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Yuruk D, Ozger C, Garzon JF, Nakonezny PA, Vande Voort JL, Croarkin PE. A retrospective, naturalistic study of deep brain stimulation and vagal nerve stimulation in young patients. Brain Behav 2024; 14:e3452. [PMID: 38468454 PMCID: PMC10928335 DOI: 10.1002/brb3.3452] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/15/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Invasive neuromodulation interventions such as deep brain stimulation (DBS) and vagal nerve stimulation (VNS) are important treatments for movement disorders and epilepsy, but literature focused on young patients treated with DBS and VNS is limited. This retrospective study aimed to examine naturalistic outcomes of VNS and DBS treatment of epilepsy and dystonia in children, adolescents, and young adults. METHODS We retrospectively assessed patient demographic and outcome data that were obtained from electronic health records. Two researchers used the Clinical Global Impression scale to retrospectively rate the severity of neurologic and psychiatric symptoms before and after patients underwent surgery to implant DBS electrodes or a VNS device. Descriptive and inferential statistics were used to examine clinical effects. RESULTS Data from 73 patients were evaluated. Neurologic symptoms improved for patients treated with DBS and VNS (p < .001). Patients treated with DBS did not have a change in psychiatric symptoms, whereas psychiatric symptoms worsened for patients treated with VNS (p = .008). The frequency of postoperative complications did not differ between VNS and DBS groups. CONCLUSION Young patients may have distinct vulnerabilities for increased psychiatric symptoms during treatment with invasive neuromodulation. Child and adolescent psychiatrists should consider a more proactive approach and greater engagement with DBS and VNS teams that treat younger patients.
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Affiliation(s)
- Deniz Yuruk
- Research Fellow in the Department of Psychiatry and PsychologyMayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Can Ozger
- Department of Psychiatry and PsychologyMayo Clinic Children's Research Center, and Mayo Clinic Depression Center, Mayo ClinicRochesterMinnesotaUSA
| | - Juan F. Garzon
- Research Fellow in the Department of Psychiatry and PsychologyMayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Paul A. Nakonezny
- Department Of Population And Data SciencesUT Southwestern Medical CenterDallasTexasUSA
| | - Jennifer L. Vande Voort
- Department of Psychiatry and PsychologyMayo Clinic Children's Research Center, and Mayo Clinic Depression Center, Mayo ClinicRochesterMinnesotaUSA
| | - Paul E. Croarkin
- Department of Psychiatry and PsychologyMayo Clinic Children's Research Center, and Mayo Clinic Depression Center, Mayo ClinicRochesterMinnesotaUSA
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Sachs R, Nakonezny PA, Balzen KM, Heerschap J, Kennard BD, Emslie GJ, Stewart SM. The effect of parent-adolescent discrepancies in reports of familial dysfunction and depression on suicidal ideation in adolescents. Suicide Life Threat Behav 2024. [PMID: 38385782 DOI: 10.1111/sltb.13062] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/14/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Parents and adolescents are often discrepant in their reports of adolescent psychosocial factors. Few studies have addressed parent-adolescent discrepancies in subjective ratings of familial dysfunction and depression as longitudinal predictor variables, and none have done so in a treatment setting for adolescents with acute suicidality. This study examined how parent-adolescent discrepancies in familial dysfunction and depression impact adolescent treatment response in an intensive outpatient program for suicidality. METHODS Adolescents (N = 315) were assessed at treatment entry and exit for familial dysfunction, depression, and suicidal ideation. Parents received parallel assessments of familial dysfunction and adolescent depression at each time point. A polynomial regression was conducted to determine whether parent-adolescent discrepancies in reports of familial dysfunction and depression at entry related to the treatment outcome of adolescent-reported depression and suicide ideation at exit. RESULTS Significant discrepancies were present with on average adolescents reporting more depression and familial dysfunction than parents. Entry discrepancy in familial dysfunction (but not depression) predicted suicide ideation at exit. CONCLUSIONS Our results suggest that parent-adolescent discrepancies in perception of familial dysfunction is a risk factor for poor outcomes in suicidal youth and might be a fruitful target in treatment programs.
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Affiliation(s)
- Raney Sachs
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paul A Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jessica Heerschap
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Psychiatry, Children's Health Children's Medical Center, Dallas, Texas, USA
| | - Betsy D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Psychiatry, Children's Health Children's Medical Center, Dallas, Texas, USA
| | - Graham J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Psychiatry, Children's Health Children's Medical Center, Dallas, Texas, USA
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Psychiatry, Children's Health Children's Medical Center, Dallas, Texas, USA
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Gaddis JM, de Souza R, Montanez B, Nakonezny PA, Laboret B, Bialaszewski R, Wells JE. Hip Preservation Surgery in Patients With Femoroacetabular Impingement Syndrome and Acetabular Dysplasia Improves Functional Measures and Pain Catastrophizing. Cureus 2024; 16:e52461. [PMID: 38371072 PMCID: PMC10873215 DOI: 10.7759/cureus.52461] [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] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background Chronic hip pain is a debilitating condition that severely reduces one's quality of life. Prior studies uncovered a link between hip pathologies and pain catastrophizing, anxiety, and depression. The purpose of this study was to investigate whether hip preservation surgery in patients with femoroacetabular impingement syndrome (FAIS) and acetabular dysplasia (AD) improves functional outcomes and pain catastrophizing. Methods Patients with FAIS and AD were requested to complete a hip questionnaire both preoperatively and postoperatively at a single academic center (University of Texas Southwestern Medical Center, Dallas, Texas, USA). Pain catastrophizing was evaluated using the pain catastrophizing scale, and pain level was assessed using the visual analog scale. Assessments of hip functional outcomes included the hip outcome score (HOS) and the hip disability and osteoarthritis outcome score (HOOS). Outcome measures before and after treatment were compared using the dependent samples t-test. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between variables. Results The results indicated a clinically significant improvement in functional measures and pain catastrophizing in patients who underwent hip preservation surgery. The most significant discovery was an inverse relationship between both HOOS quality of life (rs=-0.293, p=0.0065, false discovery rate (FDR)=0.0210) and HOS activities of daily living (rs=-0.242, p=0.0254, FDR=0.0423) and pain catastrophizing; however, similar improvements were seen in pain catastrophizing with improvements in other functional outcomes. Conclusion Undergoing hip preservation surgery for patients with AD or FAIS improved their hip functional measures and decreased pain catastrophizing postoperatively. The improvement of hip function, quality of life, and pain catastrophizing reveals an intricate link between the functional outcomes of hip preservation surgery and pain catastrophizing.
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Affiliation(s)
- John M Gaddis
- Department of Orthopedic Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Rafael de Souza
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Benjamin Montanez
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Paul A Nakonezny
- Department of Population and Data Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, USA
| | - Bretton Laboret
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Ryan Bialaszewski
- Department of Orthopedic Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, USA
| | - Joel E Wells
- Department of Orthopedic Surgery, Baylor Scott and White Health, McKinney, USA
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Karamchandani K, Khorsand S, Ebeling C, Yan L, Nakonezny PA, Carr ZJ. Predictors of Failure to Rescue After Postoperative Respiratory Failure: A Retrospective Cohort Analysis of 13,047 Patients Using the ACS-NSQIP Dataset. J Surg Res 2024; 293:482-489. [PMID: 37827025 DOI: 10.1016/j.jss.2023.09.030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Death after suffering a postoperative complication (failure to rescue) is an area of concern, and its occurrence after postoperative respiratory failure (PRF) is not well defined. We seek to identify the predictors of failure to rescue in patients who develop PRF. METHODS A retrospective cohort study of adults undergoing noncardiac surgery who developed PRF (postoperative unplanned intubation and receipt of mechanical ventilation for longer than 48 h) was conducted using the American College of Surgeons National Surgical Quality Improvement Project database. Predictors of failure to rescue after PRF were identified using the Least Absolute Shrinkage and Selection Operator (LASSO)-penalized variable selection method, with the Bayesian information criterion, in the context of a multiple logistic regression model (with Firth's bias correction). RESULTS Of the 13,047 patients that formed our final evaluable study cohort, 3669 (28.1%) patients died within 30 days of surgery. We identified age, sex, American Society of Anesthesiologists physical status, presence of preoperative ascites, disseminated cancer, bleeding disorders, elevated preoperative creatinine, and low preoperative prealbumin levels as predictors of failure to rescue. The area under the curve for the final model was 0.6804, with a standard error of 0.0104 (95% CI area under the curve: 0.6600 to 0.7008). CONCLUSIONS We observed that almost 30% of patients that develop respiratory failure after noncardiac surgery die within 30 days of surgery. The validated eight-variable perioperative predictive model provides a risk estimate for death after PRF and may be useful for the purposes of preoperative planning, prognostication, decision making and resource allocation in patients who develop this complication.
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Affiliation(s)
- Kunal Karamchandani
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Sarah Khorsand
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Callie Ebeling
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luying Yan
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut
| | - Paul A Nakonezny
- Division of Biostatistics, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zyad J Carr
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut
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Everett BP, Lin J, Gudmundsson P, Owhonda R, Nakonezny PA, Middleton E, Chhabra A, Wells JE. The Relationship Between Postoperative Patient-Reported Psychological Outcomes and Preoperative Pain Characteristics in Patients Who Underwent Periacetabular Osteotomy. Orthopedics 2024; 47:28-33. [PMID: 37126840 DOI: 10.3928/01477447-20230426-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study sought to investigate the relationship between multiple preoperative characteristics of pain (maximum pain severity location, the presence of pain in certain locations, the highest level of pain, and the number of pain locations) and psychological outcome measures as reported by patients. Fifty-four hips (50 patients) that underwent periacetabular osteotomy to treat acetabular dysplasia between February 2017 and July 2020 were reviewed using the Depression, Anxiety, and Stress Scale-21 (DASS21), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS), radiographic analysis, and questionnaires concerning pain severity/location. Twenty-six hips had their worst pain in the groin, whereas 28 hips had greater or equal levels of pain at another location. There was no significant difference between these two locations on any of the postoperative psychological outcomes (HADS, P=.53; DASS21, P=.85; PCS, P=.97). Additionally, there was not a significant relationship between pain in any location other than the groin and any postoperative psychological outcomes (P≥.08). Finally, the highest level of preoperative pain and the number of locations of pain demonstrated no significant relationship with postoperative psychological outcomes (maximum severity: HADS, P=.28; DASS21, P=.49; PCS, P=.57; number of pain locations: HADS, P=.47; DASS21, P=.60; PCS, P=.35). Variance in preoperative pain location, severity, and number of pain locations seemingly does not result in any significant effect on postoperative psychological outcomes. Thus, a large range of patients with acetabular dysplasia may experience similar, favorable psychological outcomes from treatment with periacetabular osteotomy notwithstanding the characteristics of preoperative pain. [Orthopedics. 2024;47(1):28-33.].
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Saynhalath R, Efune PN, Nakonezny PA, Alex G, Sabers JN, Clintsman LM, Poppino KF, Szmuk P, Sanford EL. Association between preoperative respiratory symptoms and perioperative respiratory adverse events in pediatric patients with positive viral testing. J Clin Anesth 2023; 90:111241. [PMID: 37659165 DOI: 10.1016/j.jclinane.2023.111241] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/18/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
STUDY OBJECTIVE To determine the association between the presence of upper respiratory tract viral infection symptoms and occurrence of perioperative respiratory adverse events (PRAE) in children with positive viral screening, and to analyze the risk of PRAE in children with SARS-CoV-2 compared to non-SARS-CoV-2 infection. DESIGN A prospective cohort study. SETTING A tertiary, freestanding pediatric hospital in Dallas, Texas. PATIENTS Children <18 years of age with positive respiratory viral testing who underwent general anesthesia. INTERVENTION Measurement of incidence of PRAE and severe adverse events during the first 7 postoperative days. MEASUREMENTS The primary outcome was a composite of PRAE: oxygen saturation < 90% for >5 min, supplemental oxygen for >2 h after anesthesia, laryngospasm, and bronchospasm. The secondary outcome was severe adverse events: high flow nasal cannula >6 l of oxygen per minute, admission to the ICU for escalation of respiratory support post-anesthetic, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death. MAIN RESULTS In this convenience sample of 196 children, 83 were symptomatic and 113 were asymptomatic. The risk of PRAE was similar in children with active viral symptoms and asymptomatic children (risk difference: -1.9%; 95% CI: -10.9, 7.9%), but higher among children with documented fever within 48 h of the anesthetic (risk difference: 20.8%; 95% CI: 5.3, 39.7%). The multivariable adjusted odds ratio of PRAE was 0.68 (95% CI: 0.25, 1.85) for symptomatic compared to asymptomatic patients, and 0.46 (95% CI: 0.14, 1.44) for patients with SARS-CoV-2 compared to non-SARS-CoV-2 infection. CONCLUSIONS There was no significant difference in the incidence of PRAE between symptomatic and asymptomatic children with laboratory confirmed viral respiratory infection, and between children with the Omicron variant of SARS-CoV-2 compared to non-SARS-CoV-2 respiratory viruses. However, the risk was increased in children with recent fever.
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Affiliation(s)
- Rita Saynhalath
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
| | - Proshad N Efune
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
| | - Paul A Nakonezny
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
| | - Gijo Alex
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States.
| | - Jessica N Sabers
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States.
| | - Lee M Clintsman
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States.
| | - Kiley F Poppino
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
| | - Ethan L Sanford
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
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Thummala A, Nakonezny PA, Mulligan EP, Chhabra A, Wells J. The Relationship Between Pelvic Tilt and Clinical Outcomes After Hip Preservation Surgery in Femoroacetabular Impingement Syndrome and Hip Dysplasia. Orthopedics 2023; 46:e341-e346. [PMID: 37052593 DOI: 10.3928/01477447-20230407-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Pelvic tilt is thought to be a compensatory mechanism in hip pathology, specifically in patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. This study investigated the relationship between preoperative pelvic tilt and postoperative outcomes in patients undergoing hip preservation surgery for FAIS or hip dysplasia. We reviewed a prospective hip preservation database for demographic, radiographic, and outcome data for 89 patients who underwent hip preservation surgery with a primary diagnosis of FAIS or dysplasia from 2016 to 2020. Pelvic tilt was assessed on the standing anteroposterior radiograph with the pubic symphysis to sacroiliac joint (PS-SI) distance measurement. The International Hip Outcome Tool 12 (iHOT-12), Hip Outcome Score, Harris Hip Score, UCLA activity score, and European Quality of Life-Visual Analog Scale were used to assess hip function and pain preoperatively and postoperatively. The mean pelvic tilt (PS-SI distance) was 86.4±18.3 mm for the FAIS group and 96.2±15.1 mm for the dysplasia group. The statistical analysis demonstrated a positive relationship between pelvic tilt and change in iHOT-12 score (rs=0.262, P=.019) for all 89 patients with hip pathology and, separately, a trend toward significance for the 42 patients with FAIS (rs=0.330, P=.056). No other significant relationships were observed. The improvement in iHOT-12 score was greater for patients with more anterior tilt and less for patients with posterior pelvic tilt, regardless of underlying hip etiology. These results provide intriguing insights into an initial investigation on pelvic tilt in patients undergoing hip preservation surgery. Further investigation is necessary to assess pelvic tilt preoperatively and postoperatively, spinal parameters, and longer-term outcomes. [Orthopedics. 2023;46(6):e341-e346.].
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Balzen KM, Hensley JK, Nakonezny PA, Jones J, Kennard BD, Emslie GJ. Predicting Remission From Depression in Youth Receiving Outpatient Medication Management. J Clin Psychiatry 2023; 84. [PMID: 37195814 DOI: 10.4088/jcp.22m14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Objective: To examine 6-month remission rates of adolescents treated for depression in a university-based clinic and examine predictors of eventual remission. Methods: All patients aged 11-18 years treated in the clinic completed self-report measures assessing depression, suicidal ideation, anxiety, and associated symptoms. Remission was operationalized as a total score of ≤ 4 on the Patient Health Questionnaire-9 (PHQ-9) within 6 months of entering treatment. Results: Of the 430 patients, (76.74% female, 65.34% Caucasian, mean ± SD age 14.65 ± 1.69 years), 26.74% achieved remission within 6 months. Mean ± SD scores on the PHQ-9 at visit 1 (clinic entry) were 11.97 ± 4.76 for remitters (n = 115) and 15.03 ± 5.21 for non-remitters (n = 315). Predicted odds of remitting decreased as depressive symptom severity at visit 1 increased (OR = 0.941; 95% CI, 0.886 to 1.000; P = .051) and as scores on the Concise Associated Symptoms Tracking scale at treatment entry increased (OR = 0.971; 95% CI, 0.948 to 0.995; P = .017). As depression severity increased between visits, odds of remitting decreased (OR = 0.873; 95% CI, 0.827 to 0.921; P < .0001). Finally, adolescent males were more likely to achieve remission than females within 6 months (OR = 2.257; 95% CI, 1.351 to 3.771; P = .002). Conclusions: This study reports remission rates for depressed youth receiving medication management in a naturalistic outpatient setting. Results confirm that depression severity at treatment initiation and over time is a strong predictor of remission status. Additionally, monitoring associated symptoms via measurement-based care can provide important clinical information to inform treatment decisions.
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Affiliation(s)
- Kennedy M Balzen
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jane K Hensley
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paul A Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jessica Jones
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Betsy D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Psychiatry, Children's Health, Children's Medical Center, Dallas, Texas
| | - Graham J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Psychiatry, Children's Health, Children's Medical Center, Dallas, Texas
- Corresponding author: Graham J. Emslie, MD, 1341 W Mockingbird Lane Suite 1200 E, Dallas, TX 75247
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Zhang AW, Nakonezny PA, Chhabra A, Fey N, Wells J. Dysplastic hips demonstrate increased joint translation at higher body mass index. Skeletal Radiol 2023; 52:715-723. [PMID: 36224400 DOI: 10.1007/s00256-022-04205-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/01/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine which radiographic measures used to define the severity of hip dysplasia are associated with hip joint translation and to investigate relationships between position, body mass index, and joint translation. MATERIALS AND METHODS This is a cross-sectional retrospective study evaluating 10 validated radiographic measures of dysplasia on weight-bearing AP pelvis and supine 45-degree bilateral Dunn radiographs of 93 young adults with symptomatic hip dysplasia presenting to a single academic institution between October 2016 and May 2019. We determined the difference between standing and supine measurements for each hip and the correlation of each measure with the patient's body mass index. RESULTS Femoral head extrusion index was 2.49% lower on supine X-ray (p = 0.0020). Patients with higher body mass index had higher center gap distance (p = 0.0274), femoral head extrusion (p = 0.0170), and femoral head lateralization (p = 0.0028) when standing. They also had higher Tönnis angle (pstanding = 0.0076, psupine = 0.0121) and lower lateral center-edge angle (pstanding = 0.0196, psupine = 0.0410) in both positions. The difference in femoral head lateralization between standing and supine positions increased with higher body mass index (p = 0.0081). CONCLUSION Translation of the hip joint with position change is demonstrated by decreased femoral head extrusion index on supine X-ray. Patients with higher body mass index had more dysplastic hips, as measured by five of six radiographic outcomes of dysplasia, and experienced more translation with weight-bearing, reflected by increased femoral head lateralization.
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Affiliation(s)
| | - Paul A Nakonezny
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Orthopedics, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Nicholas Fey
- Department of Bioengineering, University of Texas at Dallas, Dallas, TX, 75080, USA
| | - Joel Wells
- Department of Orthopedics, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
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Yuruk D, Ozger C, Garzon JF, Leffler JM, Shekunov J, Vande Voort JL, Zaccariello MJ, Nakonezny PA, Croarkin PE. Sequential bilateral accelerated theta burst stimulation in adolescents with suicidal ideation associated with major depressive disorder: Protocol for a randomized controlled trial. PLoS One 2023; 18:e0280010. [PMID: 37053246 PMCID: PMC10101506 DOI: 10.1371/journal.pone.0280010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/26/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of death in adolescents worldwide. Previous research findings suggest that suicidal adolescents with depression have pathophysiological dorsolateral prefrontal cortex (DLPFC) deficits in γ-aminobutyric acid neurotransmission. Interventions with transcranial magnetic stimulation (TMS) directly address these underlying pathophysiological deficits in the prefrontal cortex. Theta burst stimulation (TBS) is newer dosing approach for TMS. Accelerated TBS (aTBS) involves administering multiple sessions of TMS daily as this dosing may be more efficient, tolerable, and rapid acting than standard TMS. MATERIALS AND METHODS This is a randomized, double-blind, sham-controlled trial of sequential bilateral aTBS in adolescents with major depressive disorder (MDD) and suicidal ideation. Three sessions are administered daily for 10 days. During each session, continuous TBS is administered first to the right DPFC, in which 1,800 pulses are delivered continuously over 120 seconds. Then intermittent TBS is applied to the left DPFC, in which 1,800 pulses are delivered in 2-second bursts and repeated every 10 seconds for 570 seconds. The TBS parameters were adopted from prior research, with 3-pulse, 50-Hz bursts given every 200 ms (at 5 Hz) with an intensity of 80% active motor threshold. The comparison group will receive 3 daily sessions of bilateral sham TBS treatment for 10 days. All participants will receive the standard of care for patients with depression and suicidal ideation including daily psychotherapeutic skill sessions. Long-interval intracortical inhibition (LICI) biomarkers will be measured before and after treatment. Exploratory measures will be collected with TMS and electroencephalography for biomarker development. DISCUSSION This is the first known randomized controlled trial to examine the efficacy of sequential bilateral aTBS for treating suicidal ideation in adolescents with MDD. Results from this study will also provide opportunities to further understand the neurophysiological and molecular mechanisms of suicidal ideation in adolescents. TRIAL REGISTRATION Investigational device exemption (IDE) Number: G200220, ClinicalTrials.gov (ID: NCT04701840). Registered August 6, 2020. https://clinicaltrials.gov/ct2/show/NCT04502758?term=NCT04701840&draw=2&rank=1.
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Affiliation(s)
- Deniz Yuruk
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Can Ozger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Juan F Garzon
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jarrod M Leffler
- Virginia Treatment Center for Children, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Children's Research Center, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michael J Zaccariello
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Children's Research Center, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Paul A Nakonezny
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Children's Research Center, Mayo Clinic, Rochester, Minnesota, United States of America
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11
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Wang B, Manchanda K, Lalli T, Wukich DK, Liu GT, Raspovic K, VanPelt M, Nakonezny PA, Johnson MJ. Identifying Risk Factors for Nonunion of the Modified Lapidus Procedure for the Correction of Hallux Valgus. J Foot Ankle Surg 2022; 61:1001-1006. [PMID: 35221219 DOI: 10.1053/j.jfas.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 06/14/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
There is a paucity of literature characterizing risk factors for nonunion associated with the modified Lapidus procedure for correction of hallux valgus. The purpose of this study was to evaluate risk factors associated with nonunion for Lapidus bunionectomies. Patients who underwent modified Lapidus procedure from 2009 to 2018 were retrospectively reviewed. Patient's age, sex, body mass index, prior bunionectomy, history of tobacco use, presence of diabetes mellitus or hypothyroidism, and fixation method were recorded along with pre- and postoperative radiographic parameters. A multiple logistic regression analysis was implemented to estimate the odds of nonunion. Of the 222 patients who met inclusion criteria, nonunion with modified Lapidus procedure was observed in 20 patients (9.01%). Odds of nonunion with modified Lapidus procedure were greater for patients who had undergone previous bunionectomy (odds ratio [OR] = 3.957, 95% confidence interval [CI]: 1.021-15.338), as body mass index increased (OR = 1.091, 95% CI: 1.018-1.170), and as preoperative HV angle increased (OR = 1.108, 95% CI: 1.020-1.203). Odds of nonunion were lower for patients as preoperative intermetatarsal angle increased (OR = 0.739, 95% CI: 0.580-0.941). No significant increased odds of nonunion were found between fixation methods.
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Affiliation(s)
- Benjamin Wang
- University of Texas Southwestern Medical School, Dallas, TX
| | - Kshitij Manchanda
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Trapper Lalli
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - George Tye Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael VanPelt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul A Nakonezny
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew J Johnson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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12
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Wukich DK, Raspovic KM, Jupiter DC, Heineman N, Ahn J, Johnson MJ, Liu GT, VanPelt MD, Lafontaine J, Lavery L, Kim P, Nakonezny PA. Amputation and infection are the greatest fears in patients with diabetes foot complications. J Diabetes Complications 2022; 36:108222. [PMID: 35717355 DOI: 10.1016/j.jdiacomp.2022.108222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/30/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022]
Abstract
AIMS To determine the degree patients with diabetic foot ulcers, Charcot neuroarthropathy and neuropathic fractures and dislocations fear complications (death, dialysis, heart attack, stroke, blindness, diabetic foot infection, minor and major lower extremity amputation [LEA]) that can occur and to assess if there is a difference between fears of patients with diabetic foot ulcers, Charcot neuroarthropathy and neuropathic fractures and dislocations and diabetic patients without these complications. METHODS 478 patients completed an eight question Likert scale survey. The study group was defined as non-infected foot ulcers, neuropathic fractures and Charcot neuroarthropathy. RESULTS Of the 478 patients, 121 (25.3 %) had diabetic foot ulcers, Charcot neuroarthropathy or neuropathic fractures and dislocations and 357 (74.7 %) did not. The study group had significantly higher odds of reporting extreme fear of foot infection (OR 2.8, 95 % CI 1.8-4.5), major LEA (OR 2.8, 95 % CI 1.8-4.4), minor LEA (OR 2.3, 95 % CI 1.5-3.5), blindness (OR 2.0, 95 % CI 1.3-3.2), dialysis (OR 2.0, 95 % CI 1.1-3.3), and death (OR 2.4, 95 % CI 1.4-4.2). In the study group highest rated fear measures were foot infection (3.71, SD 1.23), minor amputation (3.67, SD 1.45) and major amputation (3.63, SD 1.52). There were no significant differences in the mean fear of infection, minor amputation or major amputation. CONCLUSION Patients with diabetic foot ulcers, Charcot neuroarthropathy or neuropathic fractures and dislocations reported higher fear ratings of diabetes-related complications compared to those without these complications.
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Affiliation(s)
- Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America.
| | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health Office of Biostatistics, University of Texas Medical Branch Galveston, TX 77550, United States of America
| | - Nathan Heineman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Matthew J Johnson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - George T Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Michael D VanPelt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Javier Lafontaine
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Larry Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Paul Kim
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, United States of America
| | - Paul A Nakonezny
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, United States of America
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13
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Everett BP, Sherrill G, Nakonezny PA, Wells JE. The relationship between patient-reported outcomes and preoperative pain characteristics in patients who underwent total hip arthroplasty. Bone Jt Open 2022; 3:332-339. [PMID: 35440177 PMCID: PMC9044086 DOI: 10.1302/2633-1462.34.bjo-2021-0206.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent total hip arthroplasty (THA): are patient-reported outcome measures (PROMs) affected by the location of the maximum severity of pain?; are PROMs affected by the presence of non-groin pain?; are PROMs affected by the severity of pain?; and are PROMs affected by the number of pain locations? Methods We reviewed 336 hips (305 patients) treated with THA for hip OA from December 2016 to November 2019 using pain location/severity questionnaires, modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), international Hip Outcome Tool (iHOT-12) score, and radiological analysis. Descriptive statistics, analysis of covariance (ANCOVA), and Spearman partial correlation coefficients were used. Results There was a significant difference in iHOT-12 scores between groups experiencing the most severe pain in the groin and the trochanter (p = 0.039). Additionally, more favourable mHHS scores were related to the presence of preoperative pain in trochanter (p = 0.049), lower back (p = 0.056), lateral thigh (p = 0.034), and posterior thigh (p = 0.005). Finally, the maximum severity of preoperative pain and number of pain locations had no significant relationship with PROMs (maximum severity: HHS: p = 0.928, HOS: p = 0.163, iHOT-12 p = 0.233; number of pain locations: HHS: p = 0.211; HOS: p = 0.801; iHOT-12: p = 0.112). Conclusion Although there was a significant difference in iHOT-12 scores between patients with the most severe pain in the groin or trochanter, and the presence of pain in the trochanter, lower back, lateral thigh, or posterior thigh was related to higher mHHS scores, the majority of preoperative pain characteristics did not have a significant impact on outcomes. Therefore, a broad array of patients with hip OA might expect similar, favourable outcomes from THA notwithstanding preoperative pain characteristics. Cite this article: Bone Jt Open 2022;3(4):332–339.
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Affiliation(s)
- Brandon Paul Everett
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Garrett Sherrill
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paul A. Nakonezny
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joel E. Wells
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Johnson MJ, Wukich DK, Nakonezny PA, Lavery LA, La Fontaine J, Ahn J, Truong DH, Liu GT, VanPelt M, Kim PJ, Raspovic KM. The Impact of Hospitalization for Diabetic Foot Infection on Health-Related Quality of Life: Utilizing PROMIS. J Foot Ankle Surg 2022; 61:227-232. [PMID: 34389216 DOI: 10.1053/j.jfas.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 08/16/2020] [Revised: 10/26/2020] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
Diabetic foot infections (DFI) are an increasingly common cause of hospitalizations. Once hospitalized with DFI, many patients require some level of amputation, often undergoing multiple operations. With increasing importance on patient-centered metrics, self-reported health-related quality of life (HRQOL) tools have been developed. This prospective cohort study aimed assessed the impact of DFI on HRQOL. Two hundred twenty-four patients completed the 29-item Patient-Reported Outcome Measurement Information System (PROMIS) and 12-Item Short Form (SF-12) survey. Secondary outcomes using the Foot and Ankle Ability Measures survey were obtained and included in the analysis. The study group was comprised of hospitalized patients with DFIs (n = 120), and the control group was comprised of patients with diabetes who were evaluated for routine outpatient foot care (n = 104); diabetic foot screening, wound care, onychomycosis, and/or callosities. Using this cohort, a propensity score-matched sample of hospitalized patients with DFI (n = 35) and control group patients (n = 35) was created for comparative analysis. The 2-independent sample t test was used to test for group differences on each of the PROMIS subscale outcomes. Using PROMIS, we found that hospitalized patients with DFI reported significantly worse HRQOL in 6 of 7 subscales (physical function, anxiety, depression, fatigue, social role, pain intensity; p value range: .0001-.02) compared to outpatients with diabetes evaluated for routine foot care. There was no significant difference between the 2 groups on sleep disturbance (p = .22). Patients hospitalized for DFI report lower HRQOL compared to patients with diabetes receiving routine outpatient foot care.
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Affiliation(s)
- Matthew J Johnson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul A Nakonezny
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier La Fontaine
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - David H Truong
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - George Tye Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael VanPelt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul J Kim
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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15
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Everett BP, Nakonezny PA, Mulligan EP, Chhabra A, Wells J. The relationship between pre-operative pain characteristics and periacetabular osteotomy outcomes in patients with acetabular dysplasia. J Hip Preserv Surg 2022; 9:44-50. [PMID: 35651711 PMCID: PMC9142189 DOI: 10.1093/jhps/hnac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/29/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
The aims of this study were to determine if pre-operative pain characteristics (location of maximum severity of pain, presence of non-groin pain, maximum severity of pain and number of pain locations) affect patient-reported outcome measures in patients undergoing periacetabular osteotomy (PAO) for acetabular dysplasia. We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) and international Hip Outcome Tool (iHOT-12) score, radiographic analysis and pain location/severity questionnaires. Descriptive statistics, analysis of covariance and Spearman partial correlation coefficients were implemented. Twenty-six hips experienced the most severe pre-operative pain in the groin, and 26 hips experienced equal or greater pain in a non-groin location. Outcome scores between these groups were not significantly different (mHHS P = 0.59, HOS P = 0.48, iHOT-12 P = 0.99). Additionally, the presence of pre-operative pain in any non-groin location had no significant relationship with PROM (all P-values ≥0.14). Furthermore, the maximum severity of pre-operative pain and number of pain locations showed no significant relationship with PROM (maximum severity: mHHS P = 0.82, HOS P = 0.99, iHOT-12 P = 0.36; number of pain locations: mHHS P = 0.56, HOS P = 0.10, iHOT-12 P = 0.62). Varying pre-operative pain characteristics do not appear to have any significant impact on outcomes. Therefore, a wide array of patients with acetabular dysplasia might expect similar, favourable outcomes from PAO regardless of pre-operative pain characteristics.
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Affiliation(s)
- Brandon P Everett
- Medical School, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Paul A Nakonezny
- Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Edward P Mulligan
- School of Health Professions, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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16
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Ahn J, Farahani F, Raspovic KM, Liu GT, Lalli TA, VanPelt MD, Nakonezny PA, Wukich DK. Are Readmission and Reoperation Rates for Lower Extremity Necrotizing Fasciitis Different Between Patients With and Without Diabetes Mellitus? J Foot Ankle Surg 2022; 61:132-138. [PMID: 34373115 DOI: 10.1053/j.jfas.2021.07.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/02/2020] [Accepted: 07/14/2021] [Indexed: 02/03/2023]
Abstract
Necrotizing fasciitis is a condition associated with high morbidity and mortality unless emergent surgery is performed. This study aims to understand the hospital course of diabetic and nondiabetic patients managed for lower-extremity necrotizing fasciitis by identifying factors contributing to readmissions and reoperations. About 562 patients treated for lower-extremity necrotizing fasciitis were selected from the American College of Surgeons-National Surgical Quality Improvement Program database between 2012 and 2017. The unplanned reoperation and readmission rates for all patients during the 30-day postoperative period were 9.4% and 5.3%, respectively. Out of 562 patients with lower-extremity necrotizing fasciitis, 326 (58.0%) patients had diabetes. Diabetes patients were more likely to undergo amputation (p < .00001). Neither readmission (6.1% vs 4.2%, p = .411) nor reoperation (8.6% vs 10.6%, p = .482) were significantly different between patients with and without diabetes. Neither readmission (7.2% vs 4.0%, p = .159) nor reoperation (4.1% vs 3.7%, p = .842) were significantly different between patients undergoing amputation and nonamputation procedures. In simple logistic regression, factors associated with unplanned reoperation included poorer renal function, thrombocytopenia, longer duration of surgery, longer hospital length of stay, postoperative surgical site infection, postoperative respiratory distress, and postoperative septic shock. Body mass index >30 kg/m2 was associated with decreased odds of readmission. In multiple logistic regression, surgical site infection was the only predictor of reoperation (adjusted odds ratio 7.32, 95% confidence interval 2.76-19.1), and any amputation was associated with readmission (adjusted odds ratio 4.53, 95% confidence interval 1.20-29.6). Further study is needed to understand patient characteristics to better direct management. However, the current study elucidates patient outcomes for a relatively rare condition.
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Affiliation(s)
- Junho Ahn
- Resident, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Farzam Farahani
- Medical Student, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Katherine M Raspovic
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - George T Liu
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Trapper A Lalli
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael D VanPelt
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul A Nakonezny
- Professor, Division of Biostatistics, Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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17
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Wang C, Hu Y, Nakonezny PA, Melo V, Ale C, Athreya AP, Shekunov J, Lynch R, Croarkin PE, Romanowicz M. A Retrospective Examination of the Impact of Pharmacotherapy on Parent-Child Interaction Therapy. J Child Adolesc Psychopharmacol 2021; 31:685-691. [PMID: 34319785 PMCID: PMC8721494 DOI: 10.1089/cap.2021.0043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Parent-child interaction therapy (PCIT) is an evidence-based approach for children aged 2-7 years with disruptive behavior problems. This study examined the effectiveness of PCIT with and without concurrent pharmacotherapy. Methods: A convenience sample was collected from a retrospective chart review of preschool-aged children treated with PCIT at the Mayo Clinic Young Child Clinic between 2016 and 2020. Quantitative and qualitative data were abstracted from all patients. The sample was divided into two groups based on psychotropic medications status (medicated and unmedicated) at the initiation of PCIT. Effectiveness of treatment was assessed with the change in Eyberg Child Behavior Inventory (ECBI) score. The change over time in ECBI score was compared between the two PCIT groups with and without concurrent pharmacotherapy using a linear mixed model. Results: Of the 62 youth, 38.71% were females. Mean age was 4.71 ± 1.17 years. The mean baseline ECBI score was 148.74 ± 30.86, indicating clinically significant disruptive behaviors. The mean number of PCIT sessions was 6.59 ± 3.82. There was no statistically significant difference in ECBI scores between the two groups at pre-PCIT (medication group: 149.68, standard error [SE] = 11.61 vs. unmedicated group: 147.92, SE = 10.93, p = 0.8904) and at post-PCIT (medication group: 116.27 [SE = 11.89] vs. unmedicated group: 128.86 [SE = 11.57], p = 0.3464). There was a statistically significant improvement in ECBI scores for both groups after completing therapy (medication group = -33.41 [-22.32%], SE = 6.27, p < 0.0001; d = 1.144; unmedicated group = -19.06 [-12.88%], SE = 5.78, p = 0.0022; d = 1.078). Conclusions: PCIT reduced disruptive behaviors in this sample of young children regardless of concurrent pharmacotherapy. Future prospective studies should consider one particular pharmacological agent and long-term outcomes of treatment. PCIT and certain pharmacological treatments could have complex and important bidirectional priming effects for both treatments.
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Affiliation(s)
- Chris Wang
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yuliang Hu
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A. Nakonezny
- Department of Psychiatry and University of Texas Southwestern, Dallas, Texas, USA.,Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA
| | - Valeria Melo
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Chelsea Ale
- Department of Psychiatry and Psychology, Mayo Clinic, La Crosse, Wisconsin, USA
| | - Arjun P. Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Lynch
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.,Address correspondence to: Magdalena Romanowicz, MD, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
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18
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Liu JW, Ahn J, Nakonezny PA, Lalli T, VanPelt MD, Raspovic KM, Wukich DK, Liu GT. Insulin Dependence Increases the Risk of 30-Day Postoperative Complications Following Ankle Fracture Surgery in Patients With Diabetes Mellitus. J Foot Ankle Surg 2021; 60:917-922. [PMID: 33947590 DOI: 10.1053/j.jfas.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 04/16/2019] [Accepted: 05/09/2019] [Indexed: 02/03/2023]
Abstract
Patients with diabetes mellitus that undergo ankle fracture surgery have higher rates of postoperative complications compared to patients without diabetes mellitus. We evaluated the rate of complications in insulin-dependent diabetes mellitus patients, non-insulin-dependent diabetes mellitus patients, and patients without diabetes in the 30-day postoperative period following ankle fracture surgery. We also analyzed hospital length of stay, unplanned readmission, unplanned reoperation, and death. Patients who underwent operative management for ankle fractures between 2012 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program® database using Current Procedural Terminology codes. Multiple logistic regression was implemented. Adjusted odds ratios were calculated along with the 95% confidence interval. A total of 19,547 patients undergoing ankle surgery were identified from 2012 to 2016. Of these patients, 989 (5.06%) had insulin-dependent diabetes mellitus, 1256 (6.43%) had noninsulin-dependent diabetes mellitus, and 17,302 (88.51%) did not have diabetes mellitus. Compared to patients without diabetes, patients with insulin-dependent diabetes mellitus had significantly greater adjusted odds of superficial surgical site infections, deep surgical site infections, osteomyelitis, wound dehiscence, pneumonia, unplanned intubation, mechanical ventilation, urinary tract infection, cardiac arrest, bleeding requiring transfusion, sepsis, hospital length of stay, unplanned readmission, unplanned reoperation, and death following ankle fracture surgery. We demonstrate that insulin-dependent diabetes mellitus is a strong predictor of 30-day postoperative complications, unplanned readmission, unplanned reoperation, and death following ankle fracture surgery.
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Affiliation(s)
- Jennifer W Liu
- Medical Student, University of Texas Southwestern Medical Center, Dallas, TX
| | - Junho Ahn
- Resident, Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul A Nakonezny
- Associate Professor, Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Trapper Lalli
- Assistant Professor, Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
| | - Michael D VanPelt
- Associate Professor, Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine M Raspovic
- Associate Professor, Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Professor and Chairman, Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - George T Liu
- Associate Professor, Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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19
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Farahani F, Ahn J, Nakonezny PA, Wukich DK, Wimberly RL, Riccio AI. Postoperative Outcomes in Diabetic Pediatric Orthopaedic Surgery Patients: A National Database Study. J Pediatr Orthop 2021; 41:e664-e670. [PMID: 34138820 DOI: 10.1097/bpo.0000000000001879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the negative effects of diabetes mellitus (DM) on operative outcomes in orthopaedic surgery is a well-studied topic in adults, little is known about the impact of this disease in children undergoing orthopaedic procedures. This study aims to describe the postoperative complications in pediatric orthopaedic surgery patients with DM. METHODS Pediatric patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) were retrospectively identified while selecting for elective orthopaedic surgery cases from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-Pediatric) database from 2012 to 2015. Univariate and multivariate analyses were performed to describe and assess outcomes when compared with nondiabetic patients undergoing similar procedures. RESULTS Of the 17,647 patients identified, 105 (0.60%) had DM. Of those 105 patients, 68 had IDDM and 37 had NIDDM. The median age of DM patients was 13.8 years (11.9 to 15.5 y) and 37.1% of all DM patients were male. Comparing DM to non-DM patients, no significant differences were noted in the overall complications (1.4% vs. 1.9%, P>0.05) or reoperation rates (1.2% vs. 1.9%, P>0.05); however, DM patients did have a higher occurrence of unplanned readmissions (4.8% vs. 1.7%; P=0.037). Diabetic patients were statistically more likely to have an unplanned readmission with 30 days (adjusted odds ratio=3.34; 95% confidence interval=1.21-9.24, P=0.021). when comparing IDDM to NIDDM, there was no significant difference in outcomes. Comparing NIDDM to non-DM patients, there was an increased incidence of nerve injury (5.6% vs. 0.18%; P=0.023), readmission rate (11.1% vs. 1.8%; P=0.043), and reoperation rate (11.1% vs. 1%; P=0.013) in nonspinal procedures and an increased incidence of pulmonary embolism (10% vs. 0%; P=0.002) in spinal arthrodesis procedures. NIDDM predicted longer hospital stays (adjusted odds ratio=1.49; 95% confidence interval=1.04, 2.14; P=0.028) compared with nondiabetic patients in extremity deformity procedures. CONCLUSIONS The 30-day complication, reoperation, and readmission rates for NIDDM patients were higher than that of non-DM patients. Furthermore, NIDDM is a predictor of longer hospital stays while DM is a predictor of unplanned readmissions. No statistical differences were noted when comparing outcomes of NIDDM to IDDM patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Farzam Farahani
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
| | - Paul A Nakonezny
- Department of Clinical Science, Division of Biostatistics, University of Texas Southwestern Medical Center
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
| | - Robert L Wimberly
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children
| | - Anthony I Riccio
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children
- Department of Orthopedics, Children's Medical Center in Dallas, Dallas, TX
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20
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Zullo L, King J, Nakonezny PA, Kennard BD, Emslie G, Stewart SM. Implementing the interpersonal theory of suicide to improve outcomes in suicidal adolescents: A pilot trial. Suicide Life Threat Behav 2021; 51:633-640. [PMID: 33665839 DOI: 10.1111/sltb.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Interpersonal Psychological Theory of Suicide proposes two constructs that serve as a final common pathway to suicidal ideation: thwarted belongingness and perceived burdensomeness. There have been few translations of this theory to clinical care. This study aimed to address this limitation by targeting burden cognitions with novel interventions. METHODS A pilot clinical trial was conducted in an evidence-based intensive outpatient program for suicidal youth. Participants were 123 adolescents who completed measures at intake, discharge, and one-month follow-up. The experimental group consisted of standard care plus study interventions, which was compared with an active control group of standard care. Feedback on intervention acceptability was gathered through qualitative interviews with parents and adolescents. RESULTS There was a statistically significant drop in thwarted belongingness at discharge and an improvement in perceived burdensomeness at discharge (not statistically significant, small effect size). Feedback on acceptability was favorable and supported implementation. CONCLUSION This study adds to the literature by being the first to utilize the construct of perceived burdensomeness in clinical interventions for suicidal youth; illustrating one potential avenue for translating theory to practice. The unexpected effects on thwarted belongingness have implications for the role of these constructs in a treatment setting.
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Affiliation(s)
- Lucas Zullo
- UT Southwestern Medical Center, Dallas, TX, USA.,Children's Health System of Texas, Dallas, TX, USA
| | - Jessica King
- Children's Health System of Texas, Dallas, TX, USA
| | | | - Betsy D Kennard
- UT Southwestern Medical Center, Dallas, TX, USA.,Children's Health System of Texas, Dallas, TX, USA
| | - Graham Emslie
- UT Southwestern Medical Center, Dallas, TX, USA.,Children's Health System of Texas, Dallas, TX, USA
| | - Sunita M Stewart
- UT Southwestern Medical Center, Dallas, TX, USA.,Children's Health System of Texas, Dallas, TX, USA
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21
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Shafi RMA, Nakonezny PA, Miller KA, Desai J, Almorsy AG, Ligezka AN, Morath BA, Romanowicz M, Croarkin PE. An exploratory study of clinical and physiological correlates of problematic social media use in adolescents. Psychiatry Res 2021; 302:114020. [PMID: 34098156 PMCID: PMC8277714 DOI: 10.1016/j.psychres.2021.114020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 12/06/2020] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
Prior validation studies of the Bergen Social Media Addiction Scale (BSMAS) demonstrate its utility for identifying problematic social media use in adolescents. There are knowledge gaps regarding the potential clinical and physiological underpinnings of problematic social media use in adolescents. This cross-sectional, single-visit study examined a sample of depressed (n = 30) and healthy (n = 30) adolescents who underwent clinical assessments of depressive symptom severity, bullying, cyberbullying, self-esteem, salivary measures of stress (cortisol and α-amylase) to identify correlates with adolescent and parental reports of the BSMAS. LASSO-penalized multiple linear regression models were implemented. With respect to the adolescent BSMAS scores in all subjects, the risk of problematic social media increased as depressive symptom severity increased. Depressed female adolescents appeared to have a greater risk. Based on parental BSMAS scores, depression status, depressive symptom severity, cyberbullying score, and salivary cortisol significantly predicted problematic social media use. For the depressed sample, the risk of problematic social media use increased as salivary cortisol increased. No significant predictors of problematic social media usage emerged in the healthy control sample. These preliminary results provide novel insights into clinical and physiological characteristics of problematic social media use in adolescents.
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Affiliation(s)
- Reem M. A. Shafi
- Department of Psychiatry and Psychology and Mayo Clinic, Rochester, Minnesota, USA.,Cairns and Hinterland Hospital and Health Service, QLD, Australia.,Corresponding author: Reem M. A. Shafi, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ( Phone: 507-293-2557 Fax: 507-284-3933)
| | - Paul A. Nakonezny
- Department of Psychiatry and Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Keith A. Miller
- Department of Psychiatry and Psychology and Mayo Clinic, Rochester, Minnesota, USA
| | - Jinal Desai
- Department of Psychiatry and Psychology and Mayo Clinic, Rochester, Minnesota, USA
| | - Ammar G. Almorsy
- Department of Psychiatry and Psychology and Mayo Clinic, Rochester, Minnesota, USA
| | - Anna N. Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - Brooke A. Morath
- Department of Psychiatry and Psychology and Mayo Clinic, Rochester, Minnesota, USA
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology and Mayo Clinic, Rochester, Minnesota, USA
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology and Mayo Clinic, Rochester, Minnesota, USA
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22
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Shafi RMA, Nakonezny PA, Miller KA, Desai J, Almorsy AG, Ligezka AN, Morath BA, Romanowicz M, Croarkin PE. Altered markers of stress in depressed adolescents after acute social media use. J Psychiatr Res 2021; 136:149-156. [PMID: 33592386 PMCID: PMC8009842 DOI: 10.1016/j.jpsychires.2021.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 01/13/2023]
Abstract
Social media use (SMU) is an inherent element in the daily life and neurodevelopment of adolescents, but broad concerns exist regarding the untoward effects of social media on adolescents. We conducted a prospective, cross-sectional study that sought to examine the acute effects of SMU on clinical measures and biomarkers of stress in healthy and depressed adolescents. After at least 24 h of abstinence from social media, depressed adolescents (n = 30) and healthy control adolescents (n = 30) underwent baseline clinical assessment of their prior SMU, depressive symptom severity, self-esteem, and exposure to bullying. Participants provided salivary samples that were analyzed for α-amylase and cortisol levels. After 20 min of unsupervised SMU, saliva analyses and clinical assessments were repeated. After 20 min of SMU, salivary cortisol and α-amylase levels were significantly higher in adolescents with depression but not in healthy control adolescents. Furthermore, small but statistically significant changes in depressive symptom severity occurred in all participants. These changes in depressive symptoms were not clinically meaningful. SMU did not significantly change self-esteem measures among participants. Adolescents with depression appeared to have more physiological reactivity after SMU compared with healthy adolescents. Further research should characterize SMU as a clinical dimension and risk factor among adolescents with depression and other psychiatric disorders.
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Affiliation(s)
- Reem M A Shafi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Cairns and Hinterland Hospital and Health Service, QLD, Australia.
| | - Paul A Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Keith A Miller
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jinal Desai
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ammar G Almorsy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Anna N Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Brooke A Morath
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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23
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Brown NH, Carter JE, Nakonezny PA, Phelan HA. 615 The Effects of the COVID-19 Pandemic on Implementation of a Psychological Distress Screening Program after Burn Injury. J Burn Care Res 2021. [PMCID: PMC8083583 DOI: 10.1093/jbcr/irab032.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction The relationship between psychiatric conditions and burn injury is complex, as disorders in thought or mood can both predispose to as well as result from thermal injury. We sought to describe our center’s experience with implementation of a psychological distress screening program in the run-up to and during the COVID-19 pandemic. Methods We undertook an analysis of de-identified data as part of a quality improvement review focusing on the results of psychological screening of our outpatient burn population. In the spring of 2019, our verified burn center implemented an outpatient screening program consisting of a registered nurse administering three validated test to screen for Post-Traumatic Stress Disorder screen, depression and anxiety, and problematic alcohol consumption to all patients at the time of physically checking in for their first burn clinic appointment. All outpatients triggering a positive screen are subsequently referred to the burn unit PsyD while a negative screen results in monthly repeat screenings until discharge from the burn clinic or a positive screen, whichever comes first. We analyzed data from the last twelve months of normal outpatient workflow. Loess regression was used to analyze the monthly proportions of patients screening positive. Results During the peak of COVID-19 in our region, clinic staff were reduced, and screening procedures suspended for the months of March and April 2020. Therefore, the study period consisted of 01 July 2019 to 31 August 2020. A median of 36.5 screens were conducted per month [interquartile range 27.75, 44.75]. Of these screens, 26.5% were positive, with 94.2% successfully referred to the burn unit’s postdoctoral fellow. The Loess regression showed the proportion of patients screening positive for psychological stressors from July 2019 until a peak in November 2019. A downtrend was then noted in the proportion screening positive from December 2019 to date (Figure). Conclusions Psychological stressors are prevalent in burn outpatients. We attribute the decrease in positive responses beginning in December 2019 to a combination of a decrease in the frequency of repeat administrations of the screening test in patients after screening positive, and a reluctance of anxious patients to present to the burn clinic for fear of COVID exposure while at the facility. ![]()
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Affiliation(s)
- Nathan H Brown
- LSU Health Sciences Center- New Orleans, University Medical Center, New Orleans, Louisiana; Louisiana State University Health Science Center, River Ridge, Louisiana; Division of Biostatistics, Dallas, Texas; LSU Health Sciences Center-New Orleans, New Orleans, Louisiana
| | - Jeffrey E Carter
- LSU Health Sciences Center- New Orleans, University Medical Center, New Orleans, Louisiana; Louisiana State University Health Science Center, River Ridge, Louisiana; Division of Biostatistics, Dallas, Texas; LSU Health Sciences Center-New Orleans, New Orleans, Louisiana
| | - Paul A Nakonezny
- LSU Health Sciences Center- New Orleans, University Medical Center, New Orleans, Louisiana; Louisiana State University Health Science Center, River Ridge, Louisiana; Division of Biostatistics, Dallas, Texas; LSU Health Sciences Center-New Orleans, New Orleans, Louisiana
| | - Herb A Phelan
- LSU Health Sciences Center- New Orleans, University Medical Center, New Orleans, Louisiana; Louisiana State University Health Science Center, River Ridge, Louisiana; Division of Biostatistics, Dallas, Texas; LSU Health Sciences Center-New Orleans, New Orleans, Louisiana
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24
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Gudmundsson P, Nakonezny PA, Lin J, Owhonda R, Richard H, Wells J. Functional improvement in hip pathology is related to improvement in anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being. BMC Musculoskelet Disord 2021; 22:133. [PMID: 33535999 PMCID: PMC7860171 DOI: 10.1186/s12891-021-04001-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/20/2021] [Indexed: 12/13/2022] Open
Abstract
Background Pain catastrophizing, anxiety, and depression are risk factors for poor functional outcomes and worse post-treatment pain that can be treated alongside physical care given to orthopedic patients. While these factors have been shown to be common in patients with hip pathology, there is limited literature that follows these conditions throughout treatment. The purpose of this study was to track psychological factors in patients with various hip pathology to determine if they improved alongside functional measures following treatment. Methods Patients presenting to a specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, depression, and hip function. Pre- and post-treatment assessments were undertaken: Pain Catastrophizing Scale, the Hospital Anxiety Depression Scale, the Hip Outcome Survey, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Patient characteristics were recorded. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between change in psychological factors with change in functional outcomes. Results A total of 201 patients (78 male, 123 female) with a mean age of 53.75 ± 18.97 years were included, with diagnoses of hip dysplasia (n = 35), femoroacetabular impingement (n = 35), lateral trochanteric pain syndrome (n = 9), osteoarthrosis (n = 109), and avascular necrosis of the hip (n = 13). Statistical analysis revealed a significant negative relationship between change in function level (as measured by HOOS ADL) and change in pain catastrophizing (rs = − 0.373, p < 0.0001), depression (rs = − 0.363, p < 0.0001), and anxiety (rs = − 0.264, p = 0.0002). Pain catastrophizing, depression, and anxiety improved with function. Spearman correlation coefficients also revealed that pain catastrophizing, HADS anxiety, and HADS depression improved with improvement in other patient-reported functional outcomes. Conclusions Patients with hip pathology often exhibit pain catastrophizing, anxiety, and depression, but improvements in hip functionality are associated with decreased severity of these psychological comorbidities. Exploring this connection demonstrates the correlation between musculoskeletal impairment and psychosocial outcomes and mental health. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04001-5.
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Affiliation(s)
- Paul Gudmundsson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75390, USA
| | - Paul A Nakonezny
- Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Jason Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75390, USA
| | - Rebisi Owhonda
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75390, USA
| | - Heather Richard
- Department of Psychology, TX Scottish Rite Hospital, Dallas, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75390, USA.
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25
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Bunt SC, Didehbani N, LoBue C, Stokes M, Heinzelmann M, Rossetti H, Miller SM, Nakonezny PA, Bell K, Batjer H, Cullum CM. Sex differences in reporting of concussion symptoms in adults. Clin Neuropsychol 2020; 36:1290-1303. [PMID: 33258703 DOI: 10.1080/13854046.2020.1842500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine differences in concussion symptom reporting between female and male adults considering current psychological symptoms such as anxiety and depression and pre-injury factors in order to identify sex differences which may guide treatment efforts. Method: This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N = 132) age 19 to 78 years had sustained a concussion within 30 days of clinic visit. The independent variable was sex and covariates included age, ethnicity, current anxiety and depression ratings, history of attention deficit disorder, history of headache/migraine, and time to clinic. The dependent variables were 22 post-concussion symptoms as measured by the Sport Concussion Assessment Tool-5 Post-Concussion Symptom Scale. Results: Analysis of covariance and ordinal logistic regression results both revealed that females had a greater likelihood of reporting increased symptom severity for 15/22 concussion symptoms. The largest risk ratios (effect size) in symptom reporting between sexes (higher symptoms in females) included: feeling more emotional 4.05 (0.72), fatigue or low energy 4.05 (0.72), sensitivity to light 3.74 (0.69), headache 3.65 (0.57), balance problems 3.31 (0.53), pressure in head 3.06 (0.51), and neck pain 2.97 (0.60). Conclusions: Adult females in our sample reported higher levels of many concussion symptoms than males and showed an increased risk of developing these same symptoms following concussion. Examination of the magnitude of sex difference in concussion symptom reporting will better inform medical staff to anticipate and address symptoms that may present greater challenges for adult females.
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Affiliation(s)
- Stephen C Bunt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mathew Stokes
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Morgan Heinzelmann
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Heidi Rossetti
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shane M Miller
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Orthopedics, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.,Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Paul A Nakonezny
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hunt Batjer
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
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26
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Diwan W, Nakonezny PA, Wells J. The Effect of Length of Hospital Stay and Patient Factors on Patient Satisfaction in an Academic Hospital. Orthopedics 2020; 43:373-379. [PMID: 32956469 DOI: 10.3928/01477447-20200910-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 02/03/2023]
Abstract
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a metric for patient satisfaction consisting of 19 questions divided into 10 domains. Scores affect hospital reimbursements and accreditation and may play a role in patient outcomes. It is unclear how length of stay and other factors affect each of the 10 domains. This retrospective review gathered data of 600 patients between December 2008 and January 2017 who completed the HCAHPS survey. The odds of complete satisfaction in each of the 10 domains was evaluated. The results suggest increased length of stay is associated with lower odds of patient satisfaction and decreased likelihood of recommending the hospital. The odds of being completely satisfied regarding communication with physicians, discharge information, and responsiveness of the hospital staff, as well as the odds of recommending the hospital to others, were lower if the care provider was younger than the patient. Obese patients were also more likely to be satisfied with responsiveness and care transition. Male patients were more satisfied with communication about medications (odds ratio [OR], 1.694), care transition (OR, 1.489), and cleanliness (OR, 2.120). Medicare and fewer consults were related to increased odds of patient satisfaction with care transition (OR, 1.748 and 0.573, respectively). Males, older patients, and White patients were more likely to recommend the hospital (OR, 1.476, 1.025, and 1.690, respectively). Length of stay affects patient satisfaction and likelihood of recommending the hospital to others. Other factors such as a younger provider age than the patient, lower body mass index, female sex, non-Medicare insurance, and higher number of consults are also associated with lower satisfaction in various domains. Hospital systems can bolster patient satisfaction by strategizing day-of-surgery and weekend staffing to reduce length of stay. [Orthopedics. 2020;43(6):373-379.].
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27
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Madni TD, Lu K, Nakonezny PA, Imran JB, Cunningham HB, Clark AT, Taveras L, Hoopman JE, Wolf SE, Kenkel JM, Phelan HA. Treating Hypertrophic Burn Scar With 2940-nm Er:YAG Laser Fractional Ablation Improves Scar Characteristics as Measured by Noninvasive Technology. J Burn Care Res 2020; 40:416-421. [PMID: 31046088 DOI: 10.1093/jbcr/irz056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Their group previously demonstrated high-patient satisfaction for the treatment of hypertrophic burn scar (HBS) with the erbium: yttrium aluminum garnet (Er:YAG) laser, but this and other literature supporting the practice suffer from a common weakness of a reliance on subjective assessments by patients or providers. Herein, they sought to prospectively study the effects of Er:YAG fractional ablation on HBS using noninvasive, objective technologies to measure outcomes. Patients with HBS had identical regions of scar designated for treatment by the Er:YAG laser (TREAT) or to be left untreated (CONTROL). They prospectively collected scar measurements of TREAT and CONTROL regions preoperatively, 3 weeks, and 3 months after Er:YAG treatment. Scar measurements included viscoelastometry, transepidermal water loss, optical coherent tomography, and high-frequency ultrasound. Outcomes were measured for the aggregate difference between the TREAT group vs the CONTROL group, as well as within each group in isolation. Seventeen patients were seen preoperatively, followed by n = 15 at 3 weeks and n = 11 at 3 months. A mixed-model repeated measures analysis showed no significant effect of fractional ablation when comparing the overall TREAT group measurements with those of the CONTROL group. However, when considered as within-group measurements, TREAT scars showed significant improvement in viscoelastic deformity (P = .03), elastic deformity (P = .004), skin roughness (P = .05), and wrinkle depth (P = .04) after fractional ablation, whereas CONTROL scars showed no such within-group changes. HBS treated by the Er:YAG laser showed objective improvements, whereas no such changes were seen within the untreated scars over the same time frame.
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Affiliation(s)
- Tarik D Madni
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | - Karen Lu
- UT Southwestern Department of Plastic Surgery, Division of Biostatistics Dallas, Texas
| | - Paul A Nakonezny
- UT Southwestern Department of Clinical Sciences, Division of Biostatistics, Dallas, Texas
| | - Jonathan B Imran
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | - Holly B Cunningham
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | - Audra T Clark
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | - Luis Taveras
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | | | | | - Jeffrey M Kenkel
- UT Southwestern Department of Plastic Surgery, Division of Biostatistics Dallas, Texas
| | - Herb A Phelan
- UT Southwestern Division of Burns/Trauma/Critical Care, Dallas, Texas
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28
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Comish PB, Madni TD, Nakonezny PA, Mayo H, Imran JB, Kuhlenschmidt KM, Taveras LR, Vela RJ, Goldenmerry YL, Clark AT, Weis HB, Cripps MW, Wolf SE. An analysis of surgical literature trends over four decades. Am J Surg 2020; 221:53-54. [PMID: 32711859 DOI: 10.1016/j.amjsurg.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Paul B Comish
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
| | - Tarik D Madni
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Paul A Nakonezny
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Helen Mayo
- Department of Education, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan B Imran
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | | | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Ryan J Vela
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | | | - Audra T Clark
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Holly B Weis
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Nakonezny PA, Lindow JC, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Byerly MJ. A single assessment with the Brief Adherence Rating Scale (BARS) discriminates responders to long-acting injectable antipsychotic treatment in patients with schizophrenia. Schizophr Res 2020; 220:92-97. [PMID: 32269005 PMCID: PMC7306424 DOI: 10.1016/j.schres.2020.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 05/06/2019] [Revised: 01/30/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine if a single baseline adherence assessment (Brief Adherence Rating Scale [BARS]) could identify patients who are likely to respond to long-acting injectable (LAI) antipsychotic treatment. METHOD The current secondary analysis included a sub-sample of adult outpatients (N = 176) with schizophrenia or schizoaffective disorder who participated in the "A Comparison of Long-Acting Injectable Medications for Schizophrenia (ACLAIMS)" trial and had a baseline BARS assessment and a baseline and month 3 Positive and Negative Syndrome Scale (PANSS) rating. The main outcome was LAI treatment response, defined as a ≥ 20% decrease (baseline to month 3) on the PANSS total score. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analysis was conducted to determine the optimal cutpoint of baseline BARS adherence in discriminating LAI treatment response at month 3. A logistic mixed model estimated the odds of response to LAI treatment at month 3 from the optimal baseline BARS cutpoint. RESULTS The ROC analysis determined that the single baseline BARS rating (cutoff ≤66%), indicating low adherence, best discriminated patients likely to respond to LAI treatment (AUC = 0.603, SE = 0.046, 95% binomial exact CI = 0.527 to 0.676, p = 0.025), with 38% sensitivity and 85% specificity. The logistic mixed model analysis revealed that patients with ≤66% BARS adherence had 3.464 times the predicted odds (95% CI = 1.604 to 7.480, p = 0.001) of responding to LAI treatment than those who were >66% BARS adherent. CONCLUSION A single baseline BARS assessment discriminated response to LAI treatment suggesting it is a reasonable tool to identify candidates for LAI antipsychotic treatment.
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Affiliation(s)
- Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA,Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Janet C. Lindow
- Department of Psychiatry, University of Arizona, Biomedical Research Foundation of Southern Arizona, and Southern Arizona VA Health Care System, Tucson, AZ 85723 USA
| | - T. Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY 10032 USA
| | - Joseph P. McEvoy
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA 30912 USA
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Robert A. Rosenheck
- Veterans Affairs (VA) New England Mental Illness, Research Education and Clinical Center, VA Connecticut Healthcare System, West Haven, and the Yale School of Medicine, New Haven, CT 06516 USA
| | - Matthew J. Byerly
- Department of Psychiatry, University of Arizona and Southern Arizona VA Health Care System, Tucson, AZ 85723 USA
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Cunningham HB, Scielzo SA, Nakonezny PA, Bruns BR, Brasel KJ, Inaba K, Brakenridge SC, Kerby JD, Joseph BA, Mohler MJ, Cuschieri J, Paulk ME, Ekeh AP, Madni TD, Taveras LR, Imran JB, Wolf SE, Phelan HA. Burn Surgeon and Palliative Care Physician Attitudes Regarding Goals of Care Delineation for Burned Geriatric Patients. J Burn Care Res 2020; 39:1000-1005. [PMID: 29771351 DOI: 10.1093/jbcr/iry027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Palliative care specialists (PCS) and burn surgeons (BS) were surveyed regarding: 1) importance of goals of care (GoC) conversations for burned seniors; 2) confidence in their own specialty's ability to conduct these conversations; and 3) confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multicenter consortium dedicated to palliative care in the injured geriatric patient and beta-tested by BS and PCS unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Burn Association and American Academy for Hospice and Palliative Medicine. Forty-five BS (7.3%) and 244 PCS (5.7%) responded. Palliative physicians rated being more familiar with GoC, were more comfortable having a discussion with laypeople, were more likely to have reported high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to BS. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so. BS favored leading team discussions, whereas palliative specialists preferred jointly led discussions. Both groups agreed that discussions should occur within 72 hours of admission. Both groups believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions for the optimal leadership of these discussions.
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Affiliation(s)
- Holly B Cunningham
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Shannon A Scielzo
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Paul A Nakonezny
- Department of Clinical Science and Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Brandon R Bruns
- Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Karen J Brasel
- Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health Science University, Portland, OR, USA
| | - Kenji Inaba
- Division of Acute Care Surgery and Critical Care, University of Southern California, Los Angeles, CA, USA
| | | | - Jeffrey D Kerby
- Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bellal A Joseph
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ, USA
| | - M J Mohler
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Joseph Cuschieri
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Mary E Paulk
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Akpofure P Ekeh
- Department of Surgery, Wright State University, Dayton, OH, USA
| | - Tarik D Madni
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan B Imran
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
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Gates S, Nguyen I, Del Core M, Nakonezny PA, Bradley H, Khazzam M. Incidence and predictors of positive intraoperative cultures in primary shoulder arthroplasty following prior ipsilateral shoulder surgery. JSES Int 2020; 4:366-371. [PMID: 32490428 PMCID: PMC7256896 DOI: 10.1016/j.jseint.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background To our knowledge, the rate of positive intraoperative cultures in patients undergoing primary shoulder arthroplasty with prior ipsilateral nonarthroplasty shoulder surgery is unknown. The aim of this study was to determine the incidence and predictors of positive cultures in these patients. Methods We performed a retrospective review of patients with prior ipsilateral shoulder surgery with intraoperative cultures taken at the time of primary shoulder arthroplasty. We evaluated culture results, demographics, and number of prior surgeries. Regression analysis was used to determine patient-related risk factors that predict positive cultures. Results A total of 682 patients underwent primary shoulder arthroplasty, 83 had at least 1 prior ipsilateral shoulder surgery: 65.1% male, mean age 64.2 ± 10.9 years. For the cohort of 83 patients, an average of 3.2 ± 1.2 tissue samples were obtained for each patient, with a mean of 0.84 ± 1.14 tissue cultures being positive (range 0-5). Thirty-seven of the 83 patients (44.5%) had at least 1 positive culture, with Cutibacterium acnes the most frequent organism (31/37; 83.4%). An average of 1.9 ± 0.96 tissue cultures resulted positive (range 1-5) for the 37 patients who had positive cultures, 40.5% (15/37) had only 1 positive tissue culture (12/15 C acnes, 2/15 Staphylococcus epidermidis, and 1/15 vancomycin-resistant enterococcus). Male sex and history of prior shoulder infection were predictive of culture positivity (odds ratios: 2.5 and 20.9, respectively). Age, race, medical comorbidities, number of prior shoulder surgeries, and time from index shoulder surgery were not predictive of culture positivity. Conclusion About 45% of patients with no clinical signs of infection and a history of prior ipsilateral shoulder surgery undergoing primary shoulder arthroplasty grew positive intraoperative cultures. The significance of these findings remains unclear with regard to risk of periprosthetic infection and how these patients should be managed.
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Affiliation(s)
- Stephen Gates
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ivy Nguyen
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Del Core
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Paul A Nakonezny
- Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hallie Bradley
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Khazzam
- Shoulder Service, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Gloger AN, Nakonezny PA, Phelan HA. Use of Tailored Feedback Improves Accuracy of Delirium Documentation in the Burn ICU: Results of a Performance Improvement Initiative. J Burn Care Res 2020; 41:299-305. [PMID: 31504614 DOI: 10.1093/jbcr/irz153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
One of the most widely used tools for delirium assessment in burn intensive care units is the Confusion Assessment Method for the Intensive Care Unit delirium assessment tool. However, some nurses struggle with inaccurate delirium documentation. This performance improvement project was undertaken to assess the impact that routine chart audits with tailored feedback would have on documentation accuracy. An a priori goal of at least 90% documentation accuracy was set by burn leadership at our academic, American Burn Association-verified burn center. For the precorrectional feedback time period, nursing delirium documentation was reviewed for accuracy by the nurse educator. In the postcorrectional feedback time period, an intervention was started, in which the educator sent tailored feedback to nurses with inaccurate delirium documentation. A Poisson regression with robust standard errors was used to compare the proportions of correct delirium documentation for the precorrectional feedback and postcorrectional feedback time periods. The overall rates of correct delirium documentation in the precorrectional feedback time period were 49.15% (SD = 31.86), 95% CI: 36.43 to 66.31. A significant increase was seen in the rates of correct delirium documentation for the postcorrectional feedback time period (91.47% [SD = 8.28], 95% CI: 87.45 to 95.67), P = .0001. In the 4 months prior to starting corrective feedback, zero out of five (0%) audits reached the 90% goal of accurate delirium documentation. In the 8 months in which corrective feedback was being given, 9 out of 15 (60%) audits reached the compliance goal set by leadership. Using corrective feedback improves the accuracy of nursing delirium documentation.
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Affiliation(s)
- Amy N Gloger
- Department of Surgical Services, Parkland Health and Hospital System, Dallas, Texas
| | - Paul A Nakonezny
- Department of Surgery, University of Texas Southwestern Medical Branch, Dallas, Texas
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern Medical Branch, Dallas, Texas
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Hernandez PA, Wells J, Usheva E, Nakonezny PA, Barati Z, Gonzalez R, Kassem L, Henson FMD. Early-Onset Osteoarthritis originates at the chondrocyte level in Hip Dysplasia. Sci Rep 2020; 10:627. [PMID: 31953438 PMCID: PMC6969105 DOI: 10.1038/s41598-020-57431-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/31/2019] [Indexed: 01/05/2023] Open
Abstract
Subjects with developmental dysplasia of the hip (DDH) often show early-onset osteoarthritis (OA); however, the molecular mechanisms underlying this pathology are not known. We investigated whether cellular changes in chondrocytes from OA cartilage can be detected in chondrocytes from DDH cartilage before histological manifestations of degeneration. We characterized undamaged and damaged articular cartilage from 22 participants having hip replacement surgery with and without DDH (9 DDH-OA, 12 OA-only, one femoral fracture). Tissue immunostaining revealed changes in damaged OA-only cartilage that was also found in undamaged DDH-OA cartilage. Chondrocytes in situ from both groups show: (i) thicker fibers of vimentin intermediate filaments, (ii) clusters of integrin α5β1, (iii) positive MMP13 staining and (iv) a higher percentage of cells expressing the serine protease HtrA1. Further characterization of the extracellular matrix showed strong aggrecan and collagen II immunostaining in undamaged DDH cartilage, with no evidence of augmented cell death by activation of caspase 3. These findings suggest that early events in DDH cartilage originate at the chondrocyte level and that DDH cartilage may provide a novel opportunity to study these early changes for the development of therapeutic targets for OA.
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Affiliation(s)
- Paula A Hernandez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Emiliya Usheva
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Paul A Nakonezny
- Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Zahra Barati
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Roberto Gonzalez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Layla Kassem
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Frances M D Henson
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, CB2 2QQ, UK
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Tisano BK, Nakonezny PA, Gross BS, Martinez JR, Wells JE. Depression and Non-modifiable Patient Factors Associated with Patient Satisfaction in an Academic Orthopaedic Outpatient Clinic: Is it More Than a Provider Issue? Clin Orthop Relat Res 2019; 477:2653-2661. [PMID: 31764330 PMCID: PMC6907291 DOI: 10.1097/corr.0000000000000927] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 08/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient satisfaction surveys play an increasingly important role in United States healthcare policy and serve as a marker of provided physician services. In attempts to improve the patient's clinical experience, focus is often placed on components of the healthcare system such as provider interaction and other experiential factors. Patient factors are often written off as "non-modifiable"; however, by identifying and understanding these risk factors for dissatisfaction, another area for improvement and intervention becomes available. QUESTIONS/PURPOSES (1) Do patients in the orthopaedic clinic with a preexisting diagnosis of depression report lower satisfaction scores than those without a preexisting diagnosis of depression? (2) What other non-modifiable patient factors influence patient-reported satisfaction? METHODS We reviewed Press Ganey Survey scores, which assess patient experiential satisfaction with a single clinical encounter, from 3044 clinic visits (2527 patients) in adult reconstructive, sports, and general orthopaedic clinics at a single academic medical center between November 2010 and May 2017, during which time approximately 19,000 encounters occurred. Multiple patient factors including patient age, gender, race, health insurance status, number of previous clinic visits with their physician, BMI, and a diagnosis of depression were recorded. Patient satisfaction was operationalized as a binary outcome as satisfied or less satisfied, and a multiple logistic regression analysis was used to estimate the odds of being satisfied. RESULTS After adjusting for all other covariates in the model, we found that patients with a diagnosis of depression were less likely to be satisfied than patients without this diagnosis (odds ratio 0.749 [95% confidence interval, 0.600-0.940]; p = 0.01). Medicare-insured patients were more likely to be satisfied than non-Medicare patients (OR 1.257 [95% CI, 1.020-1.549]; p = 0.03), patients in the sports medicine clinic were more likely to be satisfied than those seen in the general orthopaedic clinic (OR 1.397 [95% CI, 1.096-1.775]; p = 0.007), and established patients were more likely to be satisfied than new patients (OR 0.763 [95% CI, 0.646-0.902]; p = 0.002). CONCLUSIONS Given the association of depression with lower satisfaction with a single visit at the orthopaedic clinic, providers should screen for depression and address the issue during the outpatient encounter. The impact of such comprehensive care or subsequent treatment of depression on improving patient-reported satisfaction offers areas of future study. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Breann K Tisano
- B. K. Tisano, B. S. Gross, J. R. Martinez, J. E. Wells, Department of Orthopaedic Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA P. A. Nakonezny, Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical School, Dallas, TX, USA
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Shafi RM, Nakonezny PA, Romanowicz M, Nandakumar AL, Suarez L, Croarkin PE. The Differential Impact of Social Media Use on Middle and High School Students: A Retrospective Study. J Child Adolesc Psychopharmacol 2019; 29:746-752. [PMID: 31233343 PMCID: PMC6885760 DOI: 10.1089/cap.2019.0071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/31/2022]
Abstract
Background: Social media use is now a central aspect of adolescent life and development. Little is known about the clinical implications of social media use in children and adolescents presenting in acute crisis for psychiatric admission. This study sought to compare the potential effects of social media use among middle and high school students on outcomes of psychiatric morbidity. It was hypothesized that among social media users, high school students would have greater psychiatric morbidity compared with middle school students. Methods: The research team extracted clinical and demographic data from adolescents (aged 12-17 years) presenting for acute psychiatric admission who also had documented social media use (N = 56). Educational status, middle school (n = 21) versus high school (n = 35), was examined as an independent variable. Psychotropic medication use, self-injurious behavior, suicide risk, and suicidal ideation were examined as dependent variables in logistic regression models. Results: High school students using social media had significantly greater predicted odds of psychotropic medication use and self-injurious behavior compared with students in middle school who used social media. High school students using social media had greater, although not statistically significant, predicted odds of suicide risk and suicidal ideation compared with middle school students using social media. Conclusions: Social media use is likely an important factor to consider in psychiatric evaluations. The present findings suggest that social media use in high school students is associated with greater psychiatric morbidity compared with middle school students. Further research could illuminate the developmental lines of social media use and age-specific risks.
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Affiliation(s)
- Reem M.A. Shafi
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota.,Address correspondence to: Reem M.A. Shafi, MBBS, BSc, Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.,Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota
| | - Aiswarya L. Nandakumar
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota
| | - Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota
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Schure MB, Lindow JC, Greist JH, Nakonezny PA, Bailey SJ, Bryan WL, Byerly MJ. Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial. J Med Internet Res 2019; 21:e14754. [PMID: 31738173 PMCID: PMC6887812 DOI: 10.2196/14754] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/23/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Although internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist. Objective The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms. Methods Using no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, participants were evaluated at baseline and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation. Results Over the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity than the control group (n=162; P<.001), with a moderate treatment effect size (d=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (P<.001; d=0.47), work/social functioning (P<.001; d=0.39), and resilience (P<.001; d=0.55). Although not significant, the intervention group was 45% less likely than the control group to experience increased suicidal ideation (odds ratio 0.55). Conclusions These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, stand-alone intervention. Trial Registration ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878
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Affiliation(s)
- Mark B Schure
- Department of Health & Human Development, Montana State University, Bozeman, MT, United States.,Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States
| | - Janet C Lindow
- Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States.,Biomedical Research and Education Foundation of Southern Arizona, Tucson, AZ, United States.,Southern Arizona VA Health Care System, Tucson, AZ, United States
| | - John H Greist
- Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States.,School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States.,Healthcare Technology Systems, Madison, WI, United States.,Department of Cell Biology and Neuroscience, Montana State University, Bozeman, MT, United States
| | - Paul A Nakonezny
- Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sandra J Bailey
- Department of Health & Human Development, Montana State University, Bozeman, MT, United States.,Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,Montana State University Extension, Bozeman, MT, United States
| | - William L Bryan
- Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,One Montana, Bozeman, MT, United States
| | - Matthew J Byerly
- Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States.,Southern Arizona VA Health Care System, Tucson, AZ, United States.,Department of Cell Biology and Neuroscience, Montana State University, Bozeman, MT, United States
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Abstract
Chronic kidney disease (CKD) is a major concern in patients with foot disease because it is associated with high rates of neuropathy, peripheral vascular disease, and poor wound healing. The purpose of this study was to evaluate renal dysfunction as a risk factor for reamputation after initial transmetatarsal amputation (TMA). Patients who underwent a TMA were retrospectively identified in the American College of Surgeons National Surgical Quality Improvement Program database. Of 2018 patients, reamputation after TMA occurred in 4.4%. End-stage renal disease (ESRD) was associated with 100% increased odds of TMA failure (adjusted odds ratio [OR] = 2.00; 95% CI = 1.10, 3.52), 128% increased odds of major amputation (adjusted OR = 2.28; 95% CI = 1.27, 3.96), and 182% increased odds of 30-day mortality (adjusted OR = 2.82; 95% CI = 1.69, 4.64). In addition, white blood cell count >10 000/mm3 and deep infection at the time of surgery were independently associated with TMA failure. In conclusion, severe renal dysfunction is associated with TMA failure in the short-term, perioperative period. There was no incremental increase in risk of TMA failure with worsening level of renal function before ESRD. A multidisciplinary approach should be implemented in patients with CKD to prevent foot-related pathologies that may necessitate lower-extremity amputation. Levels of Evidence: Level III: Retrospective cohort study.
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Affiliation(s)
- Junho Ahn
- Department of Orthopaedic Surgery (JA, KMR, GTL, DKW), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Plastic Surgery (LAL, JLF), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Science, Division of Biostatistics (PAN), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katherine M Raspovic
- Department of Orthopaedic Surgery (JA, KMR, GTL, DKW), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Plastic Surgery (LAL, JLF), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Science, Division of Biostatistics (PAN), University of Texas Southwestern Medical Center, Dallas, Texas
| | - George T Liu
- Department of Orthopaedic Surgery (JA, KMR, GTL, DKW), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Plastic Surgery (LAL, JLF), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Science, Division of Biostatistics (PAN), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lawrence A Lavery
- Department of Orthopaedic Surgery (JA, KMR, GTL, DKW), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Plastic Surgery (LAL, JLF), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Science, Division of Biostatistics (PAN), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Javier La Fontaine
- Department of Orthopaedic Surgery (JA, KMR, GTL, DKW), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Plastic Surgery (LAL, JLF), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Science, Division of Biostatistics (PAN), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paul A Nakonezny
- Department of Orthopaedic Surgery (JA, KMR, GTL, DKW), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Plastic Surgery (LAL, JLF), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Science, Division of Biostatistics (PAN), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dane K Wukich
- Department of Orthopaedic Surgery (JA, KMR, GTL, DKW), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Plastic Surgery (LAL, JLF), University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Science, Division of Biostatistics (PAN), University of Texas Southwestern Medical Center, Dallas, Texas
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Lindow JC, Becker MN, Nakonezny PA, Byerly MJ. Evaluating an antistigma intervention combining personal account with musical performance among rural adolescents. ACTA ACUST UNITED AC 2019. [DOI: 10.1037/rmh0000122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
AIMS Psychological factors play a critical role in patient presentation, satisfaction, and outcomes. Pain catastrophizing, anxiety, and depression are important to consider, as they are associated with poorer outcomes and are potentially modifiable. The aim of this study was to assess the level of pain catastrophizing, anxiety, and depression in patients with a range of hip pathology and to evaluate their relationship with patient-reported psychosocial and functional outcome measures. PATIENTS AND METHODS Patients presenting to a tertiary-centre specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, and depression. Validated assessments were undertaken such as: the Pain Catastrophizing Scale (PCS), the Hospital Anxiety Depression Scale (HADS), and the 12-Item Short-Form Health Survey (SF-12). Patient characteristics and demographics were also recorded. Multiple linear regression modelling, with adaptive least absolute shrinkage and selection operator (LASSO) variable selection, was used for analysis. RESULTS A total of 328 patients were identified for inclusion, with diagnoses of hip dysplasia (DDH; n = 50), femoroacetabular impingement (FAI; n = 55), lateral trochanteric pain syndrome (LTP; n = 23), hip osteoarthrosis (OA; n = 184), and avascular necrosis of the hip (AVN; n = 16) with a mean age of 31.0 years (14 to 65), 38.5 years (18 to 64), 63.7 years (20 to 78), 63.5 years (18 to 91), and 39.4 years (18 to 71), respectively. The percentage of patients with abnormal levels of pain catastrophizing, anxiety, or depression was: 22.0%, 16.0%, and 12.0% for DDH, respectively; 9.1%, 10.9%, and 7.3% for FAI, respectively; 13.0%, 4.3%, and 4.3% for LTP, respectively; 21.7%, 11.4%, and 14.1% for OA, respectively; and 25.0%, 43.8%, and 6.3% for AVN, respectively. HADS Anxiety (HADSA) and Hip Disability Osteoarthritis Outcome Score Activities of Daily Living subscale (HOOS ADL) predicted the PCS total (adjusted R2 = 0.4599). Age, HADS Depression (HADSD), and PCS total predicted HADSA (adjusted R2 = 0.4985). Age, HADSA, patient's percentage of perceived function, PCS total, and HOOS Quality of Life subscale (HOOS QOL) predicted HADSD (adjusted R2 = 0.5802). CONCLUSION Patients with hip pathology may exhibit significant pain catastrophizing, anxiety, and depression. Identifying these factors and understanding the impact of psychosocial function could help improve patient treatment outcomes. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care. Cite this article: Bone Joint J 2019;101-B:800-807.
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Affiliation(s)
- S N Hampton
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Centre, Dallas, Texas, USA
| | - P A Nakonezny
- Department of Population and Data Sciences, Division of Biostatistics, Secondary Faculty in the Department of Psychiatry, The University of Texas Southwestern Medical Centre, Dallas, Texas, USA
| | - H M Richard
- Department of Orthopaedic Surgery and Psychology, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - J E Wells
- Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Centre, Dallas, Texas, USA
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Martinez JR, Nakonezny PA, Batty M, Wells J. The Dimension of the Press Ganey Survey Most Important in Evaluating Patient Satisfaction in the Academic Outpatient Orthopedic Surgery Setting. Orthopedics 2019; 42:198-204. [PMID: 31323103 DOI: 10.3928/01477447-20190625-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/21/2019] [Indexed: 02/03/2023]
Abstract
Many studies have examined modifiable and nonmodifiable patient factors influencing patient satisfaction scores. The objective of this study was to evaluate which of the 6 domains making up the Press Ganey Survey had a greater magnitude of relative importance in the expected relationship with patient satisfaction in outpatient orthopedic surgery encounters. Press Ganey Survey satisfaction scores from 4737 clinical encounters from adult reconstructive surgery, sports medicine, hand, foot and ankle, trauma, and general orthopedic clinics at a single academic center from November 2010 to May 2017 were reviewed. Multiple patient factors, modifiable and nonmodifiable, were recorded. The Press Ganey Survey was divided into 6 domains to evaluate the relative importance of each to total patient satisfaction. The standardized parameter estimates from the multiple linear regression revealed that of the 6 domains making up the Press Ganey Survey, care provider had the greatest magnitude of relative importance in the expected relationship with total patient satisfaction (ß=0.53972). Approximately 80% of the variance in total patient satisfaction was accounted for by the care provider. The relative importance of the remaining 5 domains was as follows: access (ß=0.23483), personal issues (ß=0.16796), moving through the visit (ß=0.16795), nurse/assistant (ß=0.10010), and special services/valet (ß=0.06302). A principal components analysis suggested a 6-factor solution for the Press Ganey total satisfaction scale; care provider was the most dominant factor, and valet parking services was the least. The care provider had the most influence on the patient's overall satisfaction. Altogether, access, personal issues, moving through the visit, nurse/assistant, and special services/valet accounted for only approximately 20% of the total variance in patient satisfaction. This knowledge can be used by providers in the current health care climate, where patient consumerism is developing into the driver of care. This could allow resources to be focused on areas of influence, yielding a greater impact on patient satisfaction scores. [Orthopedics. 2019; 42(4):198-204.].
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Liu JW, Ahn J, Raspovic KM, Liu GT, Nakonezny PA, Lavery LA, Wukich DK. Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated With Diabetes Mellitus. J Foot Ankle Surg 2019; 58:470-474. [PMID: 30760411 DOI: 10.1053/j.jfas.2018.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Received: 08/04/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the rates of readmission, reoperation, and mortality in patients with and without diabetes mellitus during the 30-day postoperative period after ankle fracture surgery. Patients who underwent operative management for ankle fractures between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program® database by using Current Procedural Terminology codes for ankle fracture surgery. A total of 17,464 patients undergoing ankle fracture surgery were identified. Of these patients, 2044 (11.7%) had diabetes and 15,420 (88.3%) did not have diabetes. We excluded patients older than 90 years or with inadequate perioperative data. Patients with diabetes had significantly higher rates of readmission (2.84% vs 1.05%, p < .0001), significantly higher rates of unplanned reoperation (2.3% vs 0.74%, p < .0001), and significantly higher rates of mortality (0.7% vs 0.2%, p < .0001) compared with patients without diabetes. Additionally, patients with diabetes had significantly greater age-adjusted odds ratios (ORs) of unplanned readmission (OR 2.40, 95% confidence interval [CI] 1.74 to 3.31, p < .0001), unplanned reoperation (OR 2.56, 95% CI 1.44 to 3.27, p < .0001), and mortality (OR 2.01, 95% CI 1.08 to 3.62, p = .0432) than did patients without diabetes after ankle surgery. In this large-scale retrospective study, we demonstrated that the presence of diabetes significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality during the 30-day postoperative period after ankle fracture surgery.
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Affiliation(s)
- Jennifer W Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - George T Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul A Nakonezny
- Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Madni TD, Nakonezny PA, Imran JB, Barrios E, Rizk P, Clark AT, Cunningham HB, Taveras L, Arnoldo BD, Cripps MW, Phelan HA, Wolf SE. Prospective Analysis of Operating Room and Discharge Delays in a Burn Center. J Burn Care Res 2019; 40:281-286. [PMID: 30816420 DOI: 10.1093/jbcr/irz015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Delays to the operating room (OR) or discharge (DC) lead to longer lengths of stay and increased costs. Surprisingly, little work has been done to quantify the number and cost of delays for inpatients to the OR, and to DC to outpatient status. They reviewed their burn admissions to determine how often a patient experiences delays in healthcare delivery. Data for all burn admissions were prospectively collected from 2014 to 2016. A quality improvement filter was created to define acceptable parameters for patient throughput. Every hospital day was labeled as 1) No delay, 2) Operation, 3) Delay to the OR, or 4) Delay to DC. They had 1633 admissions: 432 ICU admissions (26%) and 1201 floor admissions (74%). Six hundred fifteen patients (37.7%) received an operation. Patients with delays included 331 with OR delays (20.3%) and 503 with DC delays (30.8%). Average delay days included (Mean ± SD): OR delay days = 4.7 ± 6.2 and DC delay days = 4.1 ± 4.4. Total number of hospital days was 13,009, divided into 1616 OR delay days (12%) and 2096 DC delay days (16%). Significant OR delays were due to patient unstable for OR (n = 387 [24%]), OR space availability (n = 662 [41%]), indeterminate wound depth (n = 437 [27%]), and donor site availability (n = 83 [5%]). Significant DC delays were due to medical goals not reached (n = 388 [19%]), pain control and wound care (n = 694 [33%]), PT/OT clearance (n = 168 [8.0%]), and DC placement delays (n = 754 [36%]). Costs for OR and DC delays ranged between US$1,000,000 and US$5,000,000. Costs of increasing OR capacity and/or additional social work ancillary staff can be justified through millions of dollars of savings annually.
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Affiliation(s)
- Tarik D Madni
- UT Southwestern Department of Surgery, Dallas, Texas
| | - Paul A Nakonezny
- UT Southwestern Department of Clinical Sciences, Division of Biostatistics, Dallas, Texas
| | | | - Evan Barrios
- UT Southwestern Department of Surgery, Dallas, Texas
| | - Paul Rizk
- UT Southwestern Department of Surgery, Dallas, Texas
| | - Audra T Clark
- UT Southwestern Department of Surgery, Dallas, Texas
| | | | - Luis Taveras
- UT Southwestern Department of Surgery, Dallas, Texas
| | | | | | - Herb A Phelan
- UT Southwestern Department of Surgery, Dallas, Texas
| | - Steven E Wolf
- UT Medical Branch Division of Burn and Trauma Surgery, Galveston, Texas
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Ahn J, Raspovic KM, Liu GT, Lavery LA, La Fontaine J, Nakonezny PA, Wukich DK. Lower Extremity Necrotizing Fasciitis in Diabetic and Nondiabetic Patients: Mortality and Amputation. INT J LOW EXTR WOUND 2019; 18:114-121. [DOI: 10.1177/1534734619836464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Lower extremity necrotizing fasciitis (NF) is a severe infection requiring immediate surgery. The aim of this study was to assess patient factors predictive of amputation and mortality in diabetes mellitus (DM) and non-DM patients with lower extremity NF. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. Out of 674 patients with lower extremity NF, 387 had DM (57.4%). Patients with DM had lower mortality ( P = .004). Increased mortality was independently associated with age >60 years (adjusted odds ratio [aOR] = 3.96, 95% confidence interval [CI] = 1.69-9.77), partial thromboplastin time >38 seconds (aOR = 2.66, 95% CI = 1.09-6.62), albumin <2.0 mg/dL (aOR = 2.84, 95% CI = 1.13-7.37), coagulopathy (aOR = 3.29, 95% CI = 1.24-9.19), higher anesthesia risk category (aOR = 3.08, 95% CI = 1.18, 8.59), chronic obstructive pulmonary disease (aOR = 3.46, 95% CI = 1.13-10.9), postoperative acute respiratory distress syndrome (aOR = 5.24, 95% CI = 2.04-14.4), and postoperative septic shock (aOR = 5.14, 95% CI = 1.94-14.1). Amputation was independently associated with DM (aOR = 4.35, 95% CI = 2.63-7.35) but not mortality. Although DM was associated with more amputations for lower extremity NF, patients with DM had lower mortality than non-DM patients in the bivariate analysis. Further research is needed to investigate outcomes among DM and non-DM patients in the context of lower extremity NF.
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Affiliation(s)
- Junho Ahn
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - George T. Liu
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Dane K. Wukich
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Nandakumar AL, Vande Voort JL, Nakonezny PA, Orth SS, Romanowicz M, Sonmez AI, Ward JA, Rackley SJ, Huxsahl JE, Croarkin PE. Psychometric Properties of the Patient Health Questionnaire-9 Modified for Major Depressive Disorder in Adolescents. J Child Adolesc Psychopharmacol 2019; 29:34-40. [PMID: 30388048 PMCID: PMC6354604 DOI: 10.1089/cap.2018.0112] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 11/13/2022]
Abstract
OBJECTIVES The Patient Health Questionnaire-9 Modified (PHQ-9M) is a self-report tool used to assess the presence and severity of depressive symptoms in teenagers. Despite widespread use in primary care clinics and psychiatric settings, the PHQ-9M has not been validated nor are its psychometric properties adequately understood for the adolescent population. This study sought to examine the psychometrics of the PHQ-9M in treatment-seeking, depressed adolescents at a psychiatric psychopharmacology clinic who were concurrently assessed with the Children's Depression Rating Scale Revised (CDRS-R) and Quick Inventory of Depressive Symptomatology-Adolescent (17-item) Self-Report (QIDS-A17-SR). METHODS Adolescents (N = 160) aged 13 through 18 years with a diagnosis of major depressive disorder, determined on the basis of a clinical interview and semi-structured interview using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, were assessed for severity of depressive symptoms with the PHQ-9M, CDRS-R (adolescent interview only), and QIDS-A17-SR assessments at baseline, 4, and 8 weeks. Classical test theory analysis was used to evaluate the internal consistency and dimensionality of the PHQ-9M. Convergent validity was evaluated via intraclass correlations of the PHQ-9M with the CDRS-R and QIDS-A17-SR. Sensitivity to treatment response was also evaluated. RESULTS The internal consistency (Cronbach's coefficient α) at baseline, 4, and 8 weeks was 0.879, 0.859, and 0.827 for the PHQ-9M; 0.739, 0.835, and 0.867 for CDRS-R; and 0.712, 0.777, and 0.804 for QIDS-A17-SR, respectively. The PHQ-9M had moderate convergent validity with the CDRS-R but good convergent validity with the QIDS-A17-SR. The PHQ-9M was less sensitive to changes in symptom severity than the CDRS-R and QIDS-A17-SR. CONCLUSIONS The PHQ-9M appears to be a valid and reliable assessment tool for the severity of depressive symptoms in a psychiatric clinic setting. However, its utility as a treatment outcome measure may be limited compared with other available rating scales.
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Affiliation(s)
| | | | - Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott S. Orth
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Ayse Irem Sonmez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Jessica A. Ward
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Sandra J. Rackley
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - John E. Huxsahl
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.,Address correspondence to: Paul E. Croarkin, DO, MS, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Wolfe KL, Nakonezny PA, Owen VJ, Rial KV, Moorehead AP, Kennard BD, Emslie GJ. Hopelessness as a Predictor of Suicide Ideation in Depressed Male and Female Adolescent Youth. Suicide Life Threat Behav 2019; 49:253-263. [PMID: 29267993 PMCID: PMC6013307 DOI: 10.1111/sltb.12428] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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] [Received: 04/13/2017] [Accepted: 09/07/2017] [Indexed: 11/26/2022]
Abstract
We examined hopelessness as a predictor of suicide ideation in depressed youth after acute medication treatment. A total of 158 depressed adolescents were administered the Children's Depression Rating Scale-Revised (CDRS-R) and Columbia Suicide Severity Rating Scale (C-SSRS) as part of a larger battery at baseline and at weekly visits across 6 weeks of acute fluoxetine treatment. The Beck Hopelessness Scale (BHS) was administered at baseline and week 6. A negative binomial regression model via a generalized estimating equation analysis of repeated measures was used to estimate suicide ideation over the 6 weeks of acute treatment from baseline measure of hopelessness. Depression severity and gender were included as covariates in the model. The negative binomial analysis was also conducted separately for the sample of males and females (in a gender-stratified analysis). Mean CDRS-R total scores were 60.30 ± 8.93 at baseline and 34.65 ± 10.41 at week 6. Mean baseline and week 6 BHS scores were 9.57 ± 5.51 and 5.59 ± 5.38, respectively. Per the C-SSRS, 43.04% and 83.54% reported having no suicide ideation at baseline and at week 6, respectively. The analyses revealed that baseline hopelessness was positively related to suicide ideation over treatment (p = .0027), independent of changes in depression severity. This significant finding persisted only for females (p = .0024). These results indicate the importance of early identification of hopelessness.
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Affiliation(s)
- Kristin L. Wolfe
- Children's Health; University of Texas Southwestern Medical Center; Dallas TX USA
| | | | - Victoria J. Owen
- Children's Health; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Katherine V. Rial
- Children's Health; University of Texas Southwestern Medical Center; Dallas TX USA
| | | | - Beth D. Kennard
- Children's Health; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Graham J. Emslie
- Children's Health; University of Texas Southwestern Medical Center; Dallas TX USA
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Cunningham HB, Scielzo SA, Nakonezny PA, Bruns BR, Brasel KJ, Inaba K, Brakenridge SC, Kerby JD, Joseph BA, Mohler MJ, Cuschieri J, Paulk ME, Ekeh AP, Madni TD, Taveras LR, Imran JB, Wolf SE, Phelan HA. Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients. Am J Hosp Palliat Care 2019; 36:669-674. [DOI: 10.1177/1049909118823182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties’ attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty’s ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. Methods: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine. Results: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions. Conclusions: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.
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Affiliation(s)
| | - Shannon A. Scielzo
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Brandon R. Bruns
- Department of Surgery, University of Maryland, College Park, MD, USA
| | - Karen J. Brasel
- Department of Surgery, Oregon Health Science University, Portland, OR, USA
| | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | | | - Jeffrey D. Kerby
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bellal A. Joseph
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ, USA
| | - M. J. Mohler
- Department of Surgery, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Joseph Cuschieri
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Mary E. Paulk
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | | | - Tarik D. Madni
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Luis R. Taveras
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan B. Imran
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Herb A. Phelan
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
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Madni TD, Nakonezny PA, Barrios E, Imran JB, Clark AT, Taveras L, Cunningham HB, Christie A, Eastman AL, Minshall CT, Luk S, Minei JP, Phelan HA, Cripps MW. Prospective validation of the Parkland Grading Scale for Cholecystitis. Am J Surg 2019; 217:90-97. [DOI: 10.1016/j.amjsurg.2018.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 12/24/2022]
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48
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Croarkin PE, Nakonezny PA, Deng ZD, Romanowicz M, Vande Voort JL, Camsari DD, Schak KM, Port JD, Lewis CP. High-frequency repetitive TMS for suicidal ideation in adolescents with depression. J Affect Disord 2018; 239:282-290. [PMID: 30031247 PMCID: PMC6431788 DOI: 10.1016/j.jad.2018.06.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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] [Received: 03/10/2018] [Revised: 04/27/2018] [Accepted: 06/26/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND This exploratory study sought to examine the effect of an acute course of high-frequency repetitive TMS on suicidal ideation in adolescents. METHODS Data were pooled from 3 prior protocols providing a 30-session course of open-label TMS treatment for adolescents with treatment-resistant depression. All participants (n = 19) were outpatients taking antidepressant medication, with TMS provided as adjunctive treatment. Suicidality was assessed at baseline, after 10 treatments, after 20 treatments, and after 30 treatments. Outcome measures of suicidal ideation included the Columbia Suicide Severity Rating Scale (C-SSRS) "Intensity of Ideation" subscale and Item 13 "Suicidality" on the Children's Depression Rating Scale, Revised (CDRS-R). RESULTS The predicted odds of suicidal ideation (CDRS-R Item 13 and C-SSRS Intensity of Ideation subscale) significantly decreased over 6 weeks of acute TMS treatment without adjustments for illness (depression) severity. However, the magnitude of the decrease in the predicted odds of suicidal ideation across 6 weeks of treatment was attenuated and rendered non-significant in subsequent analyses that adjusted for illness (depression) severity. LIMITATIONS This was an exploratory study with a small sample size and no sham control. Regulatory and ethical barriers constrained enrollment of adolescents with severe suicidality. CONCLUSIONS The present findings suggest that open-label TMS mitigated suicidal ideation in adolescents through the treatment and improvement of depressive symptom severity. Although caution is warranted in the interpretation of these results, the findings can inform the design and execution of future interventional trials targeting suicidal ideation in adolescents.
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Affiliation(s)
- Paul E. Croarkin
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA,Corresponding Author: Paul E. Croarkin DO, MS, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, Tel: (507) 293-2557, Fax: (507) 284-3933,
| | - Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zhi-De Deng
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Magdalena Romanowicz
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L. Vande Voort
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Deniz Doruk Camsari
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Kathryn M. Schak
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - John D. Port
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA,Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Charles P. Lewis
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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49
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Lewis CP, Nakonezny PA, Blacker CJ, Vande Voort JL, Port JD, Worrell GA, Jo HJ, Daskalakis ZJ, Croarkin PE. Cortical inhibitory markers of lifetime suicidal behavior in depressed adolescents. Neuropsychopharmacology 2018; 43:1822-1831. [PMID: 29703993 PMCID: PMC6046050 DOI: 10.1038/s41386-018-0040-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/05/2018] [Accepted: 02/26/2018] [Indexed: 11/09/2022]
Abstract
Although suicide is the second-leading cause of death in adolescents and young adults worldwide, little progress has been made in developing reliable biological markers of suicide risk and suicidal behavior. Converging evidence suggests that excitatory and inhibitory cortical processes mediated by the neurotransmitters glutamate and γ-aminobutyric acid (GABA) are dysregulated in suicidal individuals. This study utilized single- and paired-pulse transcranial magnetic stimulation (TMS) to assess excitatory and inhibitory cortical functioning in healthy control adolescents (n = 20), depressed adolescents without any history of suicidal behavior ("Depressed", n = 37), and depressed adolescents with lifetime history of suicidal behavior ("Depressed+SB", n = 17). In a fixed-effects general linear model analysis, with age, sex, and depression severity as covariates, no significant group main effects emerged for resting motor threshold, intracortical facilitation, short-interval intracortical inhibition, or cortical silent period. However, group main effects were significant for long-interval intracortical inhibition (LICI) at interstimulus intervals (ISIs) of 100 ms and 150 ms, but not 200 ms. Depressed+SB adolescents demonstrated impaired LICI compared to healthy control and Depressed adolescents, while healthy control and Depressed participants did not differ in LICI. Multiple linear robust regression revealed significant positive linear relationships between lifetime suicidal behavior severity and impairment in LICI at 100-ms and 150-ms ISIs. In a post hoc receiver operating characteristic analysis, LICI significantly discriminated Depressed from Depressed+SB youth in 100-ms and 150-ms paradigms. These findings suggest that GABAB receptor-mediated inhibition is distinctly dysregulated in depressed adolescents with histories of suicidal behavior. Further research is warranted to establish the utility of cortical inhibition in the assessment of suicide risk and as a target for treatment interventions.
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Affiliation(s)
- Charles P Lewis
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Paul A Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caren J Blacker
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - John D Port
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Hang Joon Jo
- Department of Neurologic Surgery, Neural Engineering Lab, Mayo Clinic, Rochester, MN, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
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Westover AN, Nakonezny PA, Halm EA, Adinoff B. Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration. Addiction 2018; 113:857-867. [PMID: 29215762 DOI: 10.1111/add.14122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Received: 10/18/2016] [Revised: 02/23/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Non-medical use of prescribed stimulant medications is a growing concern. This study's aims were to ascertain the demographics of stimulant medication users compared with non-users, examine temporal trends of stimulant medication use and estimate risk factors for development of amphetamine use disorder (AUD) and mortality among new users of stimulant medications. DESIGN Cox proportional hazards regression in a retrospective cohort adjusted by baseline covariates. SETTING United States, national administrative database of the Veterans Affairs (VA) health-care system. PARTICIPANTS Adult incident users of stimulant medications (n = 78 829) from fiscal years (FY) 2001 to 2012. MEASUREMENTS Primary outcomes were time-to-event: (1) occurrence of AUD diagnosis and (2) death. Baseline covariates included demographic information, Food and Drug Administration (FDA)-approved indications for stimulant use, substance use disorders (SUD) and depression. FINDINGS Stimulant users compared with non-users were younger, more likely to be non-Hispanic white and female. Incident stimulant medication users increased threefold from FY2001-FY2012 and eightfold among adults aged 18-44 years. Nearly one in 10 incident users in FY2012 had a comorbid baseline SUD. Off-label use was common-nearly three of every five incident users in FY2012. Comorbid SUDs among incident stimulant medication users were risk factors for occurrence of AUD during follow-up, with adjusted hazard ratio (AHR) estimates ranging from 1.54 to 2.83 (Ps < 0.05). Increased mortality risk was observed with occurrence of AUD during follow-up [AHR = 1.55, 95% confidence interval (CI) = 1.13-2.14, P = 0.007], while on-label prescribing was protective against death (AHR = 0.686, 95% CI = 0.63-0.75, P < 0.0001). CONCLUSIONS In a US national cohort of adult incident stimulant medication users in the Veterans Affairs health-care system, measured from fiscal years 2001 to 2012, comorbid substance use disorders were common and were risk factors for development of an amphetamine use disorder (AUD). Increased mortality risk among incident users of stimulant medications was observed among both those who developed an AUD later and those whose use was defined as off-label.
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Affiliation(s)
- Arthur N Westover
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Paul A Nakonezny
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA.,Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bryon Adinoff
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Health Care System, Dallas VAMC, TX, USA
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