of the combination (J Antimicrob Chemother 2022; 77: 2321–40 and 2341–52). In Enterobacterales or Pseudomonas aeruginosa, single-step exposures to 8×  MIC of ceftazidime/avibactam yielded frequencies of resistance from <∼0.5 × 10−9 to 2–8 × 10−9, depending on the host strain and the β-lactamase harboured. β-Lactamase structural gene mutations mostly affected the avibactam binding site through changes in the Ω-loop: e.g. Asp179Tyr (D179Y) in KPC-2. Other mutations included ones proposed to reduce the permeability to ceftazidime and/or avibactam through changes in outer membrane structure, up-regulated efflux, or both. The existence, or otherwise, of cross-resistance between ceftazidime/avibactam and other antibacterial agents was also reviewed as a key element of the preclinical primary pharmacology of the new agent. Cross-resistance between ceftazidime/avibactam and other β-lactam-based antibacterial agents was caused by MBLs. Mechanism-based cross-resistance was not observed between ceftazidime/avibactam and fluoroquinolones, aminoglycosides or colistin. A low level of general co-resistance to ceftazidime/avibactam was observed in MDR Enterobacterales and P. aeruginosa. For example, among 2821 MDR Klebsiella spp., 3.4% were resistant to ceftazidime/avibactam, in contrast to 0.07% of 8177 non-MDR isolates. Much of this was caused by possession of MBLs. Among 1151 MDR, XDR and pandrug-resistant isolates of P. aeruginosa from the USA, 11.1% were resistant to ceftazidime/avibactam, in contrast to 3.0% of 7452 unselected isolates. In this case, the decreased proportion susceptible was not due to MBLs.
Population pharmacokinetics and limited sampling strategies of polymyxin B in critically ill patients
Authors: Pi Meng-Ying , Cai Chang-Jie , Zuo Ling-Yun , Zheng Jun-Tao , Zhang Miao-Lun , Lin Xiao-Bin , Chen Xiao , Zhong Guo-Ping , Xia Yan-Zhe
Published: January 2023

Objectives

To characterize the pharmacokinetics (PK) of polymyxin B in Chinese critically ill patients. The factors significantly affecting PK parameters are identified, and a limited sampling strategy for therapeutic drug monitoring of polymyxin B is explored.

Methods

Thirty patients (212 samples) were included in a population PK analysis. A limited sampling strategy was developed using Bayesian estimation, multiple linear regression and modified integral equations. Non-linear mixed-effects models were developed using Phoenix NLME software.

Results

A two-compartment population PK model was used to describe polymyxin B PK. Population estimates of the volumes of central compartment distribution (V) and peripheral compartment distribution (V2), central compartment clearance (CL) and intercompartmental clearance (Q) were 7.857 L, 12.668 L, 1.672 L/h and 7.009 L/h. Continuous renal replacement therapy (CRRT) significantly affected CL, and body weight significantly affected CL and Q. The AUC0-12h of polymyxin B in patients with CRRT was significantly lower than in patients without CRRT. CL and Q increased with increasing body weight. A limited sampling strategy was suggested using a two-sample scheme with plasma at 0.5h and 8h after the end of infusion (C0.5 and C8) for therapeutic drug monitoring in the clinic.

Conclusions

A dosing regimen should be based on body weight and the application of CRRT. A two-sample strategy for therapeutic drug monitoring could facilitate individualized treatment with polymyxin B in critically ill patients.
Binary modal logic and unary modal logic
Authors: de Jongh Dick , Shirmohammadzadeh Maleki Fatemeh
Published: January 2023

Standard unary modal logic and binary modal logic, i.e. modal logic with one binary operator, are shown to be definitional extensions of one another when an additional axiom $U$ is added to the basic axiomatization of the binary side. This is a strengthening of our previous results. It follows that all unary modal logics extending Classical Modal Logic, in other words all unary modal logics with a neighborhood semantics, can equivalently be seen as binary modal logics. This in particular applies to standard modal logics, which can be given simple natural axiomatizations in binary form. We illustrate this in the logic K. We call such logics binary expansions of the unary modal logics. There are many more such binary expansions than the ones given by the axiom $U$. We initiate an investigation of the properties of these expansions and in particular of the maximal binary expansions of a logic. Our results directly imply that all sub- and superintuitionistic logics with a standard modal companion also have binary modal companions. The latter also applies to the weak subintuitionistic logic WF of our previous papers. This logic doesn’t seem to have a unary modal companion.
Application of Geant4-DNA for simulating water radiolysis induced by Auger electron-emitting radionuclides
Authors: Adjei Daniel , Trinh Ngoc Duy , Mostafavi Mehran
Published: January 2023

Auger-emitting radionuclides have potential application in targeted radiotherapy, particularly for metastatic cancers. This possibility, especially, is stemmed from their characteristic short-range (a few μm) in biological systems allowing localization of high dose within small tumours. To explore this potential application, a Geant4 Monte Carlo toolkit has been employed to simulate the energy deposition of different radionuclides in a water model. The Geant4 Monte Carlo toolkit has model packages to simulate the interaction of radiation with matter and with diverse applications such as studies in science and medicine. In this study, the Geant4-DNA package was used to simulate the radiolytic yields induced by some Auger electron-emitting (AE) radionuclides including; I-131, I-125 and Pd-103, In-111, Ru-97 and Rh-103 m in water model. The results showed that the transient yield of the radiolytic species is characterized by the kinetic energies of the emitted electrons. It was observed that almost all the radionuclides, except I-131, deposited more energy in their proximity thereby inducing a high density of spurs to interact in a short time. It is, therefore, important to consider the kinetic energies of the emitted particles in choosing a radionuclide for specified targeted radiotherapy. This means that apart from their toxicity, compatibility with chelator and carrier molecules, and method of production, we can predict radionuclides such as In-111, Ru-97, Pb-103 m and I-125 could be relevant for targeted radiotherapy for the treatment of metastasis lesions, or tiny tumours at the cellular level, and tumours after surgical resection.
A comprehensive account of the burden of persuasion in abstract argumentation
Authors: Kampik Timotheus , Gabbay Dov , Sartor Giovanni
Published: January 2023

In this paper, we provide a formal framework for modeling the burden of persuasion in legal reasoning. The framework is based on abstract argumentation, a frequently studied method of non-monotonic reasoning, and can be applied to different argumentation semantics; it supports burdens of persuasion with arbitrary many levels, and allows for the placement of a burden of persuasion on any subset of an argumentation framework’s arguments. Our framework can be considered an extension of related works that raise questions on how burdens of persuasion should be handled in some conflict scenarios that can be modeled with abstract argumentation. An open source software implementation of the introduced formal notions is available as an extension of an argumentation reasoning library. A theoretical analysis shows that our approach can be generalized to a novel method for the preference-based selection of extensions from argumentation frameworks.
Focusing—Finding a Shared Goal
Authors: Starks Tyrel J.
Published: January 2023

This chapter discusses the two stages of establishing and elaborating a focus in couples Motivational Interviewing. Establishing a focus refers to the identification of a target behavior that both partners are at least willing to discuss. Elaborating a focus then subsequently involves clarifying what each partner wants, their beliefs about one another’s preferences, and the extent to which each partner believes that their perspective will be heard without doubt or judgment. In the process of elaborating a focus, challenges may emerge as partners’ initial perceptions about the presence or absence of agreement are informed by disclosures in session. They may also emerge as a result of doubt or judgment expressed by partners toward one another—an absence of trust that impedes successful negotiation around a counseling focus. The purpose of the focusing process is not to achieve agreement about whether or how change should happen, but rather to ensure that all parties have an accurate understanding of one another’s views before an emphasis on evoking change talk emerges as salient.
Evoking Change Talk From a Couple
Authors: Starks Tyrel J.
Published: January 2023

This chapter discusses the impact of dyadic ambivalence on the process of evoking change talk. Dyadic ambivalence occurs when partners have divergent perspectives on change. In such instances, the use of traditional Motivational Interviewing strategies may exacerbate conflict. Counselor utterances that elicit change talk from one partner may elicit counter–change talk from the other. This chapter reviews a set of strategies for mitigating relationship discord—the presence of conflict between partners in session. These strategies are intended to create opportunities for partners to consider one another’s perspective and the potential for consensus. Once some degree of alignment in partners’ perceptions of the target behavior has been achieved, traditional evoking skills common in Motivational Interviewing practice can be employed successfully.
Planning—Taking Action Together
Authors: Starks Tyrel J.
Published: January 2023

This chapter discusses the role of partners in the change-planning process from the perspective of both goal-setting and interdependence theory. Emphasis is placed on the identification of couple-level or shared goals (i.e., joint goals) in which both partners feel a sense of investment. Even when such goals do not involve both partners enacting similar behavior change, partners may serve as a source of support and feedback to one another. For this reason, change planning with couples involves clarifying the role of both partners in the change process. In addition, plans incorporate how partners will communicate with one another during the change process. The chapter presents and discusses the planning process in three prototypical scenarios involving mutual change, individual change with partner support, and planning when shared goals cannot be identified. Special considerations related to planning for relationship termination are also mentioned.
Session 9: Practicing Acceptance and Commitment Therapy (ACT) and Review of Treatment
Authors: Woods Douglas W. , Twohig Michael P.
Published: January 2023

This chapter discusses practicing Acceptance and Commitment Therapy (ACT) and provides a review of treatment. It covers the session work regarding embracing urges and other inner experiences while also thinking about the values and motivation to commit to changing the behavior. Some difficulties in practicing ACT involve being overwhelmed by the exercise, undoing the work to change, and losing motivation. The chapter lists habit reversal training and trigger reduction strategies as some of the important concepts and skills in the treatment review. It highlights the significance of maintaining the gains made during treatment, such as engaging with the chosen competing response.
Session 2: Habit Reversal Training (HRT) and Trigger Reduction Strategies
Authors: Woods Douglas W. , Twohig Michael P.
Published: January 2023

This chapter discusses the second session of the Acceptance and Commitment Therapy (ACT) Enhanced Behavior Therapy for Trichotillomania (AEBT-T) treatment package. The therapist should review the client’s completed self-monitoring form, praise the client for doing the homework, and point out the importance of continued monitoring. The self-monitoring data can be plotted on the Daily Graph of Progress to examine fluctuations in pulling. The chapter explains the purpose of awareness training, which is to help the client recognize and react to episodes of pulling or subtle signs that pulling is about to start. The therapist elicits a detailed description of a client’s entire pulling episode, including actions the client takes before the actual act of pulling, the act itself, and any post-pulling behavior. Patients are taught competing responses to block pulling and trigger reduction strategies to reduce the likelihood pulling will occur.
Session 10: Review and Relapse Prevention
Authors: Woods Douglas W. , Twohig Michael P.
Published: January 2023

This chapter talks about the tenth and final session of the Acceptance and Commitment Therapy (ACT) Enhanced Behavior Therapy for Trichotillomania (AEBT-T) treatment package. The therapist should urge the client to continue using the skills learned in therapy. Common pitfalls and methods for addressing them are covered. The first pitfall involves becoming less reliable in using habit reversal training and trigger reduction strategies. The second pitfall involves more time fighting with urges, increased pulling, and less time pursuing the meaningful parts of life. Clients may once again react to pulling-related thoughts, urges, or emotions as if they were real events with physical characteristics. In the final session the therapist should review with the client the progress made in therapy and should congratulate the client on their progress.
Case 1
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 23-year-old woman in her first pregnancy presented at 32 weeks of gestation with a 1-day history of progressively worsening, constant, lower thoracic and upper lumbar back pain. There was no history of trauma or heavy lifting, and no symptoms of urinary retention, faecal incontinence, or neurological symptoms in the lower limbs. Her pregnancy had been uncomplicated prior to this. At booking her BMI was normal and her BP was 95/70 mmHg. She had a past medical history of hypermobility. Her family history included hypertension in her father, and her sister had a history of spontaneous bowel perforation. She was a non-smoker.
Case 8
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 45-year-old woman presented to the Emergency Department with a 3-day history of severe headache. She described some visual changes and nausea. Her past medical history was notable for infertility, for which she had undergone numerous investigations and three unsuccessful IVF cycles. She had a history of gastro-oesophageal reflux for which she took omeprazole daily. She had a family history of hypertension in both her parents and her older sister. She worked as an accountant. She had smoked 20 cigarettes a day for many years but stopped 1 year prior to this presentation. She drank 15–20 units of alcohol a week.
Case 11
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 44-year-old woman attended for pre-conception counselling following a review in the local fertility service. She had been trying to conceive with her current partner for four years. She had had two first trimester miscarriages during this time. Past medical history was notable for polycystic ovarian syndrome, with 6–8 spontaneous periods each year. She takes metformin 500 mg twice daily as well as pregnancy multivitamins. She is a non-smoker and drinks approximately 15 units of alcohol per week. The fertility service asked for advice about her thyroid function.
Case 18
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 35-year-old woman with type 1 diabetes mellitus was pregnant for the first time. Her glycaemic control prior to conception was very good (pre-conception HbA1c 42 mmol/mol) and she had no history of retinopathy or nephropathy. She had an insulin pump and used continuous glucose monitoring. At booking her BP was 105/65 mmHg and BMI was 21 kg/m2. She also had a history of vitiligo. She was taking folic acid 5 mg daily, vitamin D 1000 units daily, and aspirin 150 mg daily. Her family history was notable for rheumatoid arthritis and hypothyroidism in her mother. She did not smoke or drink alcohol.
Case 30
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 22-year-old woman was pregnant for the first time. At 36 weeks of gestation she presented with a 3-day history of worsening left-sided lower back pain. She had no gastrointestinal or urinary symptoms, and no symptoms in her legs, for example paraesthesia, numbness or swelling. Her pregnancy had been uncomplicated prior to this presentation; her booking blood pressure was normal (100/60 mmHg) and her BMI was 24 kg/m2. She had no significant past medical history or family history. She took pregnancy multivitamins and no other medications. On examination her observations were normal. Tenderness in her left flank was identified on palpation.
Case 34
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 38-year-old woman was brought to the Emergency Department at 28 weeks of gestation. She was unwell, complaining of acute severe epigastric pain and vomiting for the preceding 8 hours. She complained of mild constipation throughout pregnancy, but last opened her bowels 2 days previously. She had no fever and no other symptoms. The pregnancy was uneventful aside from nausea and vomiting in the first trimester. This was her second pregnancy, her first being 10 years previously. She was diagnosed with gestational diabetes in that pregnancy. Two years prior to this pregnancy she underwent a Roux-en-Y gastric bypass. Her BMI at the start of pregnancy was 26 kg/m2, having been 39 kg/m2 prior to surgery.
Case 48
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 43-year-old woman with type 2 diabetes mellitus was seen in the antenatal clinic at 9 weeks of gestation in her first pregnancy. This pregnancy was unplanned, and she had never discussed pregnancy or pre-pregnancy counselling with healthcare professionals. In addition to diabetes, she had a history of hypertension and polycystic ovarian syndrome. Her current medications include metformin, liraglutide, and ramipril. She has no features of diabetic neuropathy or nephropathy and no history of cardiovascular disease. She attends her first trimester retinal screening which shows proliferative diabetic retinopathy and mild macular oedema.
Test Accuracy As Positive and Negative Predictive Values
Authors: Boyles Tom
Published: January 2023

This chapter explains how to generate positive and negative predictive values from the rows of a 2×2 table and that unlike sensitivity and specificity, they answer patient-relevant questions such as the probability of disease with a given result. It goes on to describe an important drawback of predictive values, namely that they vary with disease prevalence. It emphasizes that positive and negative predictive values are only meaningful when quoted alongside disease prevalence and are only directly applicable to individual patients when the probability of disease approximates the prevalence in the study from which the values are calculated.
Diagnostic and Prognostic Research
Authors: Boyles Tom
Published: January 2023

This chapter describes methods of drawing together multiple strands of information about patients, often in the form of multivariable prediction models (MPMs). It references two landmark papers that explain the process of developing MPMs and then uses the Framingham Heart Study as an example. It gives examples of web-based tools and nomograms for calculating predicted outcomes and then explains discrimination and calibration as valuable statistics for evaluating MPM as well as the importance of internal and external validation. Finally, the chapter gives a brief introduction to machine learning approaches to developing MPMs.
Conclusions
Authors: Boyles Tom
Published: January 2023

This chapter provides a four-point plan to be considered before requesting any test, which begins with formulating a patient-relevant question, determining if the test can answer the question, considering costs, and then pausing to think. It continues with common pitfalls of testing such as mindlessly ticking boxes on request forms and asking for multiple pieces of information when one will suffice. It continues with a summary of the second half of the book and brings in examples from the media, who often portray tests as ‘game changers’ before adequate evaluation. The chapter finishes by returning to the professor from Chapter 1 and explaining in terms of likelihood ratios, probabilities, and thresholds how she was able to solve a seemingly difficult case with a simple urinary pregnancy test.
Anxiety in Palliative Care
Authors: Chin Martin S. , Roth Andrew J. , Matsoukas Konstantina
Published: January 2023

This chapter discusses the prevalence, assessment, and management of anxiety in patients receiving palliative care. Anxiety commonly increases as patients become aware of both the relative ineffectiveness of medical treatments in halting the progress of their disease and, consequently, of approaching death. The aim of this chapter is to build awareness of anxiety as an important factor in this patient population and to emphasize the importance of the systematic workup and management of anxiety in the terminal phase of illness. Guidance for recognizing the symptoms of anxiety at the end of life is provided, and available psychological, pharmacological, and multimodal treatment options are explored.
Family and Couple Issues in Palliative Care
Authors: Kissane David W. , Zaider Talia I.
Published: January 2023

For dying patients, their partners and families are integral to their overall care and support needs. Distress and grief reverberate among all involved, necessitating couple- and family centered care as the norm. Psychiatry and psycho-oncology contribute much to our understanding of how to deliver couple-focused and family centered care at the end of life. Through promoting open disclosure and mutual support, couples and families can comfort one another, celebrate their shared lives, express gratitude, and prepare to say goodbye. Key skills in running family meetings include the development of shared agendas, use of circular questions, and integrated summaries that bring consensus and understanding to those involved. Enhanced coping, adaptation to illness, and prevention of mental illness and complicated grief are salient outcomes. Intervention studies show such clear benefits that palliative care does well to include couple- and family centered care within its routine practice.
Treatment of Suffering in Patients with Advanced Cancer
Authors: Cherny Nathan I. , Reyners Anna K. L.
Published: January 2023

The relief of suffering is a cardinal goal of medicine and cancer care. The ability to formulate a response to the challenge of suffering requires a clinically relevant understanding of the nature of the problem and familiarity with the factors that cause it. Suffering can be defined as an aversive experience characterized by the perception of personal distress that is generated by adverse factors that undermine quality of life. The defining characteristics of suffering include the presence of perceptual capacity (sentience), that the factors undermining quality of life are appraised as distressing, and that the experience is aversive. The encounter with advanced cancer is a potential cause of great distress to patients, their families, and the professional caregivers attending them. Emphasizing this triangular relationship, this chapter describes the many factors that contribute to the experience of suffering in the context of advanced cancer and an approach to care planning that addresses all aspects of the care trilogy: patient, family, and healthcare providers
Interprofessional Spiritual Care in Palliative Care
Authors: Puchalski Christina , Ferrell Betty R. , Battista Vanessa , Waldman Elisha , Bauer Richard W.
Published: January 2023

Palliative care, often referred to as “whole-person care,” addresses pain and suffering across the physical, emotional, psychosocial, and spiritual continuum. An increasing amount of evidence supports that individuals from pediatrics through adulthood living with serious, chronic illness and their families have significant spiritual needs. Palliative care is delivered by an interdisciplinary team and involves the use of comprehensive assessments and treatments for spiritual, physical, and psychosocial symptoms. This care, based on a generalist-specialist model, includes trained and certified chaplains. Guidelines and evidence support the inclusion of spiritual care models in clinical palliative care. Spiritual care is more than religious care and is based on spirituality broadly defined to include spiritual, existential, and religious care. Spiritual care is respectful care for all people. Spiritual health is a domain of whole-person care with spiritual distress as a clinical symptom that must be assessed and treated routinely in the care of seriously and chronically ill patients no matter their age. It is the responsibility of all clinicians to address the spiritual needs of their patients and work collaboratively with spiritual care professionals. Spiritual care professionals are essential members of the team, providing spiritual care for both the patient and family and the interprofessional team. Spiritual care may include moments of reflection, pause, ritual, and renewal to support the team in their shared values and vision of providing optimal palliative care.
Psychodynamic Therapy in the Terminally Ill
Authors: Emanuel Linda , Brody Stephanie
Published: January 2023

This chapter describes how psychodynamic approaches contribute to understanding and fostering quality of dying. Non-existence is uniquely difficult for the psyche to understand and it terrifies. People live with a fantasy of indefinite life, yet reality puts checks on that. Such opposing perceptions, which people may be unaware of, can result in unmanageable anxiety and other suffering. Getting to know one’s deeper mind regarding mortality and finding a reasonably integrated way to understand opposing perceptions allows some acceptance and a more realistic vitality. The process, in both children and adults, entails oscillating between these divergent experiences in the holding attention of the therapist. In this fostering relationship, the therapist helps to uncover often unconscious and person-specific experiences of terror and hope, non-existence and vitality. Through constructive grief, the person can discover how to integrate realistic ways to think and feel about dying that bring resilience. These new ways can become part of how they work, love, and play whether for a short time or longer. Altogether, they provide openness to realistic continuity through in family, friends, and community. Dynamic approaches also help clarify why blocks on this growth process often come from attachment or trauma issues or from a culture of death denial. Dynamic approaches are uniquely suited to finding and redressing such blocks. A resulting realistic conception of the future allows less turbulent contemplation of death, increased capacity to meaningfully relate, less indecision, attainable goals to hope for, and readiness for tasks such as legacy making.
Supportive-Expressive Group Therapy and the Terminally Ill
Authors: Spiegel David , Kogon Manuela
Published: January 2023

Supportive-expressive group therapy (SEGT) was developed in the 1970s to help women with metastatic breast cancer find opportunities for growth as well as symptom relief by giving as well as receiving support to one another, expressing emotion, facing existential concerns openly, reordering life priorities, communicating clearly with family as well as healthcare professionals, and learning self-hypnosis to manage stress and pain. Key elements of the psychotherapeutic method are personalizing the discussion using the group’s here-and-now interaction, encouraging the expression and exploration of emotion, supporting constructive group interaction among all members, and facilitating active coping. This psychotherapeutic approach has been carefully studied and found effective in reducing distress, anxiety, depression, and pain in a number of randomized clinical trials, and it has been utilized in cancer treatment programs around the world. In addition, some but not all studies have shown that those randomized to SEGT experience longer survival as well. Essentials of the treatment technique and evidence regarding psychological and physiological outcome are reviewed. Opportunities for expanding the reach of this and other therapeutic approaches utilizing internet-based intervention are discussed.
Psilocybin-Assisted Psychotherapy in Palliative Care
Authors: Ross Stephen , Bossis Anthony P.
Published: January 2023

Following a decades-long hiatus and building on an innovative research model first developed from the 1960s to 1970s utilizing psychedelic therapeutics to alleviate the marked psychic distress in end-of-life cancer patients, major academic centers are resuming contemporary clinical research into the safety and efficacy of psilocybin and other serotonergic psychedelics delivered in conjunction with psychotherapeutic platforms to treat psychiatric and existential distress associated with terminal medical illnesses. While there have been significant advances in the treatment of medical and pain symptomatology in palliative care, there remains a paucity of efficacious psychopharmacologic and psychotherapeutic interventions to alleviate the psychiatric and existential anguish—notably depression, anxiety, and demoralization—often present at the end of life. Relevant to end-of-life therapeutics, the World Health Organization and the Institute of Medicine have identified treating spiritual and existential distress as essential to improving the emotional well-being and quality of life in patients with advanced or terminal illnesses. This chapter covers topics related to psilocybin-assisted psychotherapy in palliative care: history, anthropology, ethnobotany, neuropharmacology, safety, efficacy data from first and second waves of psychedelic research, putative mechanisms of action, and future directions. Psilocybin-assisted psychotherapy offers a potential paradigm shift to improve the existential, psychosocial, and spiritual well-being of patients in palliative care settings.
The emergence of a right to pain relief
Authors: Sullivan Mark D. , Ballantyne Jane C.
Published: January 2023

This chapter describes the gradual establishment of a right to pain relief. After the Second World War, and because of the horrors that war, Western nations formed the United Nations, which saw the protection of human rights as part of its role. The United Nations wrote a Declaration of Human Rights in 1948. Although it did not initially establish a right to pain relief per se, later amendments established a right to pain relief at the end of life. Other bodies, including the U.S. Supreme Court, similarly established a right to pain relief at the end of life. Although these august bodies have never followed with statements of a right to the relief of all pain, the largest and most influential international pain society, the International Association for the Study of Pain, in 2011 wrote its own declaration, the Declaration of Montreal, which states that access to pain management is a “fundamental human right.”