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Wade T, Roberts N, Ban JW, Waweru-Siika W, Winston H, Williams V, Heneghan CJ, Onakpoya IJ. Utility of healthcare-worker-targeted antimicrobial stewardship interventions in hospitals of low- and lower-middle-income countries: a scoping review of systematic reviews. J Hosp Infect 2023; 131:43-53. [PMID: 36130626 DOI: 10.1016/j.jhin.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) initiatives in hospitals often include the implementation of clustered intervention components to improve the surveillance and targeting of antibiotics. However, impacts of the individual components of AMS interventions are not well known, especially in low- and lower-middle-income countries (LLMICs). OBJECTIVE A scoping review was conducted to summarize evidence from systematic reviews (SRs) on the impact of common hospital-implemented healthcare-worker-targeted components of AMS interventions that may be appropriate for LLMICs. METHODS Major databases were searched systematically for SRs of AMS interventions that were evaluated in hospitals. For SRs to be eligible, they had to report on at least one intervention that could be categorized according to the Effective Practice and Organisation of Care taxonomy. Clinical and process outcomes were considered. Primary studies from LLMICs were consulted for additional information. RESULTS Eighteen SRs of the evaluation of intervention components met the inclusion criteria. The evidence shows that audit and feedback, and clinical practice guidelines improved several clinical and process outcomes in hospitals. An unintended consequence of interventions was an increase in the use of antibiotics. There was a cumulative total of 547 unique studies, but only 2% (N=12) were conducted in hospitals in LLMICs. Two studies in LLMICs reported that guidelines and educational meetings were effective in hospitals. CONCLUSION Evidence from high- and upper-middle-income countries suggests that audit and feedback, and clinical practice guidelines have the potential to improve various clinical and process outcomes in hospitals. The lack of evidence in LLMIC settings prevents firm conclusions from being drawn, and highlights the need for further research.
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Affiliation(s)
- T Wade
- Department for Continuing Education, University of Oxford, Oxford, UK.
| | - N Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - J-W Ban
- Section of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - W Waweru-Siika
- Section of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - H Winston
- Department of Family Medicine, University of Pittsburgh Medical Center, McKeesport, PA, USA
| | - V Williams
- School of Nursing, Nipissing University, North Bay, Ontario, Canada
| | - C J Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - I J Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
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Suddath A, Franks A, Winston H. Catatonia in Obsessive-Compulsive Disorder: A case study and literature review. Eur Psychiatry 2022. [PMCID: PMC9567556 DOI: 10.1192/j.eurpsy.2022.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction
There are extremely few reported cases of OCD causing catatonia and some of those cases are possibly associated with the somewhat contentious diagnosis of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus. As there is a symptom overlap between OCD and catatonia some cases of catatonia are possibly being missed, warranting discussion regarding differential diagnosis, symptomatology, and treatment of catatonia and OCD. Objectives We describe a case of a 18-year-old patient who developed severe catatonia secondary to OCD, possibly related to PANDAS/PANS. We discuss the complex work-up, differential diagnosis, and treatment of this patient. Methods Discussion of a single case and a review of catatonia literature as it relates to OCD and autoimmune disorders. Results Our patient was an 18-year-old Ukrainian male who presented with sub-acute onset of decreased movement, decreased oral intake, and inability to speak. He was diagnosed with catatonia of an unclear etiology and treated with high-dose lorazepam at an outside hospital then transferred to our care. Presenting symptoms were then clarified and found to be consistent with OCD, upon which OCD treatment was initiated. The patient’s sub-acute and severe onset of OCD raised the question of a PANDAS/PANS diagnosis, which was further investigated. Ultimately, his symptoms improved with ongoing lorazepam and he was transferred to another hospital for ECT treatment. Conclusions OCD has been observed to cause catatonia in extremely rare cases. Diagnosing catatonia associated with OCD is challenging and important as catatonia is associated with significant morbidity and mortality if left untreated. Our patient improved with concurrent treatment of catatonia and OCD. Disclosure No significant relationships.
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Murray HJ, Winston H. (PO-178) A Case of Acute Psychosis following COVID-19 Illness. J Acad Consult Liaison Psychiatry 2022. [PMCID: PMC9296156 DOI: 10.1016/j.jaclp.2022.03.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Davis RA, Winston H, Gault JM, Kern DS, Mikulich-Gilbertson SK, Abosch A. Deep Brain Stimulation for OCD in a Patient With Comorbidities: Epilepsy, Tics, Autism, and Major Depressive Disorder. J Neuropsychiatry Clin Neurosci 2021; 33:167-171. [PMID: 33535803 DOI: 10.1176/appi.neuropsych.20060153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rachel A Davis
- Department of Psychiatry (Davis, Winston, Mikulich-Gilbertson), Department of Neurosurgery (Gault, Kern, Abosch) and Department of Neurology (Kern, Abosch), University of Colorado Denver School of Medicine, Aurora, Colo
| | - Helena Winston
- Department of Psychiatry (Davis, Winston, Mikulich-Gilbertson), Department of Neurosurgery (Gault, Kern, Abosch) and Department of Neurology (Kern, Abosch), University of Colorado Denver School of Medicine, Aurora, Colo
| | - Judith M Gault
- Department of Psychiatry (Davis, Winston, Mikulich-Gilbertson), Department of Neurosurgery (Gault, Kern, Abosch) and Department of Neurology (Kern, Abosch), University of Colorado Denver School of Medicine, Aurora, Colo
| | - Drew S Kern
- Department of Psychiatry (Davis, Winston, Mikulich-Gilbertson), Department of Neurosurgery (Gault, Kern, Abosch) and Department of Neurology (Kern, Abosch), University of Colorado Denver School of Medicine, Aurora, Colo
| | - Susan K Mikulich-Gilbertson
- Department of Psychiatry (Davis, Winston, Mikulich-Gilbertson), Department of Neurosurgery (Gault, Kern, Abosch) and Department of Neurology (Kern, Abosch), University of Colorado Denver School of Medicine, Aurora, Colo
| | - Aviva Abosch
- Department of Psychiatry (Davis, Winston, Mikulich-Gilbertson), Department of Neurosurgery (Gault, Kern, Abosch) and Department of Neurology (Kern, Abosch), University of Colorado Denver School of Medicine, Aurora, Colo
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5
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Davis RA, Giordano J, Hufford DB, Sheth SA, Warnke P, Widge AS, Richardson RM, Rosenow JM, Rossi PJ, Storch EA, Winston H, Zboyan J, Dougherty DD, Foote KD, Goodman WK, McLaughlin NCR, Ojemann S, Rasmussen S, Abosch A, Okun MS. Restriction of Access to Deep Brain Stimulation for Refractory OCD: Failure to Apply the Federal Parity Act. Front Psychiatry 2021; 12:706181. [PMID: 34456762 PMCID: PMC8387630 DOI: 10.3389/fpsyt.2021.706181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rachel A. Davis
- Department of Psychiatry, University of Colorado Anschutz, Aurora, CO, United States
| | - James Giordano
- Neuroethics Studies Program, Department of Neurology, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, United States
| | | | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Peter Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL, United States
| | - Alik S. Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurosurgery, Harvard Medical School, Boston, MA, United States
| | - Joshua M. Rosenow
- Department of Neurological Surgery, Northwestern University, Chicago, IL, United States
| | - Peter Justin Rossi
- University of California San Francisco Department of Psychiatry, San Francisco, CA, United States
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Helena Winston
- Department of Psychiatry, University of Colorado Anschutz, Aurora, CO, United States
- Denver Health Hospital Authority, Denver, CO, United States
| | - JoAnne Zboyan
- Springer and Steinberg, PC, Denver, CO, United States
| | - Darin D. Dougherty
- Department of Neurosurgery, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Kelly D. Foote
- Departments of Neurosurgery and Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nicole C. R. McLaughlin
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz, Aurora, CO, United States
| | - Steven Rasmussen
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
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Fage B, Winston H. Resilience: Management for the Disease of Physician Burnout: In Reply. Psychiatr Serv 2019; 70:1181-1182. [PMID: 31787064 DOI: 10.1176/appi.ps.701206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brunette MF, Oslin DW, Dixon LB, Adler DA, Berlant J, Erlich M, First MB, Goldman B, Levine B, Siris S, Winston H. The Opioid Epidemic and Psychiatry: The Time for Action Is Now. Psychiatr Serv 2019; 70:1168-1171. [PMID: 31500545 DOI: 10.1176/appi.ps.201800582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The number of people with opioid use disorder and the number of overdose deaths in the United States have increased dramatically over the past 20 years. U.S. Congress passed the SUPPORT for Patients and Communities Act, which was signed into law in 2018, authorizing almost $8 billion to address the crisis. As experts in the treatment of central nervous systems disorders, psychiatrists can play a leading role in expanding treatment for people with opioid use disorder and in advocating for policy changes to support community treatment for this group.
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Affiliation(s)
- Mary F Brunette
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - David W Oslin
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Lisa B Dixon
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - David A Adler
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Jeffrey Berlant
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Matthew Erlich
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Michael B First
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Beth Goldman
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Bruce Levine
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Samuel Siris
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Helena Winston
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
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Abstract
There is an increasing focus on physician wellness as an indicator of health system quality, and terms related to wellness, such as "burnout" and "resilience," have blossomed in the international discourse. An emphasis on the current concept of resilience shifts the responsibility for systemic problems to the individual. Examining the history of the term "resilience" reveals its origins in ecological studies and its subsequent mobilization by economic theorists and politics. Understanding this historical context when considering wellness initiatives may help providers recognize which interventions and changes to individual behaviors or systems might be useful; it also encourages providers to focus on political action (local and national) to facilitate change.
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Affiliation(s)
- Helena Winston
- Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston); Department of Psychiatry, University of Toronto, Toronto (Fage)
| | - Bruce Fage
- Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston); Department of Psychiatry, University of Toronto, Toronto (Fage)
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9
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Oslin D, Dixon L, Adler DA, Winston H, Erlich MD, Levine B, Berlant J, Goldman B, First MB, Siris SG. Adaptation in Delivering Integrated Care: The Tension Between Care and Evidence-Based Practice. Psychiatr Serv 2018; 69:1029-1031. [PMID: 29962306 DOI: 10.1176/appi.ps.201800028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clinical practice is assumed to be informed and supported by evidence-based clinical research. Nonetheless, clinical practice often deviates from the research evidence base, sometimes leading and sometimes lagging. Two examples from integrated care in mental health care (care for serious mental illness and collaborative mental health care in primary care settings) illustrate the natural space and therefore tension between evidence and implementation that needs to be better understood. Using the tools and perspectives of both examples, the authors present a framework for the connected relationship between practice and research that is founded on measurement and uses iterative adaptation guided by oversight of and feedback from the stakeholders in this process.
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Affiliation(s)
- David Oslin
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Lisa Dixon
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - David A Adler
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Helena Winston
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Matthew D Erlich
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Bruce Levine
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Jeffrey Berlant
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Beth Goldman
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Michael B First
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Samuel G Siris
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
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Ruppert L, Køster B, Siegert AM, Cop C, Boyers L, Karimkhani C, Winston H, Mounessa J, Dellavalle RP, Reinau D, Diepgen T, Surber C. YouTube as a source of health information: Analysis of sun protection and skin cancer prevention related issues. Dermatol Online J 2017; 23:13030/qt91401264. [PMID: 28329465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 06/06/2023] Open
Abstract
Although social media ubiquitously supplementstraditional information sources such as newspapers,magazines, radio, and television, investigation of onlinehealth information related to sun protection and skincancer prevention has been scarce and largely limitedto English language sources. Using the search terms"sun protection," "sunscreen," "skin cancer prevention,""tanning bed" and "vitamin D," we investigated 281YouTube videos presented in 6 languages: English,German, French, Spanish, Swedish, and Danish. Foreach video, we used a four-sectioned checklist toassess general information, popularity, expert drivenmeasures, and heuristic driven measures. Differencesbetween languages were detected: English languagevideos were most frequently viewed (median numberof views: 5488 compared to 248 -1591 in otherlanguages). Approximately 60% of videos revealednegative effects of solar ultraviolet (UV)-exposure.The majority of videos (75%) targeted adults. Videoson tanning beds and sunscreen contained false ormisleading information 40% and 20% of the time,respectively. We confirm observations made withrespect to other medical disciplines that the generalquality of YouTube contributions is often inferiorand does not deliver sustainable information. Othersources of information should be included whensearching for health information online.
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Ruppert L, Køster B, Siegert AM, Cop C, Boyers L, Karimkhani C, Winston H, Mounessa J, Dellavalle RP, Reinau D, Diepgen T, Surber C. YouTube as a source of health information: Analysis of sun protection and skin cancer prevention related issues. Dermatol Online J 2017. [DOI: 10.5070/d3231033669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Lynn D, Jones T, Whitsitt J, Trikha R, Schlichte MJ, Karimkhani C, Boyers L, Winston H, Dunnick CA, Dellavalle RP. The impact of ultraviolet photography on the sun safety awareness and behavior of skiers and snowboarders. ACTA ACUST UNITED AC 2015. [DOI: 10.5430/jer.v2n1p9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Snow sport enthusiasts, such as snowboarders and skiers, are a less studied population at significant risk for ultraviolet(UV) exposure due to long hours spent at high altitudes with more intense UV radiation. Studies have documented the efficacy ofUV photography to impact sun protection habits by individuals with a range of skin cancer risk factors. Informing snow sportenthusiasts of their sun damage through UV photography may be a way to change this population’s perception and behavior of sun protection.Methods: A UV camera was utilized at the 2013 SnowSports Industries America Snow Show in Colorado to assess the levelof accumulated sun damage in show attendees. A follow-up survey was performed at this same event one year later in 2014. Participants at the 2013 event were recruited to a UV camera booth and completed a ten-question pre-survey assessing baselinesun-safety awareness and behaviors. Full-face frontal photographs using two different UV camera models were then takenand shown on a digital screen to the participants. Individualized education was provided regarding the degree of sun damage revealed by the intervention as well as sun safety recommendations. Participants were at the 2013 event were then contacted viaemail six months later to complete a ten-question survey on surveymonkey.com. The survey assessed the permanence of the UV photography intervention on sun habits over the duration of the ski/snowboard season. Email was used for communication purposes after a poor response rate using telephone for a one-month post-intervention follow-up.Results: The 2013 post-intervention study revealed a 41% response rate (n=46) with overall positive influence of UV photographyon sun protection behavior in the survey. Post-intervention survey results for the 2014 study with an observed response rate of 28% (n=37) with a similar overall positive influence of our intervention on sun protection behavior.Conclusions: UV photography-based interventions and education may impact sun-safety behavior in high-risk populations such as skiers and snowboarders that may otherwise not receive appropriate education regarding the dangers of UV exposure and prevention of skin cancer. However, more controlled studies should be conducted to positively associate UV photography intervention and education and sun safety behavior.
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Green TJ, Rochon PJ, Chang S, Ray CE, Winston H, Ruef R, Kreidler SM, Glueck DH, Shulman BC, Brown AC, Durham J. Downstaging disease in patients with hepatocellular carcinoma outside of Milan criteria: strategies using drug-eluting bead chemoembolization. J Vasc Interv Radiol 2013; 24:1613-22. [PMID: 24060436 DOI: 10.1016/j.jvir.2013.07.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/28/2013] [Accepted: 07/29/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess downstaging rates in patients with United Network for Organ Sharing stage T3N0M0 hepatocellular carcinoma (HCC) treated with doxorubicin-eluting bead transarterial chemoembolization to meet Milan criteria for transplantation. MATERIALS AND METHODS A single-center retrospective review of 239 patients treated with doxorubicin-eluting bead (DEB) chemoembolization between September 2008 and December 2011 was undertaken. Baseline and follow-up computed tomography or magnetic resonance imaging was assessed for response based on the longest enhancing axial dimension of each tumor (ie, modified Response Evaluation Criteria In Solid Tumors measurements), and medical records were reviewed. Fisher exact tests and exact logistic regression were used to test the association of patient and disease characteristics with downstaging. RESULTS After exclusions, 22 patients remained in the analysis, 17 of whom (77%) had their HCC downstaged to meet Milan criteria. Among those whose disease was downstaged, seven underwent transplantation, one remained listed for transplantation, six had disease progression beyond Milan criteria, two underwent conventional transarterial chemoembolization, and one underwent radiofrequency ablation. The seven patients who received transplants were still living, but recurrent HCC developed in two. Baseline age (P = .25), Model for End-stage Liver Disease score (P = .77), and α-fetoprotein (AFP) level (P = 1.00) were similar between patients with and without downstaged HCC. No associations were observed between the odds of downstaging and sex (P = .21), Child-Pugh class (P = .14), Child-Pugh class controlling for baseline tumor multiplicity (P = .15), Eastern Cooperative Oncology Group performance status (P = 1.00), tumor burden (P = .31), multiple tumors (P = .31), or hepatitis C virus infection (P = 1.00). Fifteen patients who did not receive transplants were alive at 1 year, with two progression-free. Baseline AFP levels differed between those who survived 1 year and those who did not (P = .02), but did not differ by progression-free survival status (P = .62). CONCLUSIONS T3N0M0 HCC treatment with DEB chemoembolization has a high likelihood (77%) of downstaging the disease to meet Milan criteria.
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MESH Headings
- Aged
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/adverse effects
- Carcinoma, Hepatocellular/blood
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Carcinoma, Hepatocellular/therapy
- Catheter Ablation
- Chemoembolization, Therapeutic/adverse effects
- Chemoembolization, Therapeutic/mortality
- Chemotherapy, Adjuvant
- Colorado
- Disease Progression
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Female
- Humans
- Liver Neoplasms/blood
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Neoplasms/therapy
- Liver Transplantation/adverse effects
- Liver Transplantation/mortality
- Logistic Models
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Odds Ratio
- Retrospective Studies
- Risk Factors
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- alpha-Fetoproteins/metabolism
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Affiliation(s)
- Tyler J Green
- Department of Radiology, University of Colorado Hospital, Aurora.
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Connor JL, Winston H, Bradford H. Effects of domestication, environmental familiarity, and opponent familiarity on dominance in the mouse (Mus musculus L.). Behav Genet 1973; 3:339-54. [PMID: 4798143 DOI: 10.1007/bf01070217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Connor JL, Winston H. Genetic analysis of conditioned emotional responses in the mouse (Mus musculus L.). J Comp Physiol Psychol 1972; 81:37-44. [PMID: 5074306 DOI: 10.1037/h0033310] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Winston H, Marsh OJ, Suzuki CK, Telk CL. Fluorescence of Europium Thenoyltrifluoroacetonate. I. Evaluation of Laser Threshold Parameters. J Chem Phys 1963. [DOI: 10.1063/1.1734239] [Citation(s) in RCA: 55] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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