1
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Hines SE, Gaitens JM, Brown CH, Glick DR, Reback M, Chin KH, Lawrence E, Cavanaugh KL, Lawson WE, Sriram P, Beck L, Duch J, Aguayo SM, Permana P, McDiarmid MA. Respiratory Health Associated with Systemic Metal Exposure in Post 9/11 Veterans in the Department of Veterans Affairs Toxic Embedded Fragment Registry. J Occup Environ Med 2024:00043764-990000000-00574. [PMID: 38739926 DOI: 10.1097/jom.0000000000003143] [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] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Adverse respiratory outcomes in post-9/11 Veterans with elevated urinary metal measures and enrolled in the VA's Toxic Embedded Fragment registry were compared to those without elevated urinary metals. METHODS Veterans completed questionnaires, pulmonary physiology tests (pulmonary function and oscillometry) and provided urine samples for analysis of 13 metals. Respiratory symptoms, diagnoses and physiology measures were compared in Veterans with ≥1 urine metal elevation to those without metal elevations, adjusted for covariates, including smoking. RESULTS Among 402 study participants, 24% had elevated urine metals, often just exceeding upper limits of reference values. Compared to Veterans without elevated metals, those with elevated metals had had higher FEV1 values but similar frequencies of respiratory symptoms and diagnoses and abnormalities on pulmonary physiology tests. CONCLUSIONS Mild systemic metal elevations in post 9/11 Veterans are not associated with adverse respiratory health outcomes.
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Affiliation(s)
| | | | | | | | - Maxwell Reback
- University of Maryland School of Medicine, Baltimore, MD
| | | | - Emma Lawrence
- University of Maryland School of Medicine, Baltimore, MD
| | - Kerri L Cavanaugh
- Tennessee Valley Healthcare System Veterans Affairs Medical Center, Nashville, TN
| | - William E Lawson
- Tennessee Valley Healthcare System Veterans Affairs Medical Center, Nashville, TN
| | - Peruvemba Sriram
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Lisa Beck
- Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK
| | - John Duch
- Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX
| | | | - Paska Permana
- Phoenix Veterans Affairs Healthcare System, Phoenix, AZ
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2
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Cowan T, Phalen P, Brown CH, Blanchard J, Bennett M. We need to make progress on blunted affect: A commentary. Schizophr Res 2024; 264:263-265. [PMID: 38198877 DOI: 10.1016/j.schres.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Affiliation(s)
- T Cowan
- Department of Psychiatry, University of Maryland School of Medicine, 717 W. Lombard St. 5th Floor, Baltimore, MD 21201, United States of America
| | - P Phalen
- Department of Psychiatry, University of Maryland School of Medicine, 717 W. Lombard St. 5th Floor, Baltimore, MD 21201, United States of America
| | - C H Brown
- Department of Epidemiology, University of Maryland School of Medicine, 660 W. Redwood St., Baltimore, MD 21201, United States of America; VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Maryland Health Care System (Baltimore Annex), 209 West Fayette Street, Baltimore, MD 20210, United States of America
| | - J Blanchard
- Department of Psychology, University of Maryland College Park, Biology/Psychology Building, 4094 Campus Dr., College Park, MD 20742, United States of America
| | - M Bennett
- Department of Psychiatry, University of Maryland School of Medicine, 717 W. Lombard St. 5th Floor, Baltimore, MD 21201, United States of America; VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Maryland Health Care System (Baltimore Annex), 209 West Fayette Street, Baltimore, MD 20210, United States of America.
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3
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Sokol Y, Andrusier S, Glatt S, Dixon L, Ridley J, Brown CH, Landa Y, Glynn S, Goodman M. Feasibility and acceptability of continuous identity cognitive therapy as a recovery-oriented suicide treatment for Veterans: A study protocol. Contemp Clin Trials Commun 2023; 35:101193. [PMID: 37546228 PMCID: PMC10400862 DOI: 10.1016/j.conctc.2023.101193] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 08/08/2023] Open
Abstract
Background Suicide is a leading cause of death among Veterans, with rates significantly higher than the general population. To address this issue, it is crucial to develop and implement more effective treatments for Veterans with suicidal thoughts and/or behaviors, particularly those in the post-acute suicidal episode (PASE) stage. The present study aims to establish the feasibility and acceptability of a novel, recovery-oriented treatment called Continuous Identity Cognitive Therapy (CI-CT) for PASE Veterans. Methods This 3-year open-label pilot study will include three one-arm trials and a pilot randomized controlled trial (RCT). A total of 57 Veterans with a history of an acute suicidal episode within the previous year will be recruited. Primary outcome measures will include changes in personal recovery, suicidal thoughts, and behaviors. Secondary outcomes will include changes in self-identity, life satisfaction, and hopefulness. Feasibility and acceptability will be assessed through attendance and retention rates, drop-out rates, and client satisfaction. Conclusion This study aims to develop and evaluate the feasibility and acceptability of a novel recovery-oriented intervention for Veterans experiencing PASE. If the intervention is found to be feasible and acceptable, a manualized version will be finalized and a large-scale multi-site RCT will be designed to assess its clinical efficacy on a broader Veteran population. The results of this trial will aid in the development of effective treatment and provide valuable insights into the preliminary feasibility, acceptability, and effectiveness of this approach in reducing suicidal thoughts and behaviors and promoting recovery and rehabilitation in this population.
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Affiliation(s)
- Yosef Sokol
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychology, Touro University, School of Health Sciences, New York, NY, USA
| | - Sarah Andrusier
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Sofie Glatt
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, USA
- Vagelos College of Physicians and Surgeons, Columbia University/New York-Presbyterian, New York, NY, USA
| | - Josephine Ridley
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Clayton H. Brown
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
- Veterans Affairs Capitol Healthcare Network, Mental Illness Research, Education and Clinical Center, Baltimore, MD, USA
| | - Yulia Landa
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shirley Glynn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- VISN 22 Mental Illness Research, Education and Clinical Center, Los Angeles, CA, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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4
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Shanholtz CB, Terrin ML, Harrington T, Chan C, Warren W, Walter R, Armstrong F, Marshall J, Scheraga R, Duggal A, Formanek P, Baram M, Afshar M, Marchetti N, Singla S, Reilly J, Knox D, Puri N, Chung K, Brown CH, Hasday JD. Design and rationale of the CHILL phase II trial of hypothermia and neuromuscular blockade for acute respiratory distress syndrome. Contemp Clin Trials Commun 2023; 33:101155. [PMID: 37228902 PMCID: PMC10191700 DOI: 10.1016/j.conctc.2023.101155] [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] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
The Cooling to Help Injured Lungs (CHILL) trial is an open label, two group, parallel design multicenter, randomized phase IIB clinical trial assessing the efficacy and safety of targeted temperature management with combined external cooling and neuromuscular blockade to block shivering in patients with early moderate-severe acute respiratory distress syndrome (ARDS). This report provides the background and rationale for the clinical trial and outlines the methods using the Consolidated Standards of Reporting Trials guidelines. Key design challenges include: [1] protocolizing important co-interventions; [2] incorporation of patients with COVID-19 as the cause of ARDS; [3] inability to blind the investigators; and [4] ability to obtain timely informed consent from patients or legally authorized representatives early in the disease process. Results of the Reevaluation of Systemic Early Neuromuscular Blockade (ROSE) trial informed the decision to mandate sedation and neuromuscular blockade only in the group assigned to therapeutic hypothermia and proceed without this mandate in the control group assigned to a usual temperature management protocol. Previous trials conducted in National Heart, Lung, and Blood Institute ARDS Clinical Trials (ARDSNet) and Prevention and Early Treatment of Acute Lung Injury (PETAL) Networks informed ventilator management, ventilation liberation and fluid management protocols. Since ARDS due to COVID-19 is a common cause of ARDS during pandemic surges and shares many features with ARDS from other causes, patients with ARDS due to COVID-19 are included. Finally, a stepwise approach to obtaining informed consent prior to documenting critical hypoxemia was adopted to facilitate enrollment and reduce the number of candidates excluded because eligibility time window expiration.
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Affiliation(s)
- Carl B. Shanholtz
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L. Terrin
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thelma Harrington
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Caleb Chan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Whittney Warren
- Department of Pulmonary and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX, USA
| | - Robert Walter
- Department of Pulmonary and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX, USA
| | | | | | | | - Abjihit Duggal
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Perry Formanek
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Michael Baram
- Department of Medicine, Sidney Kimmel College of Medicine USA, Philadelphia, PA, USA
| | - Majid Afshar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nathaniel Marchetti
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Sunit Singla
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - John Reilly
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dan Knox
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Nitin Puri
- Division of Critical Care, Cooper University Health Care, USA
| | - Kevin Chung
- Department of Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Clayton H. Brown
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffrey D. Hasday
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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5
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Howell MK, Marggraf M, Taylor ML, Hammer LA, Girón-Hernández CY, Coakley GN, Brown CH, Drapalski AL, Hack SM. Social functioning mediates the relationship between psychiatric symptoms and recovery among veteran and community service users with serious mental illness. Psychiatr Rehabil J 2023; 46:156-162. [PMID: 37155287 DOI: 10.1037/prj0000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Previous research has established the impact of psychiatric symptoms on social functioning, while there is a paucity of research examining how social functioning relates to personal recovery, an individual's self-assessment of their mental health recovery. This study examined the mediating effect of social engagement, interpersonal communication, and satisfaction with support in the relationship between distinct psychiatric symptom clusters and perceived mental health recovery. METHODS In a cross-sectional study, both patient self-report and provider assessment data were collected for 250 patients with serious mental illness (SMI) across four mental health service sites. Parallel mediation analytic models were used. RESULTS Interpersonal communication partially mediated the relationship between positive and negative symptom clusters and personal recovery. Satisfaction with social supports partially mediated the relationship between excited symptoms and personal recovery. Both interpersonal communication and satisfaction with social supports partially mediated the relationship between general psychological distress and depressive symptoms and personal recovery. Collectively, social functioning mediators explained nearly half of the relationship between general psychological distress and excited symptoms and personal recovery and nearly all of the relationship between positive symptoms and personal recovery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Clinical providers working with persons with SMI should regularly assess social functioning in addition to assessing psychiatric symptoms and personal recovery factors and should incorporate social skills education into SMI group and individual treatments. Social functioning as a target of treatment may be especially beneficial for patients who are dissatisfied with other interventions or feel they have experienced the maximum benefit from treatment and are seeking additional methods to support personal recovery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Mary Katherine Howell
- Veterans Integrated Services Network 5 Mental Illness Research, Education, and Clinical Center
| | | | - Maddison L Taylor
- Veterans Integrated Services Network 5 Mental Illness Research, Education, and Clinical Center
| | | | | | - Gabriella N Coakley
- Veterans Integrated Services Network 5 Mental Illness Research, Education, and Clinical Center
| | - Clayton H Brown
- Veterans Integrated Services Network 5 Mental Illness Research, Education, and Clinical Center
| | - Amy L Drapalski
- Veterans Integrated Services Network 5 Mental Illness Research, Education, and Clinical Center
| | - Samantha M Hack
- Veterans Integrated Services Network 5 Mental Illness Research, Education, and Clinical Center
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6
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Drapalski AL, Tonge N, Muralidharan A, Brown CH, Lucksted A. Even mild internalized stigma merits attention among adults with serious mental illness. Psychol Serv 2023; 20:2023-52411-001. [PMID: 36892916 PMCID: PMC10491738 DOI: 10.1037/ser0000744] [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] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Internalized or self-stigma can be damaging to psychological and social functioning and recovery, especially for people with serious mental illness. Most studies have focused on the effects of high self-stigma, which has included both moderate and high self-stigma, versus low levels of self-stigma which has included no, minimal, or mild self-stigma. Therefore, little is known about the variation within these categories (e.g., minimal versus mild self-stigma) and its impact on recovery. This article examines differences in the demographic, clinical, and psychosocial variables associated with different levels of self-stigma severity. Baseline data (N = 515) from two concurrent randomized controlled trials of a psychosocial intervention aimed at reducing internalized stigma, and its effects among adults with serious mental illnesses were examined. We found that participants with greater psychological sense of belonging, and greater perceived recovery were significantly less likely to have mild or moderate/high internalized stigma than minimal stigma. Those reporting a greater frequency of stigma experiences, however, were more likely to have mild or moderate/high internalized stigma than minimal stigma. Our findings further underscore the multifaceted nature and impact of self-stigma, particularly in interpersonal relationships and interactions, and demonstrate the importance of attending to even mild levels of self-stigma endorsement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Amy L. Drapalski
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC)
- Department of Psychiatry, University of Maryland School of Medicine
| | - Natasha Tonge
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC)
- Department of Psychiatry, University of Maryland School of Medicine
| | - Anjana Muralidharan
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC)
- Department of Psychiatry, University of Maryland School of Medicine
| | - Clayton H. Brown
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC)
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - Alicia Lucksted
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC)
- Department of Psychiatry, University of Maryland School of Medicine
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7
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Bennett ME, Brown CH, Fang LJ, Blanchard JJ. Increasing social and community participation in veterans living with schizophrenia: A treatment outcome study. Schizophr Res 2023; 252:262-270. [PMID: 36682317 DOI: 10.1016/j.schres.2023.01.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
People living with schizophrenia often face challenges engaging in social and community activities. A critical barrier is negative symptoms that reflect diminished feelings and thoughts that support social interaction. Several years ago, we began a process of specifying an intervention for individuals with schizophrenia and clinically meaningful negative symptoms that could be delivered in an integrated fashion with mental health services offered in VA medical centers with the primary focus of improving social and community engagement. In the present study, we examined the impact of a multi-component intervention to improve social and community participation in a group of Veterans living with schizophrenia and negative symptoms. We compared an intervention called Engaging in Community Roles and Experiences (EnCoRE) - a 12-week program of individual and group meetings that support learning and implementing skills with the goal of helping participants increase engagement in personally-relevant social and community activities - to an active wellness education control condition. Participants in both conditions attended on average of at least half of the groups that were offered, indicating that many individuals living with negative symptoms are willing to participate in an intervention to improve social and community participation. Although there were no significant differences on the two primary outcomes, those in EnCoRE showed better social and general functioning at post treatment and improved social motivational negative symptoms and decreases in perceived limitations at a 3-month follow-up. EnCoRE may be especially beneficial for participants who endorsed more dysfunctional attitudes about their abilities.
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Affiliation(s)
- Melanie E Bennett
- VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Maryland Health Care System (Baltimore Annex), 209 West Fayette Street, Baltimore, MD 20210, United States of America; Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, 5(th) Floor, Baltimore, MD 21201, United States of America.
| | - Clayton H Brown
- VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Maryland Health Care System (Baltimore Annex), 209 West Fayette Street, Baltimore, MD 20210, United States of America; Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W. Redwood Street, Baltimore, MD 21201, United States of America.
| | - Li Juan Fang
- Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, 5(th) Floor, Baltimore, MD 21201, United States of America.
| | - Jack J Blanchard
- Department of Psychology, University of Maryland, Biology/Psychology Building, 4094 Campus Dr., College Park, MD 20742, United States of America.
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8
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Schrank GM, Sick-Samuels A, Bleasdale SC, Jacob JT, Dantes R, Gokhale RH, Mayer J, Mehrotra P, Mehta SA, Mena Lora AJ, Ray SM, Rhee C, Salinas JL, Seo SK, Shane AL, Nadimpalli G, Milstone AM, Robinson G, Brown CH, Harris AD, Leekha S. Development and evaluation of a structured guide to assess the preventability of hospital-onset bacteremia and fungemia. Infect Control Hosp Epidemiol 2022; 43:1326-1332. [PMID: 35086601 PMCID: PMC9472698 DOI: 10.1017/ice.2021.528] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess preventability of hospital-onset bacteremia and fungemia (HOB), we developed and evaluated a structured rating guide accounting for intrinsic patient and extrinsic healthcare-related risks. DESIGN HOB preventability rating guide was compared against a reference standard expert panel. PARTICIPANTS A 10-member panel of clinical experts was assembled as the standard of preventability assessment, and 2 physician reviewers applied the rating guide for comparison. METHODS The expert panel independently rated 82 hypothetical HOB scenarios using a 6-point Likert scale collapsed into 3 categories: preventable, uncertain, or not preventable. Consensus was defined as concurrence on the same category among ≥70% experts. Scenarios without consensus were deliberated and followed by a second round of rating.Two reviewers independently applied the rating guide to adjudicate the same 82 scenarios in 2 rounds, with interim revisions. Interrater reliability was evaluated using the κ (kappa) statistic. RESULTS Expert panel consensus criteria were met for 52 scenarios (63%) after 2 rounds.After 2 rounds, guide-based rating matched expert panel consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewers 1 and 2, respectively. Agreement rates between the 2 reviewers were 84% overall (κ, 0.76; 95% confidence interval [CI], 0.64-0.88]) and 87% (κ, 0.79; 95% CI, 0.65-0.94) for the 52 scenarios with expert consensus. CONCLUSIONS Preventability ratings of HOB scenarios by 2 reviewers using a rating guide matched expert consensus in most cases with moderately high interreviewer reliability. Although diversity of expert opinions and uncertainty of preventability merit further exploration, this is a step toward standardized assessment of HOB preventability.
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Affiliation(s)
- Gregory M Schrank
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anna Sick-Samuels
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan C Bleasdale
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jesse T Jacob
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Raymund Dantes
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Runa H Gokhale
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeanmarie Mayer
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Preeti Mehrotra
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sapna A Mehta
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Alfredo J Mena Lora
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Susan M Ray
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Susan K Seo
- Department of Medicine, Joan and Sanford Weil Cornell Medical College, New York, New York
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Gita Nadimpalli
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aaron M Milstone
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gwen Robinson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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9
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Hines SE, Gaitens JM, Brown CH, Glick DR, Chin KH, Reback M, McDiarmid MA. Self-reported respiratory outcomes associated with blast exposure in post 9/11 veterans. Respir Med 2022; 202:106963. [DOI: 10.1016/j.rmed.2022.106963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
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10
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Tonge NA, Travaglini LE, Brown CH, Muralidharan A, Goldberg RW. Impact of mental health on seeking pain care among veterans with serious mental illness. Gen Hosp Psychiatry 2022; 75:92-93. [PMID: 34839929 DOI: 10.1016/j.genhosppsych.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Natasha A Tonge
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St., Annex Building 7th Fl., Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, 737 W. Lombard St., Baltimore, MD 21201, USA.
| | - Letitia E Travaglini
- VA Maryland Health Care System, Department of Neurology, Chronic Pain Service, 10 N. Greene St., Baltimore, MD 21201, USA.
| | - Clayton H Brown
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St., Annex Building 7th Fl., Baltimore, MD 21201, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W. Redwood St., Baltimore, MD 21201, United States of America.
| | - Anjana Muralidharan
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St., Annex Building 7th Fl., Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, 737 W. Lombard St., Baltimore, MD 21201, USA.
| | - Richard W Goldberg
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N. Greene St., Annex Building 7th Fl., Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, 737 W. Lombard St., Baltimore, MD 21201, USA.
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11
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Postolache TT, Medoff DR, Brown CH, Fang LJ, Upadhyaya SK, Lowry CA, Miller M, Kreyenbuhl JA. Lipophilic vs. hydrophilic statins and psychiatric hospitalizations and emergency room visits in US Veterans with schizophrenia and bipolar disorder. Pteridines 2021; 32:48-69. [PMID: 34887622 PMCID: PMC8654264 DOI: 10.1515/pteridines-2020-0028] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective – Psychiatric hospitalizations and emergency department (ED) visits are costly, stigmatizing, and often ineffective. Given the immune and kynurenine activation in bipolar disorder (BD) and schizophrenia, as well as the immune-modulatory effects of statins, we aimed to compare the relative risk (RRs) of psychiatric hospitalizations and ED visits between individuals prescribed lipophilic vs. hydrophilic statins vs. no statins. We hypothesized (a) reduced rates of hospitalization and ER utilization with statins versus no statins and (b) differences in outcomes between statins, as lipophilia increases the capability to penetrate the blood–brain barrier with potentially beneficial neuroimmune, antioxidant, neuroprotective, neurotrophic, and endothelial stabilizing effects, and, in contrast, potentially detrimental decreases in brain cholesterol concentrations leading to serotoninergic dysfunction, changes in membrane lipid composition, thus affecting ion channels and receptors. Methods – We used VA service utilization data from October 1, 2010 to September 30, 2015. The RRs for psychiatric hospitalization and ED visits, were estimated using robust Poisson regression analyses. The number of individuals analyzed was 683,129. Results – Individuals with schizophrenia and BD who received prescriptions for either lipophilic or hydrophilic statins had a lower RR of psychiatric hospitalization or ED visits relative to nonstatin controls. Hydrophilic statins were significantly associated with lower RRs of psychiatric hospitalization but not of ED visits, compared to lipophilic statins. Conclusion – The reduction in psychiatric hospitalizations in statin users (vs. nonusers) should be interpreted cautiously, as it carries a high risk of confounding by indication. While the lower RR of psychiatric hospitalizations in hydrophilic statins relative to the lipophilic statins is relatively bias free, the finding bears replication in a specifically designed study. If replicated, important clinical implications for personalizing statin treatment in patients with mental illness, investigating add-on statins for improved therapeutic control, and mechanistic exploration for identifying new treatment targets are natural next steps.
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Affiliation(s)
- Teodor T Postolache
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Baltimore, MD 21201, United States of America; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Aurora, CO 80045, United States of America; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), U.S. Department of Veterans Affairs, Denver, CO 80045, United States of America
| | - Deborah R Medoff
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Clayton H Brown
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Li Juan Fang
- Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Sanjaya K Upadhyaya
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Christopher A Lowry
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Aurora, CO 80045, United States of America; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), U.S. Department of Veterans Affairs, Denver, CO 80045, United States of America; Department of Integrative Physiology, Center for Neuroscience, Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, United States of America; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
| | - Michael Miller
- Department of Medicine, VAMC Baltimore and University of Maryland School of Medicine, Baltimore, Maryland 21201, United States of America
| | - Julie A Kreyenbuhl
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
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Abstract
PURPOSE To determine how early body refrigeration affects corneal donor transplant suitability and endothelial cell density. METHODS Donor information was obtained from the CorneaGen Eye Bank including demographics, time of death to preservation, and body refrigeration status, for donors between 2012 and 2016. The death to preservation interval was classified into 3 categories: 0 to 10, 10 to 20, and 20+ hours. Two primary logistic method models were fit using a main effects model and an interaction model to determine the association of body refrigeration on unsuitability of transplantation and endothelial cell density. RESULTS Analysis was from 42,929 donor eyes, with a mean (standard deviation) endothelial cell count of 2743 (415) cells/mm2. Fifty-nine percent of donor eyes were from male donors in the eye bank data set, and the mean death to preservation interval was 11.0 (5.6) hours for all eyes. Unsuitability for transplantation demonstrated a reduced adjusted odds ratio by 22% (OR = 0.78, P = 0.009) when the body was refrigerated during the death to preservation interval versus when the body was not refrigerated. Eyes that were refrigerated, however, exhibited no statistically significant difference in endothelial cell count from eyes that were not refrigerated (P = 0.12). CONCLUSIONS We demonstrate an appreciable effect of early body refrigeration on transplant suitability in this large cohort of eye bank eyes. There was no beneficial effect of body refrigeration on endothelial cell count.
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Affiliation(s)
| | - Clayton H Brown
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; and
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13
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Weiser M, Davis JM, Brown CH, Slade EP, Fang LJ, Medoff DR, Buchanan RW, Levi L, Davidson M, Kreyenbuhl J. Differences in Antipsychotic Treatment Discontinuation Among Veterans With Schizophrenia in the U.S. Department of Veterans Affairs. Am J Psychiatry 2021; 178:932-940. [PMID: 34256606 DOI: 10.1176/appi.ajp.2020.20111657] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Effectiveness of antipsychotic drugs is inferred from relatively small randomized clinical trials conducted with carefully selected and monitored participants. This evidence is not necessarily generalizable to individuals treated in daily clinical practice. The authors compared the clinical effectiveness between all oral and long-acting injectable (LAI) antipsychotic medications used in the treatment of schizophrenia in the U.S. Department of Veterans Affairs (VA) health care system. METHODS This was an observational study utilizing VA pharmacy data from 37,368 outpatient veterans with schizophrenia. Outcome measures were all-cause antipsychotic discontinuation and psychiatric hospitalizations. Oral olanzapine was used as the reference group. RESULTS In multivariable analysis, clozapine (hazard ratio=0.43), aripiprazole long-acting injectable (LAI) (hazard ratio=0.71), paliperidone LAI (hazard ratio=0.76), antipsychotic polypharmacy (hazard ratio=0.77), and risperidone LAI (hazard ratio=0.91) were associated with reduced hazard of discontinuation compared with oral olanzapine. Oral first-generation antipsychotics (hazard ratio=1.16), oral risperidone (hazard ratio=1.15), oral aripiprazole (hazard ratio=1.14), oral ziprasidone (hazard ratio=1.13), and oral quetiapine (hazard ratio=1.11) were significantly associated with an increased risk of discontinuation compared with oral olanzapine. No treatment showed reduced risk of psychiatric hospitalization compared with oral olanzapine; quetiapine was associated with a 36% worse outcome in terms of hospitalizations compared with olanzapine. CONCLUSIONS In a national sample of veterans with schizophrenia, those treated with clozapine, two of the LAI second-generation antipsychotics, and antipsychotic polypharmacy continued the same antipsychotic therapy for a longer period of time compared with the reference drug. This may reflect greater overall acceptability of these medications in clinical practice.
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Affiliation(s)
- Mark Weiser
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - John M Davis
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Clayton H Brown
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Eric P Slade
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Li Juan Fang
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Deborah R Medoff
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Robert W Buchanan
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Linda Levi
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Michael Davidson
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Julie Kreyenbuhl
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
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14
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McDiarmid MA, Gaitens JM, Hines S, Cloeren M, Breyer R, Condon M, Oliver M, Roth T, Gucer P, Kaup B, Brown L, Brown CH, Dux M, Glick D, Lewin-Smith MR, Strathmann F, Xu H, Velez-Quinones MA, Streeten E. Surveillance of Depleted Uranium-exposed Gulf War Veterans: More Evidence for Bone Effects. Health Phys 2021; 120:671-682. [PMID: 33867437 DOI: 10.1097/hp.0000000000001395] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT Gulf War I veterans who were victims of depleted uranium (DU) "friendly-fire" incidents have undergone longitudinal health surveillance since 1994. During the spring of 2019, 36 members of the cohort were evaluated with a monitoring protocol including exposure assessment for total and isotopic uranium concentrations in urine and a comprehensive review of health outcomes, including measures of bone metabolism and bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained depleted uranium (DU) shrapnel fragments. In addition, a measure of bone resorption, N-telopeptide, showed a statistically significant increase in those in the high DU subgroup, a finding consistent with a statistically significant decrease in bone mass also observed in this high DU subgroup compared to the low DU subgroup. After more than 25 y since first exposure to DU, an aging cohort of military veterans continues to show few U-related health effects in known target organs of U toxicity. The new finding of impaired BMD in the high DU subgroup has now been detected in two consecutive surveillance visits. While this is a biologically plausible uranium effect, it is not reflected in other measures of bone metabolism in the full cohort, which have largely been within normal limits. However, ongoing accrual of the U burden from fragment absorption over time and the effect of aging further impairing BMD suggest the need for future surveillance assessments of this cohort.
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Affiliation(s)
| | | | | | | | - Richard Breyer
- Department of Veterans Affairs Medical Center Baltimore, MD
| | - Marian Condon
- Department of Veterans Affairs Medical Center Baltimore, MD
| | | | | | | | - Bruce Kaup
- Department of Veterans Affairs Medical Center Baltimore, MD
| | | | - Clayton H Brown
- Biophysical Toxicology, The Joint Pathology Center, Silver Spring, MD
| | - Moira Dux
- Department of Veterans Affairs Medical Center Baltimore, MD
| | - Danielle Glick
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Michael R Lewin-Smith
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Frederick Strathmann
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Hanna Xu
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Maria A Velez-Quinones
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Elizabeth Streeten
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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15
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Heil EL, Harris AD, Brown CH, Seung H, Thom KA, von Rosenvinge E, Sorongon S, Pineles L, Goodman KE, Leekha S. A Multi-Center Evaluation of Probiotic Use for the Primary Prevention of Clostridioides difficile infection. Clin Infect Dis 2021; 73:1330-1337. [PMID: 33972996 DOI: 10.1093/cid/ciab417] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Primary prevention of C. difficile infection (CDI) is a priority for hospitals and probiotics have the potential to interfere with colonization and infection with C. difficile. This study evaluated the impact of a computerized clinical decision support tool (CCDS) to prescribe probiotics for primary prevention of CDI among adult hospitalized patients. METHODS A CCDS tool was implemented into the electronic medical record at four hospitals prompting prescription of a probiotic preparation at the time of antibiotic prescription in high-risk patients in May 2019. Interrupted time series using segmented regression analysis was conducted to evaluate hospital-wide CDI incidence for the year pre- and post-CCDS implementation. In addition, multivariable logistic regression was used to evaluate CDI incidence in patients qualifying for probiotics in the pre- versus post-intervention periods adjusting for potential confounders. To adjust for potential differences in patients who received probiotics in the post-intervention period, propensity score matched pairs were developed to evaluate CDI risk by receipt of probiotics. RESULTS Quarterly CDI incidence increased over time post-intervention relative to baseline trends (slope change 1.4, 95% CI 0.9-1.9). The odds ratio (OR) of CDI was 1.41 in eligible patients post-intervention compared to pre-intervention (adjusted OR 1.41, 95% CI 1.11, 1.79). Propensity score matched analysis showed that patients who received probiotics did not have lower rates of CDI compared to those who did not receive probiotics (OR 1.46, 95% CI 0.87, 2.45). CONCLUSIONS Use of probiotics for primary prevention of CDI among adult inpatients receiving antibiotics is not supported.
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Affiliation(s)
- Emily L Heil
- University of Maryland School of Pharmacy, Department of Pharmacy Practice and Science, Baltimore, MD USA
| | - Anthony D Harris
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD USA
| | - Clayton H Brown
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD USA
| | - Hyunuk Seung
- University of Maryland School of Pharmacy, Department of Pharmacy Practice and Science, Baltimore, MD USA
| | - Kerri A Thom
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD USA
| | - Erik von Rosenvinge
- University of Maryland School of Medicine, Department of Medicine, Division of Gastroenterology, Baltimore, MD USA
| | - Scott Sorongon
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD USA
| | - Lisa Pineles
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD USA
| | - Katherine E Goodman
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD USA
| | - Surbhi Leekha
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD USA
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16
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Catalano LT, Brown CH, Lucksted A, Hack SM, Drapalski AL. Support for the social-cognitive model of internalized stigma in serious mental illness. J Psychiatr Res 2021; 137:41-47. [PMID: 33652325 PMCID: PMC8969461 DOI: 10.1016/j.jpsychires.2021.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/01/2020] [Revised: 01/06/2021] [Accepted: 02/08/2021] [Indexed: 12/30/2022]
Abstract
One prominent social-cognitive model of internalized stigma by Corrigan and his colleagues (2012; 2002) proposes that individuals are exposed to societal stereotypes about mental illness, at least tacitly agree with them, and may apply them to oneself, engendering harmful self-beliefs. There is limited empirical support for this model in serious mental illness. Moreover, it is not clearly established how internalized stigma and its associated factors impact recovery in this population. The current study uses structural equation modeling (SEM) to assess the social-cognitive model's goodness of fit in a sample of Veterans with serious mental illness (Veteran sample, n = 248), and then validates the model in a second and independent sample of individuals receiving community-based psychiatric rehabilitation services (community sample, n = 267). Participants completed the Self-Stigma of Mental Illness Scale (SSMIS; Corrigan et al., 2006) and measures of self-esteem, self-efficacy, and recovery attitudes. Consistent with Corrigan and colleagues' formulation of internalized stigma, SEM analyses showed a significant indirect pathway from stereotype awareness, to stereotype agreement, to application to self, to self-esteem decrement, to poorer recovery attitudes. Additionally, there was a significant direct effect from stereotype awareness to self-esteem. This study shows that individuals with serious mental illness experience psychological harm from stigma in two ways: (1) through perceived public prejudice and bias, and (2) through internalizing these negative messages. In particular, stigma harms individuals' self-esteem, which then reduces their recovery attitudes.
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Affiliation(s)
- Lauren T. Catalano
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.,Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Clayton H. Brown
- Department of Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD.,Department of Epidemiology & Public Health, University of Maryland, School of Medicine, Baltimore, MD
| | - Alicia Lucksted
- Department of Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD.,Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland, Baltimore, MD
| | - Samantha M. Hack
- Department of Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD.,School of Social Work, University of Maryland, Baltimore, MD
| | - Amy L. Drapalski
- Department of Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD.,Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland, Baltimore, MD
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17
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Blanco N, Robinson GL, Heil EL, Perlmutter R, Wilson LE, Brown CH, Heavner MS, Nadimpalli G, Lemkin D, Morgan DJ, Leekha S. Impact of a C. difficile infection (CDI) reduction bundle and its components on CDI diagnosis and prevention. Am J Infect Control 2021; 49:319-326. [PMID: 33640109 DOI: 10.1016/j.ajic.2020.10.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Published bundles to reduce Clostridioides difficile Infection (CDI) frequently lack information on compliance with individual elements. We piloted a computerized clinical decision support-based intervention bundle and conducted detailed evaluation of several intervention-related measures. METHODS A quasi-experimental study of a bundled intervention was performed at 2 acute care community hospitals in Maryland. The bundle had five components: (1) timely placement in enteric precautions, (2) appropriate CDI testing, (3) reducing proton-pump inhibitor (PPI) use, (4) reducing high-CDI risk antibiotic use, and (5) optimizing use of a sporicidal agent for environmental cleaning. Chi-square and Kruskal-Wallis tests were used to compare measure differences. An interrupted time series analysis was used to evaluate impact on hospital-onset (HO)-CDI. RESULTS Placement of CDI suspects in enteric precautions before test results did not change. Only hospital B decreased the frequency of CDI testing and reduced inappropriate testing related to laxative use. Both hospitals reduced the use of PPI and high-risk antibiotics. A 75% decrease in HO-CDI immediately postimplementation was observed for hospital B only. CONCLUSION A CDI reduction bundle showed variable impact on relevant measures. Hospital-specific differential uptake of bundle elements may explain differences in effectiveness, and emphasizes the importance of measuring processes and intermediate outcomes.
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Affiliation(s)
- Natalia Blanco
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
| | - Gwen L Robinson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Emily L Heil
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
| | - Rebecca Perlmutter
- Emerging Infections Program, Maryland Department of Health, Baltimore, MD
| | - Lucy E Wilson
- Emerging Infections Program, Maryland Department of Health, Baltimore, MD
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Mojdeh S Heavner
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
| | - Gita Nadimpalli
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel Lemkin
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Healthcare System, Baltimore, MD
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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Gaitens JM, Brown CH, Strathmann FG, Xu H, Lewin-Smith MR, Velez-Quinones MA, McDiarmid MA. The Utility of Spot vs 24-Hour Urine Samples for Metal Determination in Veterans With Retained Fragments. Am J Clin Pathol 2021; 155:428-434. [PMID: 33083816 DOI: 10.1093/ajcp/aqaa144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this investigation is to explore the utility of using a spot urine sample in lieu of a 24-hour collection in assessing fragment-related metal exposure in war-injured veterans. METHODS Twenty-four veterans collected each urine void over a 24-hour period in separate containers. Concentrations of 13 metals were measured in each void and in a pooled 24-hour sample using inductively coupled plasma mass spectrometry. To assess the reliability of spot sample measures over time, intraclass correlations (ICCs) were calculated across all spot samples. Lin's concordance correlation coefficient was used to assess agreement between a randomly selected spot urine sample and each corresponding 24-hour sample. RESULTS In total, 149 spot urine samples were collected. Ten of the 13 metals measured had ICCs more than 0.4, suggesting "fair to good" reliability. Concordance coefficients were more than 0.4 for all metals, suggesting "moderate" agreement between spot and 24-hour concentrations, and more than 0.6 for seven of the 13 metals, suggesting "good" agreement. CONCLUSIONS Our fair to good reliability findings, for most metals investigated, and moderate to good agreement findings for all metals, across the range of concentrations observed here, suggest the utility of spot urine samples to obtain valid estimates of exposure in the longitudinal surveillance of metal-exposed populations.
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Affiliation(s)
- Joanna M Gaitens
- Department of Veterans Affairs, Baltimore VA Medical Center, Baltimore, MD
- Department of Medicine, Division of Occupational and Environmental Medicine
| | - Clayton H Brown
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore
| | | | - Hanna Xu
- The Joint Pathology Center, Environmental Toxicology Laboratory, Silver Spring, MD
| | | | | | - Melissa A McDiarmid
- Department of Veterans Affairs, Baltimore VA Medical Center, Baltimore, MD
- Department of Medicine, Division of Occupational and Environmental Medicine
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Drapalski AL, Lucksted A, Brown CH, Fang LJ. Outcomes of Ending Self-Stigma, a Group Intervention to Reduce Internalized Stigma, Among Individuals With Serious Mental Illness. Psychiatr Serv 2021; 72:136-142. [PMID: 33234053 DOI: 10.1176/appi.ps.201900296] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Ending Self-Stigma is a nine-session group intervention designed to teach individuals experiencing mental illness a set of tools and strategies to effectively deal with self-stigma and its effects. The authors examined the efficacy of Ending Self-Stigma with an active comparison group focused on general health and wellness education (the Health and Wellness intervention) in a cohort of veterans. METHODS Veterans with serious mental illness (N=248) were randomly assigned to either the Ending Self-Stigma or the Health and Wellness intervention. Participants completed assessments of symptoms, internalized stigma, recovery, sense of belonging, and other aspects of psychosocial functioning at baseline, posttreatment, and 6-month follow-up. Repeated-measures, mixed-effects models were used to examine the effects of group × time interactions on outcomes. RESULTS Individuals in both groups experienced significant but modest reductions in self-stigma and increases in psychological sense of belonging after the treatments. The Ending Self-Stigma and Health and Wellness interventions did not significantly differ in primary (self-stigma) or secondary (self-efficacy, sense of belonging, or recovery) outcomes at posttreatment. Significant psychotic symptoms moderated treatment effects on self-stigma, such that among individuals with significant psychotic symptoms at baseline, those who participated in Ending Self-Stigma had a significantly greater reduction in internalized stigma than those in the Health and Wellness intervention. CONCLUSIONS Interventions directly targeting self-stigma and those that may address it more indirectly may be helpful in reducing internalized stigma. Individuals experiencing psychotic symptoms may be more likely to benefit from interventions that specifically target self-stigma.
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Affiliation(s)
- Amy L Drapalski
- U.S. Department of Veterans Affairs (VA) Capitol Health Care Network, Veterans Integrated Service Network 5 (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Drapalski, Lucksted, Brown); Department of Psychiatry (Drapalski, Lucksted, Fang) and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore
| | - Alicia Lucksted
- U.S. Department of Veterans Affairs (VA) Capitol Health Care Network, Veterans Integrated Service Network 5 (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Drapalski, Lucksted, Brown); Department of Psychiatry (Drapalski, Lucksted, Fang) and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore
| | - Clayton H Brown
- U.S. Department of Veterans Affairs (VA) Capitol Health Care Network, Veterans Integrated Service Network 5 (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Drapalski, Lucksted, Brown); Department of Psychiatry (Drapalski, Lucksted, Fang) and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore
| | - Li Juan Fang
- U.S. Department of Veterans Affairs (VA) Capitol Health Care Network, Veterans Integrated Service Network 5 (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Drapalski, Lucksted, Brown); Department of Psychiatry (Drapalski, Lucksted, Fang) and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore
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20
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Drapalski AL, Aakre J, Brown CH, Romero E, Lucksted A. The Ending Self-Stigma for Posttraumatic Stress Disorder (ESS-P) Program: Results of a Pilot Randomized Trial. J Trauma Stress 2021; 34:69-80. [PMID: 33058277 DOI: 10.1002/jts.22593] [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] [Received: 08/29/2019] [Revised: 06/21/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022]
Abstract
Experiences of and concerns about encountering stigma are common among veterans with posttraumatic stress disorder (PTSD). One common and serious consequence is self-stigma, which is when an individual comes to believe that common negative stereotypes and assumptions about PTSD are true of oneself. The current study was a pilot randomized trial that evaluated the feasibility, acceptability, and preliminary outcomes of the Ending Self-Stigma for PTSD (ESS-P) program, a nine-session group intervention that aims to assist veterans with PTSD learn tools and strategies to address stigma and self-stigma. Veterans (N = 57) with a diagnosis of PTSD who were receiving treatment in U.S. Veterans Health Administration outpatient mental health programs were recruited. Participants were randomized to either ESS-P or minimally enhanced treatment as usual and assessed at baseline and after treatment on clinical symptoms, self-stigma, self-efficacy, recovery, and sense of belonging. Information on mental health treatment utilization for the 3 months before and after group treatment was also collected. Compared to controls, there was a significant decrease in self-stigma, d = -0.77, and symptoms of depression, d = -0.76, along with significant increases in general and social self-efficacy, ds = 0.73 and 0.60, respectively, and psychological experience of belonging, d = 0.46, among ESS-P participants. There were no differences regarding recovery status or changes in treatment utilization. The results of the pilot study suggest that participation in ESS-P may help reduce self-stigma and improve self-efficacy and a sense of belonging in veterans with PTSD.
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Affiliation(s)
- Amy L Drapalski
- VA Capital Health Care (VISN 5) Mental Illness Research, Education and Clinical Center, Baltimore, Maryland, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Aakre
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Clayton H Brown
- VA Capital Health Care (VISN 5) Mental Illness Research, Education and Clinical Center, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erin Romero
- VA Capital Health Care (VISN 5) Mental Illness Research, Education and Clinical Center, Baltimore, Maryland, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alicia Lucksted
- VA Capital Health Care (VISN 5) Mental Illness Research, Education and Clinical Center, Baltimore, Maryland, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
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21
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Hines SE, Brown CH, Oliver M, Gucer P, Frisch M, Hogan R, Roth T, Chang J, McDiarmid M. Cleaning and Disinfection Perceptions and Use Practices Among Elastomeric Respirator Users in Health care. Workplace Health Saf 2020; 68:572-582. [PMID: 32812845 DOI: 10.1177/2165079920938618] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reusable elastomeric respirator use in health care may represent one solution to address N95 respirator shortages experienced during infectious disease outbreaks, but cleaning and disinfection requirements may limit their utility. Evidence of respirator cleaning and disinfection behaviors and practices by health care workers may inform guidance on reusable respirator use. METHODS Medical system elastomeric respirator users were surveyed about respirator cleaning and disinfection practices and perceptions via an electronic survey. Respondents were subsequently classified based on reported compliance with their assigned respirator use. To explore whether respirator cleaning and disinfection issues affected compliance with assigned device use, responses were compared between user groups and adjusted for covariates. RESULTS A total of 432 of 2,024 (21%) eligible elastomeric respirator users completed the survey. Most (>90%) reported that their respirator was clean, but only 52% reported that they always disinfect their respirators after use according to the hospital's expected practice. Only 40 respondents (9%) reported regularly cleaning the respirator with soap and water, in accordance with manufacturer recommendations. Reporting of suboptimal decontamination practice was not associated with assigned device compliance, however, except among providers and respiratory therapists. CONCLUSION/APPLICATION TO PRACTICE Although perceptions of cleanliness and adherence to expected decontamination practices during routine use did not appear to influence compliance with assigned respirator use overall, this did predict compliance among providers and respiratory therapists, both of whom have nonfixed workstations. Practical and effective strategies to assure easy access to and availability of clean reusable respiratory protective devices are needed to facilitate their use in health care respiratory protection programs.
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Affiliation(s)
| | | | | | | | | | | | - Tracy Roth
- University of Maryland School of Medicine
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22
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Hack SM, Muralidharan A, Brown CH, Drapalski AL, Lucksted AA. Stigma and discrimination as correlates of mental health treatment engagement among adults with serious mental illness. Psychiatr Rehabil J 2020; 43:106-110. [PMID: 31380672 PMCID: PMC7000289 DOI: 10.1037/prj0000385] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The negative impacts of stigma on mental health treatment initiation are well established, but the relationship of stigma to proactive engagement in mental health treatment (e.g., actively working toward therapy goals) is largely unexamined. This study examined the relationship between mental health treatment engagement and stigma experiences, discrimination experiences, and internalized stigma among adults with serious mental illness. Age, race, gender, and education were tested as moderators of the relationships between stigma-related variables and treatment engagement. METHOD Data were collected from 167 adults with serious mental illnesses who were receiving services at 5 psychosocial rehabilitation programs. Treatment engagement was assessed by participants' primary mental health care providers, using the Service Engagement Scale. The relationship between treatment engagement, stigma, and discrimination as well as potential demographic moderators were tested with Pearson's correlations and multiple linear regressions. RESULTS Treatment engagement was not correlated with experiences of stigma, experiences of discrimination, or application of stigmatizing beliefs to self. Gender, race, and age were not significant moderators but education was. Experiences of stigma were associated with greater treatment engagement in those with a higher level of education (p = .007), whereas application of stigma to one's self was associated with poorer treatment engagement in those with a higher level of education (p = .005). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Among individuals with higher levels of education, efforts to prevent internalization of public stigma may be crucial to promote proactive mental health treatment. Replication studies are needed to confirm these findings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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23
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Jahn DR, Leith J, Muralidharan A, Brown CH, Drapalski AL, Hack S, Lucksted A. The influence of experiences of stigma on recovery: Mediating roles of internalized stigma, self-esteem, and self-efficacy. Psychiatr Rehabil J 2020; 43:97-105. [PMID: 31233321 PMCID: PMC6928452 DOI: 10.1037/prj0000377] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Experiencing stigmatization regarding mental illness has harmful effects on recovery from serious mental illness (SMI). Stigma experiences can also lead to internalized stigma, the cognitive and emotional internalization of negative stereotypes, and application of those stereotypes to one's self. Internalized stigma may lead to additional harms, including decrements in self-esteem and self-efficacy. Therefore, this study examined the effects of stigmatization experiences on recovery-related outcomes through internalized stigma, self-esteem, and self-efficacy in a single comprehensive model. METHODS Adults with SMI (n = 516) completed standardized measures assessing the variables of interest during baseline assessments for 2 randomized controlled trials. In a secondary analysis of the trial data, separate serial mediation models were tested for recovery orientation, perceived quality of life, and social withdrawal as outcomes, with experiences of stigma as the predictor variable and internalized stigma, self-esteem, and self-efficacy as serial mediators in that order. Alternate order and parallel mediation models were also tested to evaluate directionality. RESULTS The serial mediation model was the best fit, although self-efficacy was not found to be a critical mediator. Experiences of stigma led to internalized stigma, which influenced self-esteem and recovery-related outcomes, consistent with the social-cognitive model of internalized stigma. CONCLUSION This indicates that internalized stigma is an essential target for reducing the negative impact of stigmatization on recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Danielle R Jahn
- Center for Acute Recovery Empowerment, Orlando VA Medical Center
| | | | - Anjana Muralidharan
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
| | - Clayton H Brown
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
| | - Amy L Drapalski
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
| | - Samantha Hack
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
| | - Alicia Lucksted
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
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24
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Travaglini LE, Kreyenbuhl J, Graydon M, Brown CH, Goldberg R, Himelhoch S, Fang LJ, Slade E. Access to Direct-Acting Antiviral Treatment for Hepatitis C Virus Among Veterans With Serious Mental Illness. Psychiatr Serv 2020; 71:192-195. [PMID: 31615365 DOI: 10.1176/appi.ps.201900227] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE This study examined whether serious mental illness is associated with initiating and with completing sofosbuvir-based treatment for hepatitis C virus (HCV) among veterans who started treatment after the Veterans Health Administration (VHA) received expanded funding for HCV care. METHODS Administrative health care data from fiscal years 2016-2017 revealed 4,288 treatment-naïve patients with HCV, of whom 1,311 had initiated sofosbuvir-based treatment. Dependent variables were initiation and completion of ≥8 weeks of sofosbuvir treatment. Associations with serious mental illness were estimated with adjusted odds ratios from multivariable logistic regression analyses. RESULTS No statistically significant differences were found in the proportion of veterans with and veterans without serious mental illness who initiated (p=0.628) or completed ≥8 weeks (p=0.301) of sofosbuvir treatment. CONCLUSIONS Veterans with and without serious mental illness initiated and completed sofosbuvir treatment at similar rates. The VA should continue to provide equitable access to HCV treatments and support medication adherence.
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Affiliation(s)
- Letitia E Travaglini
- Veterans Affairs (VA) Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore (Travaglini, Kreyenbuhl, Brown, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Kreyenbuhl, Goldberg, Fang, Slade), and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore; VA Maryland Health Care System, Baltimore (Graydon); Department of Psychiatry, University of Kentucky College of Medicine, Lexington (Himelhoch); Johns Hopkins University School of Nursing, Baltimore (Slade)
| | - Julie Kreyenbuhl
- Veterans Affairs (VA) Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore (Travaglini, Kreyenbuhl, Brown, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Kreyenbuhl, Goldberg, Fang, Slade), and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore; VA Maryland Health Care System, Baltimore (Graydon); Department of Psychiatry, University of Kentucky College of Medicine, Lexington (Himelhoch); Johns Hopkins University School of Nursing, Baltimore (Slade)
| | - Meagan Graydon
- Veterans Affairs (VA) Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore (Travaglini, Kreyenbuhl, Brown, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Kreyenbuhl, Goldberg, Fang, Slade), and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore; VA Maryland Health Care System, Baltimore (Graydon); Department of Psychiatry, University of Kentucky College of Medicine, Lexington (Himelhoch); Johns Hopkins University School of Nursing, Baltimore (Slade)
| | - Clayton H Brown
- Veterans Affairs (VA) Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore (Travaglini, Kreyenbuhl, Brown, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Kreyenbuhl, Goldberg, Fang, Slade), and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore; VA Maryland Health Care System, Baltimore (Graydon); Department of Psychiatry, University of Kentucky College of Medicine, Lexington (Himelhoch); Johns Hopkins University School of Nursing, Baltimore (Slade)
| | - Richard Goldberg
- Veterans Affairs (VA) Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore (Travaglini, Kreyenbuhl, Brown, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Kreyenbuhl, Goldberg, Fang, Slade), and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore; VA Maryland Health Care System, Baltimore (Graydon); Department of Psychiatry, University of Kentucky College of Medicine, Lexington (Himelhoch); Johns Hopkins University School of Nursing, Baltimore (Slade)
| | - Seth Himelhoch
- Veterans Affairs (VA) Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore (Travaglini, Kreyenbuhl, Brown, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Kreyenbuhl, Goldberg, Fang, Slade), and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore; VA Maryland Health Care System, Baltimore (Graydon); Department of Psychiatry, University of Kentucky College of Medicine, Lexington (Himelhoch); Johns Hopkins University School of Nursing, Baltimore (Slade)
| | - Li Juan Fang
- Veterans Affairs (VA) Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore (Travaglini, Kreyenbuhl, Brown, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Kreyenbuhl, Goldberg, Fang, Slade), and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore; VA Maryland Health Care System, Baltimore (Graydon); Department of Psychiatry, University of Kentucky College of Medicine, Lexington (Himelhoch); Johns Hopkins University School of Nursing, Baltimore (Slade)
| | - Eric Slade
- Veterans Affairs (VA) Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore (Travaglini, Kreyenbuhl, Brown, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Kreyenbuhl, Goldberg, Fang, Slade), and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore; VA Maryland Health Care System, Baltimore (Graydon); Department of Psychiatry, University of Kentucky College of Medicine, Lexington (Himelhoch); Johns Hopkins University School of Nursing, Baltimore (Slade)
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Muralidharan A, Brown CH, Zhang Y, Niv N, Cohen AN, Kreyenbuhl J, Oberman RS, Goldberg RW, Young AS. Quality of life outcomes of web-based and in-person weight management for adults with serious mental illness. J Behav Med 2019; 43:865-872. [PMID: 31741204 DOI: 10.1007/s10865-019-00117-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022]
Abstract
Adults with serious mental illness have high rates of obesity, with associated negative impacts on health-related quality of life. The present study utilized data from a randomized controlled trial (N = 276) to examine the effectiveness of in-person and online-delivered weight management interventions, compared to usual care, for improving health-related quality of life in this population. Participants completed quality of life assessments at baseline, 3 months, and 6 months. Mixed effects models examined group by time interactions. Compared to usual care, in-person MOVE was associated with improvements in loneliness (t = - 2.76, p = .006) and mental health related quality of life (t = 1.99, p = 0.048) at 6 months, and webMOVE was associated with improvements in weight-related self-esteem at 6 months (t = 2.23, p = .026) and mental health-related quality of life at 3 months (t = 2.17, p = 0.031) and 6 months (t = 2.38, p = .018). Web-based and in-person weight management led to improvements in health-related quality of life for adults with serious mental illness.ClinicalTrials.gov Identifier: NCT00983476.
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Affiliation(s)
- Anjana Muralidharan
- Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA. .,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Clayton H Brown
- Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yilin Zhang
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Noosha Niv
- Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Long Beach, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amy N Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Julie Kreyenbuhl
- Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Richard W Goldberg
- Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexander S Young
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Muralidharan A, Brown CH, Goldberg RW. PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE AND RECOVERY AMONG OLDER ADULTS WITH SERIOUS MENTAL ILLNESS. Innov Aging 2019. [PMCID: PMC6844814 DOI: 10.1093/geroni/igz038.3215] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Older adults with serious mental illness (i.e., schizophrenia spectrum disorders and affective psychoses) exhibit marked impairments across medical, cognitive, and psychiatric domains. The present study examined predictors of health-related quality-of-life and mental health recovery in this population. Participants (N=211) were ages 50 and older with a chart diagnosis of serious mental illness and a co-occurring medical condition, engaged in outpatient mental health services at a study site. Participants completed a battery of assessments including subtests from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the 24-Item Behavior and Symptom Identification Scale (BASIS-24), the 12-Item Short-Form Health Survey (SF-12), and the Maryland Assessment of Recovery Scale (MARS). Multiple linear regression analyses, with age, race, gender, and BMI as covariates, examined number of current medical conditions, RBANS, and BASIS as predictors of quality-of-life and recovery. Significant predictors of physical health-related quality-of-life (R-squared=.298, F(9,182)=8.57, p<.0001) were number of medical conditions (β=-1.70, p<.0001), BASIS-Depression/Functioning (β=-4.84, p<.0001), and BASIS-Psychosis (β=2.39, p<.0008). Significant predictors of mental health-related quality-of-life (R-squared=.575, F(9,182)=27.37, p<.0001) were RBANS (β=0.03, p=.05), BASIS-Depression/Functioning (β=-6.49, p<.0001), BASIS-Relationships (β=-3.17, p<.0001), and BASIS-Psychosis (β=-1.30, p=.03). Significant predictors of MARS (R-squared=.434, F(9,183)=15.56, p<.0001) were BASIS-Depression/Functioning (β=-4.68, p=.002) and BASIS-Relationships (β=-9.44, p<.0001). To promote holistic recovery among older adults with serious mental illness, integrated interventions are required. For example, to improve physical health-related quality-of-life, one should target depression and psychotic symptoms as well as medical illness burden. To improve mental health-related quality-of-life, depression symptoms and interpersonal functioning may be key targets, as well as neurocognitive function.
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Affiliation(s)
- Anjana Muralidharan
- Veterans Affairs Capitol Healthcare Network, Mental Illness Research Education and Clinical Center, Baltimore, Maryland, United States
| | - Clayton H Brown
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Richard W Goldberg
- Veterans Affairs Capitol Healthcare Network, Baltimore, Maryland, United States
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27
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Dodia NN, Richert ME, Deitchman AR, Quinn CC, Marciniak ET, Brown CH, Terrin ML, Amariei DE, Shanholtz CB, Hasday JD. A Survey of Academic Intensivists' Use of Neuromuscular Blockade in Subjects With ARDS. Respir Care 2019; 65:362-368. [PMID: 31506341 DOI: 10.4187/respcare.07026] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Our Cooling to Help Injured Lungs (CHILL) trial of therapeutic hypothermia in ARDS includes neuromuscular blockade (NMB) as an inclusion criterion to avoid shivering. NMB has been used to facilitate mechanical ventilation in ARDS and was shown to reduce mortality in the ACURASYS trial. To assess the feasibility of a multi-center CHILL trial, we conducted a survey of academic intensivists about their NMB use in patients with ARDS. METHODS We distributed via email a 16-question survey about NMB use in patients with ARDS including frequency, indications, and dosing strategy. RESULTS 212 (24.3%) of 871 respondents completed the survey: 94.7% were board-certified in internal medicine, 88% in pulmonary and critical care; 90.3% practiced in academic medical centers, with 87% working in medical ICUs; 96.6% of respondents who treat ARDS use NMB, and 39.7% use NMB in ≥ 50% of these patients. Of 4 listed indications for initiating NMB in ARDS, allowing adherence with lung-protective ventilator strategies and patient-ventilator synchrony were cited as the most important reasons, followed by the results of the ACURASYS trial and facilitating prone positioning. CONCLUSIONS We conclude that NMB is frequently used by academic intensivists to facilitate mechanical ventilation in patients with moderate to severe ARDS.
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Affiliation(s)
- Neal N Dodia
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mary E Richert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrew R Deitchman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charlene C Quinn
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ellen T Marciniak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael L Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Diana E Amariei
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Carl B Shanholtz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jeffrey D Hasday
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland. .,Baltimore Veterans Administration Medical Center, Baltimore, Maryland
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Muralidharan A, Brown CH, E Peer J, A Klingaman E, M Hack S, Li L, Walsh MB, Goldberg RW. Living Well: An Intervention to Improve Medical Illness Self-Management Among Individuals With Serious Mental Illness. Psychiatr Serv 2019; 70:19-25. [PMID: 30353790 PMCID: PMC6494087 DOI: 10.1176/appi.ps.201800162] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/30/2022]
Abstract
OBJECTIVE Many adults with serious mental illness have significant medical illness burden and poor illness self-management. In this study, the authors examined Living Well, a group-based illness self-management intervention for adults with serious mental illness that was cofacilitated by two providers, one of whom has lived experience with co-occurring mental health and medical conditions. METHODS Adults with serious mental illness (N=242) were randomly assigned to Living Well or an active control condition. Participants completed assessments of quality of life; health attitudes; self-management behaviors; and symptoms at baseline, posttreatment, and follow-up. Emergency room use was assessed by means of chart review. Mixed-effects models examined group × time interactions on outcomes. RESULTS Compared with the control group, adults in Living Well had greater improvements at posttreatment in mental health-related quality of life (t=2.15, p=.032), self-management self-efficacy (t=4.10, p<.001), patient activation (t=2.08, p=.038), internal health locus of control (t=2.01, p=.045), behavioral and cognitive symptom management (t=2.77, p=.006), and overall psychiatric symptoms (t=-2.02, p=.044); they had greater improvements at follow-up in physical activity-related self-management (t=2.55, p=.011) and relationship quality (t=-2.45, p=.015). No effects were found for emergency room use. The control group exhibited greater increases in physical health-related quality of life at posttreatment (t=-2.23, p=.026). Significant group differences in self-management self-efficacy (t=2.86,p=.004) and behavioral and cognitive symptom management (t=2.08, p= .038) were maintained at follow-up. CONCLUSIONS Compared with an active control group, a peer-cofacilitated illness self-management group was more effective in improving quality of life and self-management self-efficacy among adults with serious mental illness.
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Affiliation(s)
- Anjana Muralidharan
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Clayton H Brown
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Jason E Peer
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Elizabeth A Klingaman
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Samantha M Hack
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Lan Li
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Mary Brighid Walsh
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Richard W Goldberg
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
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Wyrobek J, LaFlam A, Max L, Tian J, Neufeld KJ, Kebaish KM, Walston JD, Hogue CW, Riley LH, Everett AD, Brown CH. Association of intraoperative changes in brain-derived neurotrophic factor and postoperative delirium in older adults. Br J Anaesth 2018; 119:324-332. [PMID: 28854532 DOI: 10.1093/bja/aex103] [Citation(s) in RCA: 30] [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] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 01/19/2023] Open
Abstract
Background Delirium is common after surgery, although the aetiology is poorly defined. Brain-derived neurotrophic factor (BDNF) is a neurotrophin important in neurotransmission and neuroplasticity. Decreased levels of BDNF have been associated with poor cognitive outcomes, but few studies have characterized the role of BDNF perioperatively. We hypothesized that intraoperative decreases in BDNF levels are associated with postoperative delirium. Methods Patients undergoing spine surgery were enrolled in a prospective cohort study. Plasma BDNF was collected at baseline and at least hourly intraoperatively. Delirium was assessed using rigorous methods, including the Confusion Assessment Method (CAM) and CAM for the intensive care unit. Associations of changes in BDNF and delirium were examined using regression models. Results Postoperative delirium developed in 32 of 77 (42%) patients. The median baseline BDNF level was 7.6 ng ml -1 [interquartile range (IQR) 3.0-11.2] and generally declined intraoperatively [median decline 61% (IQR 31-80)]. There was no difference in baseline BDNF levels by delirium status. However, the percent decline in BDNF was greater in patients who developed delirium [median 74% (IQR 51-82)] vs in those who did not develop delirium [median 50% (IQR 14-79); P =0.03]. Each 1% decline in BDNF was associated with increased odds of delirium in unadjusted {odds ratio [OR] 1.02 [95% confidence interval (CI) 1.00-1.04]; P =0.01}, multivariable-adjusted [OR 1.02 (95% CI 1.00-1.03); P =0.03], and propensity score-adjusted models [OR 1.02 (95% CI 1.00-1.04); P =0.03]. Conclusions We observed an association between intraoperative decline in plasma BDNF and delirium. These preliminary results need to be confirmed but suggest that plasma BDNF levels may be a biomarker for postoperative delirium.
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Affiliation(s)
- J Wyrobek
- Department of Anesthesiology and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - A LaFlam
- Tufts University School of Medicine, Boston, MA, USA
| | - L Max
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - J Tian
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - K J Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K M Kebaish
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J D Walston
- Department of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C W Hogue
- Department of Anesthesiology and Critical Care Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - L H Riley
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A D Everett
- Department of Pediatrics, Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C H Brown
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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McDiarmid MA, Cloeren M, Gaitens JM, Hines S, Streeten E, Breyer RJ, Brown CH, Condon M, Roth T, Oliver M, Brown L, Dux M, Lewin-Smith MR, Strathmann F, Velez-Quinones MA, Gucer P. Surveillance results and bone effects in the Gulf War depleted uranium-exposed cohort. J Toxicol Environ Health A 2018; 81:1083-1097. [PMID: 30373484 DOI: 10.1080/15287394.2018.1538914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 06/08/2023]
Abstract
A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored in a clinical surveillance program since 1993. During the spring of 2017, 42 members of the cohort were evaluated with a protocol which includes exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes including measures of bone metabolism, and for participants >50 years, bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained DU shrapnel fragments. Only the mean serum estradiol concentration, a marker of bone metabolism, was found to be significantly different for lower-vs- higher urine U (uU) cohort sub-groups. For the first time, a significant deficit in BMD was observed in the over age 50, high uU sub-group. After more than 25 years since first exposure to DU, an aging cohort of military veterans continues to exhibit few U-related adverse health effects in known target organs of U toxicity. The new finding of reduced BMD in older cohort members, while biologically plausible, was not suggested by other measures of bone metabolism in the full (all ages) cohort, as these were predominantly within normal limits over time. Only estradiol was recently found to display a difference as a function of uU grouping. As BMD is further impacted by aging and the U-burden from fragment absorption accrues in this cohort, a U effect may be clarified in future surveillance visits.
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Affiliation(s)
- Melissa A McDiarmid
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Marianne Cloeren
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Joanna M Gaitens
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Stella Hines
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Elizabeth Streeten
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Richard J Breyer
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
| | - Clayton H Brown
- d Department of Epidemiology and Preventive Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Marian Condon
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
| | - Tracy Roth
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Marc Oliver
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Lawrence Brown
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- c Department of Pathology , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Moira Dux
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
| | - Michael R Lewin-Smith
- e Environmental Toxicology Laboratory, The Joint Pathology Center , University of Maryland School of Medicine , Silver Spring , MD , USA
| | - Frederick Strathmann
- e Environmental Toxicology Laboratory, The Joint Pathology Center , University of Maryland School of Medicine , Silver Spring , MD , USA
| | - Maria A Velez-Quinones
- e Environmental Toxicology Laboratory, The Joint Pathology Center , University of Maryland School of Medicine , Silver Spring , MD , USA
| | - Patricia Gucer
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
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Muralidharan A, Niv N, Brown CH, Olmos-Ochoa TT, Fang LJ, Cohen AN, Kreyenbuhl J, Oberman RS, Goldberg RW, Young AS. Impact of Online Weight Management With Peer Coaching on Physical Activity Levels of Adults With Serious Mental Illness. Psychiatr Serv 2018; 69:1062-1068. [PMID: 30041588 PMCID: PMC6611674 DOI: 10.1176/appi.ps.201700391] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Many adults with serious mental illness are sedentary and experience significant medical illness burden. This study examined the effectiveness of online weight management with peer coaching (WebMOVE) for increasing general physical activity among adults with serious mental illness. METHODS Using quantitative and qualitative data from a randomized controlled trial (N=276), this study compared WebMOVE, in-person weight management for adults with serious mental illness (MOVE SMI), and usual care. Participants completed assessments of general physical activity (baseline, three months, and six months) and a qualitative assessment (six months). Mixed-effects models examined group × time interactions on general physical activity. RESULTS There were significant differences between MOVE SMI and usual care for total physical activity at three (t=3.06, p=.002) and six (t=3.12, p=.002) months, walking at six months (t=1.99, p=.048), and moderate (t=2.12, p=.035) and vigorous (t=2.34, p=.020) physical activity at six months. There was a significant difference between WebMOVE and usual care for total physical activity at six months (t=2.02, p=.044) and a trend for a group difference in walking at six months (t=1.78, p=.076). These findings reflected a decline in physical activity among participants in usual care and an increase in physical activity among participants in MOVE SMI or WebMOVE. CONCLUSIONS In-person weight management counseling increased total physical activity and led to initiation of moderate and vigorous physical activity among adults with serious mental illness. Computerized weight management counseling with peer support led to more gradual increases in total physical activity.
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Affiliation(s)
- Anjana Muralidharan
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Noosha Niv
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Clayton H Brown
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Tanya T Olmos-Ochoa
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Li Juan Fang
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Amy N Cohen
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Julie Kreyenbuhl
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Rebecca S Oberman
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Richard W Goldberg
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Alexander S Young
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
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Blanco N, O'Hara LM, Robinson GL, Brown J, Heil E, Brown CH, Stump BD, Sigler BW, Belani A, Miller HL, Chiplinski AN, Perlmutter R, Wilson L, Morgan DJ, Leekha S. Health care worker perceptions toward computerized clinical decision support tools for Clostridium difficile infection reduction: A qualitative study at 2 hospitals. Am J Infect Control 2018; 46:1160-1166. [PMID: 29803592 DOI: 10.1016/j.ajic.2018.04.204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/09/2018] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is associated with significant morbidity and mortality. Computerized clinical decision support (CCDS) tools can aid process improvement in infection prevention and antibiotic stewardship, but implementation and health care workers (HCWs) uptake of these tools is often variable. The objective of this study was to describe HCWs' perceptions of barriers and facilitators related to uptake of CCDS tools as part of a CDI reduction bundle. METHODS We conducted a qualitative study among HCWs at 2 acute care hospitals in Maryland. Semi-structured interviews and structured surveys were completed by HCWs to evaluate their perception to CCDS tools at 2 different stages: predevelopment and preimplementation. Emergent themes and patterns in the data were identified and condensed. RESULTS Gaps in CDI-related knowledge and in communication between HCWs were identified throughout the evaluation. HCWs agreed on the potential of the tools to improve CDI diagnosis, prevention, and control. An important barrier for uptake was the perceived loss of autonomy and clinical judgment, whereas standardization and error reduction were perceived advantages. CONCLUSIONS These observations shaped the development and implementation of the CDI reduction bundle. Qualitative findings can provide valuable contextual information during the development stages of CCDS tools in infection prevention and antibiotic stewardship.
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Affiliation(s)
- Natalia Blanco
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
| | - Lyndsay M O'Hara
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Gwen L Robinson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Jeanine Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Emily Heil
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Rebecca Perlmutter
- Emerging Infections Program, Maryland Department of Health, Baltimore, MD
| | - Lucy Wilson
- Emerging Infections Program, Maryland Department of Health, Baltimore, MD
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Healthcare System, Baltimore, MD
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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Reich CM, Hack SM, Klingaman EA, Brown CH, Fang LJ, Dixon LB, Jahn DR, Kreyenbuhl JA. Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns. Int J Psychiatry Clin Pract 2018; 22:89-94. [PMID: 28920491 PMCID: PMC5909968 DOI: 10.1080/13651501.2017.1375530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample. METHODS Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns. RESULTS The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction. CONCLUSIONS Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation. PRACTICE IMPLICATIONS Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.
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Affiliation(s)
- Catherine M Reich
- a Department of Psychology , University of Minnesota Duluth , Duluth , MN , USA
| | - Samantha M Hack
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Elizabeth A Klingaman
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Clayton H Brown
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Li Juan Fang
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Lisa B Dixon
- d New York State Psychiatric Institute , New York , NY , USA.,e Department of Psychiatry , Columbia University , New York , NY , USA
| | | | - Julie A Kreyenbuhl
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
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Travaglini LE, Li L, Brown CH, Bennett ME. Predictors of smoking cessation group treatment engagement among veterans with serious mental illness. Addict Behav 2017; 75:103-107. [PMID: 28728038 PMCID: PMC5616105 DOI: 10.1016/j.addbeh.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/29/2017] [Accepted: 07/08/2017] [Indexed: 12/31/2022]
Abstract
High prevalence rates of tobacco use, particularly cigarettes, pose a serious health threat for individuals with serious mental illness (SMI), and research has demonstrated the effectiveness of pharmacotherapy and psychosocial interventions to reduce tobacco use in this group. However, few studies have considered predictors of tobacco cessation treatment engagement among individuals with SMI. The current study examined predictors of engagement in smoking cessation groups among veterans with SMI engaged in mental health services at three VA medical centers. All veterans were participating in a smoking cessation treatment study. Of 178 veterans who completed baseline assessments, 127 (83.6%) engaged in treatment, defined as attending at least three group sessions. Forty-one (N=41) predictors across five domains (demographics, psychiatric concerns, medical concerns, smoking history, and self-efficacy to quit smoking) were identified based on previous research and clinical expertise. Using backward elimination to determine a final multivariable logistic regression model, three predictors were found to be significantly related to treatment engagement: marital status (never-married individuals more likely to engage); previous engagement in group smoking cessation services; and greater severity of positive symptoms on the Brief Psychiatric Rating Scale. When included in the multivariable logistic regression model, the full model discriminates between engagers and non-engagers reasonably well (c statistic=0.73). Major considerations based on these findings are: individuals with SMI appear to be interested in smoking cessation services; and serious psychiatric symptomatology should not discourage treatment providers from encouraging engagement in smoking cessation services.
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Affiliation(s)
- Letitia E Travaglini
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Lan Li
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Clayton H Brown
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Melanie E Bennett
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
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Margo JA, Whiting MF, Brown CH, Hoover CK, Munir WM. The Effect of Chronic Pulmonary Disease and Mechanical Ventilation on Corneal Donor Endothelial Cell Density and Transplant Suitability. Am J Ophthalmol 2017; 183:65-70. [PMID: 28890079 DOI: 10.1016/j.ajo.2017.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine how chronic obstructive pulmonary disease (COPD) and mechanical ventilation time affect corneal donor endothelial cell density (ECD) and transplant suitability. DESIGN Retrospective cohort study. METHODS Setting: Institutional. STUDY POPULATION Total of 39 679 cornea donor eyes from SightLife Eye Bank between 2012 and 2016. Demographics, death-to-preservation time, ECD, lens status, medical history, time on mechanical ventilation, and suitability for transplantation were included. MAIN OUTCOME MEASURES ECD and transplant suitability. RESULTS Mean ECD was 2733 cells/mm2. Mean age was 59 years. COPD affected 34.2% of donors. Mechanical ventilation was required in 35% of donors. Mean ventilation time was 1.3 days. After controlling for covariates, COPD was not found to be associated with poor transplant suitability (P = .22). Ventilation >7 days was associated with poor transplant suitability (P = .04). Donors with COPD and donors who were mechanically ventilated exhibited lower cell counts (P < .001, P < .01, respectively). Longer ventilation led to reduced endothelial cell density: ventilation time >7 days (-46.5 cells/mm2, P < .001) and >30 days (-101.4 cells/mm2, P = .02). Limitations of the study included the retrospective nature, dataset obtained from a single eye bank, and medical history documentation completed by eye bank technicians. CONCLUSIONS A high proportion of cornea donors have respiratory disease prior to donation. Ventilation time >7 days affected transplant suitability but the presence of COPD did not. Donors with COPD and donors who were mechanically ventilated had reduced cell counts. Longer ventilation times lead to increased cell loss. The presence of respiratory disease may affect tissue oxygenation and endothelial cell health.
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Ali MK, Hack SM, Brown CH, Medoff D, Fang L, Klingaman EA, Park SG, Dixon LB, Kreyenbuhl JA. Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness. J Racial Ethn Health Disparities 2017; 5:235-242. [PMID: 28411327 DOI: 10.1007/s40615-017-0363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
Black consumers with serious mental illness (SMI) face significant challenges in obtaining quality mental health care and are at risk for experiencing significant disparities in mental health care outcomes, including recovery from mental illness. Patient-provider interactions may partly contribute to this disparity. The purpose of the current study was to understand the effects of race, psychosis, and therapeutic alliance on mental health recovery orientation among Veterans with SMI. Participants were Veterans who had an SMI being treated at two Veteran Affairs outpatient mental health clinics by a psychiatrist or nurse practitioner. Participants completed the Behavior and Symptom Identification Scale (BASIS-24), Mental Health Recovery Measure, and patient-report Scale to Assess the Therapeutic Relationship (STAR-P) which includes three subscales: positive collaboration, positive clinician input, and non-supportive clinician input. Regression analyses were used to determine interactive effects of race, psychosis severity, and therapeutic alliance variables. The sample was 226 Veterans (50% black, 50% white). Black participants were slightly older (p < .05), had higher baseline psychosis (p < .05), higher mental health recovery (p < .05), and perceived less non-supportive clinician input (p < .01) than white participants. Regression analyses indicated a significant three-way interaction among race, psychosis, and positive collaboration (p < .01). Greater positive collaboration attenuated the negative effect of higher levels of psychosis on mental health recovery orientation for black participants. Conversely, for white participants, positive collaboration had little effect on the negative relationship between psychosis severity and mental health recovery orientation. Increased levels of psychosis may inhibit patients' perceptions of their ability to recover from SMI. However, for black participants, positive collaboration with mental health providers may moderate the effects of psychotic symptomatology.
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Affiliation(s)
- Mana K Ali
- Department on Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Samantha M Hack
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Clayton H Brown
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Howard Hall Suite 200, 660 W. Redwood Street, Baltimore, MD, 21201, USA
| | - Deborah Medoff
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Lijuan Fang
- School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Elizabeth A Klingaman
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Stephanie G Park
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Julie A Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
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Lucksted A, Drapalski AL, Brown CH, Wilson C, Charlotte M, Mullane A, Fang LJ. Outcomes of a Psychoeducational Intervention to Reduce Internalized Stigma Among Psychosocial Rehabilitation Clients. Psychiatr Serv 2017; 68:360-367. [PMID: 27903136 DOI: 10.1176/appi.ps.201600037] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This community-based randomized controlled trial was carried out to test the Ending Self-Stigma (ESS) psychoeducational intervention, which is designed to help adults with serious mental illnesses reduce internalization of mental illness stigma and its effects. METHODS A total of 268 adults from five different mental health programs in Maryland took part. After baseline interview, consenting participants were randomly assigned to the nine-week ESS intervention or a minimally enhanced treatment-as-usual control condition. Participants were assessed by using symptom, psychosocial functioning, and self-stigma measures at baseline, postintervention, and six-month follow-up. Demographic characteristics were assessed at baseline. RESULTS Compared with participants in the control condition, ESS group participants showed significant decreases on the stereotype agreement and self-concurrence subscales of the Self Stigma of Mental Illness Scale, significant improvement on the alienation and stigma resistance subscales of the Internalized Stigma Mental Illness measure, and a significant increase in recovery orientation from baseline to postintervention. None of these differences were sustained at six-month follow-up. CONCLUSIONS Results indicate that ESS was useful in helping to reduce key aspects of internalized stigma among individuals with mental illnesses and that advances in the delivery, targeting, and content of the intervention in the field may be warranted to increase its potency.
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Affiliation(s)
- Alicia Lucksted
- Dr. Lucksted, Ms. Charlotte, and Ms. Fang are with the Department of Psychiatry, Division of Psychiatric Services Research, and Dr. Brown is with the Department of Epidemiology and Public Health, all at the University of Maryland School of Medicine, Baltimore (e-mail: ). Dr. Drapalski is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Maryland Health Care System, Baltimore. Ms. Wilson is with the Department of Psychology, University of Maryland Baltimore County, Baltimore. Dr. Mullane is with the Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland
| | - Amy L Drapalski
- Dr. Lucksted, Ms. Charlotte, and Ms. Fang are with the Department of Psychiatry, Division of Psychiatric Services Research, and Dr. Brown is with the Department of Epidemiology and Public Health, all at the University of Maryland School of Medicine, Baltimore (e-mail: ). Dr. Drapalski is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Maryland Health Care System, Baltimore. Ms. Wilson is with the Department of Psychology, University of Maryland Baltimore County, Baltimore. Dr. Mullane is with the Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland
| | - Clayton H Brown
- Dr. Lucksted, Ms. Charlotte, and Ms. Fang are with the Department of Psychiatry, Division of Psychiatric Services Research, and Dr. Brown is with the Department of Epidemiology and Public Health, all at the University of Maryland School of Medicine, Baltimore (e-mail: ). Dr. Drapalski is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Maryland Health Care System, Baltimore. Ms. Wilson is with the Department of Psychology, University of Maryland Baltimore County, Baltimore. Dr. Mullane is with the Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland
| | - Camille Wilson
- Dr. Lucksted, Ms. Charlotte, and Ms. Fang are with the Department of Psychiatry, Division of Psychiatric Services Research, and Dr. Brown is with the Department of Epidemiology and Public Health, all at the University of Maryland School of Medicine, Baltimore (e-mail: ). Dr. Drapalski is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Maryland Health Care System, Baltimore. Ms. Wilson is with the Department of Psychology, University of Maryland Baltimore County, Baltimore. Dr. Mullane is with the Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland
| | - Melanie Charlotte
- Dr. Lucksted, Ms. Charlotte, and Ms. Fang are with the Department of Psychiatry, Division of Psychiatric Services Research, and Dr. Brown is with the Department of Epidemiology and Public Health, all at the University of Maryland School of Medicine, Baltimore (e-mail: ). Dr. Drapalski is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Maryland Health Care System, Baltimore. Ms. Wilson is with the Department of Psychology, University of Maryland Baltimore County, Baltimore. Dr. Mullane is with the Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland
| | - Audrina Mullane
- Dr. Lucksted, Ms. Charlotte, and Ms. Fang are with the Department of Psychiatry, Division of Psychiatric Services Research, and Dr. Brown is with the Department of Epidemiology and Public Health, all at the University of Maryland School of Medicine, Baltimore (e-mail: ). Dr. Drapalski is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Maryland Health Care System, Baltimore. Ms. Wilson is with the Department of Psychology, University of Maryland Baltimore County, Baltimore. Dr. Mullane is with the Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland
| | - Li Juan Fang
- Dr. Lucksted, Ms. Charlotte, and Ms. Fang are with the Department of Psychiatry, Division of Psychiatric Services Research, and Dr. Brown is with the Department of Epidemiology and Public Health, all at the University of Maryland School of Medicine, Baltimore (e-mail: ). Dr. Drapalski is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Maryland Health Care System, Baltimore. Ms. Wilson is with the Department of Psychology, University of Maryland Baltimore County, Baltimore. Dr. Mullane is with the Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland
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Jahn DR, Muralidharan A, Drapalski AL, Brown CH, Fang LJ, Lucksted A. Differences in suicide and death ideation among veterans and nonveterans with serious mental illness. Psychol Serv 2017; 15:31-39. [PMID: 28287770 DOI: 10.1037/ser0000127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with serious mental illness and veterans are two populations at elevated risk for suicide; however, research has not examined whether veterans with serious mental illness may be at higher suicide risk than nonveterans with serious mental illness. Additionally, overlapping risk factors for suicide in these populations may account for differences in suicide-related outcomes between these groups. Therefore, the aim of this study was to identify differences in death ideation and suicide ideation among veterans and nonveterans with serious mental illness. We also aimed to explore these effects after adjusting for potentially shared risk factors. We found that veterans with serious mental illness reported death ideation and suicide ideation more than twice as often as nonveterans with serious mental illness. After adjusting for demographic, psychiatric, and theory-driven risk factors, the effect of veteran status on death ideation remained significant, though the effect on suicide ideation was no longer significant. Depressive and psychotic symptoms were significant predictors of death ideation; depressive symptoms and hostility were significant predictors of suicide ideation. Clinicians should particularly monitor death ideation and suicide ideation in veterans with serious mental illness, as well as associated clinical risk factors such as depression, psychotic symptoms, and hostility. (PsycINFO Database Record
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Affiliation(s)
- Danielle R Jahn
- Department of Psychiatry, University of Maryland School of Medicine
| | | | - Amy L Drapalski
- Department of Psychiatry, University of Maryland School of Medicine
| | - Clayton H Brown
- Department of Psychiatry, University of Maryland School of Medicine
| | - Li Juan Fang
- Department of Psychiatry, University of Maryland School of Medicine
| | - Alicia Lucksted
- Department of Psychiatry, University of Maryland School of Medicine
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Weissman N, Batten SV, Rheem KD, Wiebe SA, Pasillas RM, Potts W, Barone M, Brown CH, Dixon LB. The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study. Journal of Couple & Relationship Therapy 2017. [DOI: 10.1080/15332691.2017.1285261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Neil Weissman
- VA Maryland Health Care System, Balitmore, Maryland, USA
| | | | - Kathryn D. Rheem
- Washington Baltimore Center for Emotionally Focused Therapy, Falls Church, Virginia, USA
| | - Stephanie A. Wiebe
- The Ottawa Hospital, Ottawa Couple and Family Institute, Ottawa, Ontario, Canada
| | | | - Wendy Potts
- University of Maryland, Department of Psychiatry, Division of Services Research, Balitmore, Maryland, USA
| | - Melissa Barone
- VA Maryland Health Care System, Balitmore, Maryland, USA
| | - Clayton H. Brown
- VISN 5 Capitol Health Care Network MIRECC and University of Maryland, Department of Epidemiology and Public Health, Balitmore, Maryland, USA
| | - Lisa B. Dixon
- VISN 5 Capitol Health Care Network, MIRECC and University of Maryland, Department of Psychiatry, Division of Services Research, Balitmore, Maryland, USA
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Margo JA, Munir WM, Brown CH, Hoover CK. Association Between Endothelial Cell Density and Transplant Suitability of Corneal Tissue With Type 1 and Type 2 Diabetes. JAMA Ophthalmol 2017; 135:124-130. [DOI: 10.1001/jamaophthalmol.2016.5095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jordan A. Margo
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore
| | - Wuqaas M. Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore
| | - Clayton H. Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
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Kreyenbuhl J, Dixon LB, Brown CH, Medoff DR, Klingaman EA, Fang LJ, Tapscott S, Walsh MB. A Randomized Controlled Trial of a Patient-Centered Approach to Improve Screening for the Metabolic Side Effects of Antipsychotic Medications. Community Ment Health J 2017; 53:163-175. [PMID: 27061185 PMCID: PMC5909966 DOI: 10.1007/s10597-016-0007-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/03/2015] [Accepted: 04/07/2016] [Indexed: 12/30/2022]
Abstract
Adherence to recommendations for monitoring of metabolic side effects of antipsychotic medications has been historically low. This randomized controlled trial tested whether a computerized, patient-centered intervention that educated Veterans with serious mental illness about these side effects and encouraged them to advocate for receipt of monitoring would increase rates of monitoring compared to enhanced treatment as usual. The mean proportion of days adherent to monitoring guidelines over the 1-year study was similarly high and did not differ between the intervention (range 0.81-0.98) and comparison (range 0.76-0.96) groups. Many individuals in both groups had persistent abnormal metabolic parameter values despite high rates of monitoring, contact with medical providers, and receipt of cardiometabolic medications. Participants exposed to the intervention were interested in receiving personalized information about their cardiometabolic status, demonstrating the preliminary feasibility of brief interventions for enhancing involvement of individuals with serious mental illness in health care decision making.
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Affiliation(s)
- Julie Kreyenbuhl
- U.S. Department of Veterans Affairs Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), 10 North Greene Street (BT/MIRECC), Baltimore, MD, 21201, USA. .,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Lisa B Dixon
- Department of Psychiatry, Center for Practice Innovations, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Clayton H Brown
- U.S. Department of Veterans Affairs Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), 10 North Greene Street (BT/MIRECC), Baltimore, MD, 21201, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deborah R Medoff
- U.S. Department of Veterans Affairs Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), 10 North Greene Street (BT/MIRECC), Baltimore, MD, 21201, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Klingaman
- U.S. Department of Veterans Affairs Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), 10 North Greene Street (BT/MIRECC), Baltimore, MD, 21201, USA
| | - Li Juan Fang
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephanie Tapscott
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mary Brighid Walsh
- U.S. Department of Veterans Affairs Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), 10 North Greene Street (BT/MIRECC), Baltimore, MD, 21201, USA
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Hack SM, Muralidharan A, Brown CH, Lucksted AA, Patterson J. Provider and Consumer Behaviors and their Interaction for Measuring Person-Centered Care. Int J Pers Cent Med 2017; 7:14-20. [PMID: 31452868 PMCID: PMC6709667] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Current research has found that higher rates of person-centered care (PCC) are associated with greater treatment adherence and positive treatment outcomes. However, the instruments used to access PCC primarily collect data on provider behavior, rather than consumer participation in PCC, despite the necessary co-equal and collaborative nature of PCC interactions. OBJECTIVES The objective of the current study was to test the hypotheses that: (1) the Perceived Involvement in Care Scale (PICS) consumer information subscale and the consumer decision making subscale are not correlated with the PPPC subscales and, (2) consumer perceptions of person-centeredness and of consumer involvement in care are significant independent explanatory variables for the theoretically or quantitatively grounded outcomes of therapeutic alliance, treatment adherence, and mental health care system mistrust. METHODS Cross-sectional survey data was collected from 82 mental health care consumers receiving services at two Veterans Health Administration (VHA) facilities. Participants completed surveys on perceptions of PCC, consumer involvement in care, therapeutic alliance, medication adherence, and mental health care system mistrust. RESULTS Significant correlation between the consumer participation and PCC subscales was mixed. Higher levels of PCC were associated with greater therapeutic alliance, less suspicion of mental health care systems, less perception of lack of support from providers, and less beliefs about group disparities in care. Consumer involvement was only significantly related to suspicion of mental health care systems. DISCUSSION AND CONCLUSIONS These findings may be a function of the locus of each outcome variable. When conducting PCC research investigators should consider how the outcomes they are examining inform the method through which they measure patient-centeredness.
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Affiliation(s)
- Samantha M Hack
- Veterans Affairs Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, USA
- University of Maryland School of Social Work, Baltimore, USA
| | - Anjana Muralidharan
- Veterans Affairs Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, USA
| | - Clayton H Brown
- Veterans Affairs Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, USA
- University of Maryland School of Medicine, Baltimore, USA
| | | | - Jennifer Patterson
- Veterans Health Administration Office of Patient Centered Care and Cultural Transformation, USA
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Ladyman SR, Augustine RA, Scherf E, Phillipps HR, Brown CH, Grattan DR. Attenuated hypothalamic responses to α-melanocyte stimulating hormone during pregnancy in the rat. J Physiol 2016; 594:1087-101. [PMID: 26613967 DOI: 10.1113/jp271605] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/23/2015] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Increased appetite and weight gain occurs during pregnancy, associated with development of leptin resistance, and satiety responses to the anorectic peptide α-melanocyte stimulating hormone (α-MSH) are suppressed. This study investigated hypothalamic responses to α-MSH during pregnancy, using c-fos expression in specific hypothalamic nuclei as a marker of neuronal signalling, and in vivo electrophysiology in supraoptic nucleus (SON) oxytocin neurons, as a representative α-MSH-responsive neuronal population that shows a well-characterised α-MSH-induced inhibition of firing. While icv injection of α-MSH significantly increased the number of c-fos-positive cells in the paraventricular, supraoptic, arcuate and ventromedial hypothalamic nuclei in non-pregnant rats, this response was suppressed in pregnant rats. Similarly, SON oxytocin neurons in pregnant rats did not demonstrate characteristic α-MSH-induced inhibition of firing that was observed in non-pregnant animals. Given the known functions of α-MSH in the hypothalamus, the attenuated responses are likely to facilitate adaptive changes in appetite regulation and oxytocin secretion during pregnancy. ABSTRACT During pregnancy, a state of positive energy balance develops to support the growing fetus and to deposit fat in preparation for the subsequent metabolic demands of lactation. As part of this maternal adaptation, the satiety response to the anorectic peptide α-melanocyte stimulating hormone (α-MSH) is suppressed. To investigate whether pregnancy is associated with changes in the response of hypothalamic α-MSH target neurons, non-pregnant and pregnant rats were treated with α-MSH or vehicle and c-fos expression in hypothalamic nuclei was then examined. Furthermore, the firing rate of supraoptic nucleus (SON) oxytocin neurons, a known α-MSH responsive neuronal population, was examined in non-pregnant and pregnant rats following α-MSH treatment. Intracerebroventricular injection of α-MSH significantly increased the number of c-fos-positive cells in the paraventricular, arcuate and ventromedial hypothalamic nuclei in non-pregnant rats, but no significant increase was observed in any of these regions in pregnant rats. In the SON, α-MSH did induce expression of c-fos during pregnancy, but this was significantly reduced compared to that observed in the non-pregnant group. Furthermore, during pregnancy, SON oxytocin neurons did not demonstrate the characteristic α-MSH-induced inhibition of firing rate that was observed in non-pregnant animals. Melanocortin receptor mRNA levels during pregnancy were similar to non-pregnant animals, suggesting that receptor down-regulation is unlikely to be a mechanism underlying the attenuated responses to α-MSH during pregnancy. Given the known functions of α-MSH in the hypothalamus, the attenuated responses will facilitate adaptive changes in appetite regulation and oxytocin secretion during pregnancy.
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Affiliation(s)
- S R Ladyman
- Department of Anatomy and Centre for Neuroendocrinology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
| | - R A Augustine
- Department of Physiology and Centre for Neuroendocrinology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
| | - E Scherf
- Department of Anatomy and Centre for Neuroendocrinology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
| | - H R Phillipps
- Department of Anatomy and Centre for Neuroendocrinology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
| | - C H Brown
- Department of Physiology and Centre for Neuroendocrinology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
| | - D R Grattan
- Department of Anatomy and Centre for Neuroendocrinology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
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Hack SM, Medoff DR, Brown CH, Fang L, Dixon LB, Klingaman EA, Park SG, Kreyenbuhl JA. Predictors of patient communication in psychiatric medication encounters among veterans with serious mental illnesses. Psychiatr Rehabil J 2016; 39:183-186. [PMID: 27159111 DOI: 10.1037/prj0000192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/08/2022]
Abstract
OBJECTIVE Person-centered psychiatric services rely on consumers actively sharing personal information, opinions, and preferences with their providers. This research examined predictors of consumer communication during appointments for psychiatric medication prescriptions. METHODS The Roter Interaction Analysis System was used to code recorded Veterans Affairs psychiatric appointments with 175 consumers and 21 psychiatric medication prescribers and categorize communication by purpose: biomedical, psychosocial, facilitation, or rapport-building. RESULTS Regression analyses found that greater provider communication, symptomology, orientation to psychiatric recovery, and functioning on the Repeatable Battery for the Assessment of Neuropsychological Status Attention and Language indices, as well as consumer diagnostic label, were positive predictors of consumer communication, though the types of communication impacted varied. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Provider communication is the easiest variable to intervene on to create changes in consumer communication. Future research should also consider how cognitive and symptom factors may impact specific types of consumer communication in order to identify subgroups for targeted interventions. (PsycINFO Database Record
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Affiliation(s)
- Samantha M Hack
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center
| | - Deborah R Medoff
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center
| | - Clayton H Brown
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center
| | - Lijuan Fang
- Department of Psychiatry, University of Maryland School of Medicine
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Medical Center
| | - Elizabeth A Klingaman
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center
| | - Stephanie G Park
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center
| | - Julie A Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center
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Augustine RA, Bouwer GT, Seymour AJ, Grattan DR, Brown CH. Reproductive Regulation of Gene Expression in the Hypothalamic Supraoptic and Paraventricular Nuclei. J Neuroendocrinol 2016; 28. [PMID: 26670189 DOI: 10.1111/jne.12350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/21/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/27/2022]
Abstract
Oxytocin secretion is required for successful reproduction. Oxytocin is synthesised by magnocellular neurones of the hypothalamic supraoptic and paraventricular nuclei and the physiological demand for oxytocin synthesis and secretion is increased for birth and lactation. Therefore, we used a polymerase chain reaction (PCR) array screen to determine whether genes that might be important for synthesis and/or secretion of oxytocin are up- or down-regulated in the supraoptic and paraventricular nuclei of late-pregnant and lactating rats, compared to virgin rats. We then validated the genes that were most highly regulated using real time-quantitative PCR. Among the most highly regulated genes were those that encode for suppressors of cytokine signalling, which are intracellular inhibitors of prolactin signalling. Prolactin receptor activation changes gene expression via phosphorylation of signal transducer and activator of transcription 5 (STAT5). Using double-label immunohistochemistry, we found that phosphorylated STAT5 was expressed in almost all oxytocin neurones of late-pregnant and lactating rats but was almost absent from oxytocin neurones of virgin rats. We conclude that increased prolactin activation of oxytocin neurones might contribute to the changes in gene expression by oxytocin neurones required for normal birth and lactation.
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Affiliation(s)
- R A Augustine
- Centre for Neuroendocrinology and Department of Physiology, University of Otago, Dunedin, New Zealand
| | - G T Bouwer
- Centre for Neuroendocrinology and Department of Physiology, University of Otago, Dunedin, New Zealand
| | - A J Seymour
- Centre for Neuroendocrinology and Department of Physiology, University of Otago, Dunedin, New Zealand
| | - D R Grattan
- Centre for Neuroendocrinology and Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - C H Brown
- Centre for Neuroendocrinology and Department of Physiology, University of Otago, Dunedin, New Zealand
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Maícas Royo J, Brown CH, Leng G, MacGregor DJ. Oxytocin Neurones: Intrinsic Mechanisms Governing the Regularity of Spiking Activity. J Neuroendocrinol 2016; 28. [PMID: 26715365 PMCID: PMC4879516 DOI: 10.1111/jne.12358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/11/2015] [Accepted: 12/26/2015] [Indexed: 12/15/2022]
Abstract
Oxytocin neurones of the rat supraoptic nucleus are osmoresponsive and, with all other things being equal, they fire at a mean rate that is proportional to the plasma sodium concentration. However, individual spike times are governed by highly stochastic events, namely the random occurrences of excitatory synaptic inputs, the probability of which is increased by increasing extracellular osmotic pressure. Accordingly, interspike intervals (ISIs) are very irregular. In the present study, we show, by statistical analyses of firing patterns in oxytocin neurones, that the mean firing rate as measured in bins of a few seconds is more regular than expected from the variability of ISIs. This is consistent with an intrinsic activity-dependent negative-feedback mechanism. To test this, we compared observed neuronal firing patterns with firing patterns generated by a leaky integrate-and-fire model neurone, modified to exhibit activity-dependent mechanisms known to be present in oxytocin neurones. The presence of a prolonged afterhyperpolarisation (AHP) was critical for the ability to mimic the observed regularisation of mean firing rate, although we also had to add a depolarising afterpotential (DAP; sometimes called an afterdepolarisation) to the model to match the observed ISI distributions. We tested this model by comparing its behaviour with the behaviour of oxytocin neurones exposed to apamin, a blocker of the medium AHP. Good fits indicate that the medium AHP actively contributes to the firing patterns of oxytocin neurones during non-bursting activity, and that oxytocin neurones generally express a DAP, even though this is usually masked by superposition of a larger AHP.
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Affiliation(s)
- J Maícas Royo
- Centre for Integrative Physiology, University of Edinburgh, Edinburgh, UK
| | - C H Brown
- Centre for Neuroendocrinology and Department of Physiology, University of Otago, Otago, New Zealand
| | - G Leng
- Centre for Integrative Physiology, University of Edinburgh, Edinburgh, UK
| | - D J MacGregor
- Centre for Integrative Physiology, University of Edinburgh, Edinburgh, UK
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Klingaman EA, Medoff DR, Park SG, Brown CH, Fang L, Dixon LB, Hack SM, Tapscott SL, Walsh MB, Kreyenbuhl JA. Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship. Psychiatr Rehabil J 2015; 38:242-8. [PMID: 25664755 PMCID: PMC5909963 DOI: 10.1037/prj0000114] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 11/08/2022]
Abstract
OBJECTIVE Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of this study was to explore how dimensions of consumer preferences for shared decision making (i.e., preferences for obtaining knowledge about one's mental illness, being offered and asked one's opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction. METHODS Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction. RESULTS Preferences for involvement in treatment decisions was the unique component of shared decision making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE When consumers with serious mental illnesses express preferences to be involved in shared decision making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers' interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision making should occur within the context of a strong therapeutic relationship.
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Affiliation(s)
- Elizabeth A Klingaman
- Mental Illness Research, Education, and Clinical Center, VA Capitol Health Care Network (VISN 5)
| | - Deborah R Medoff
- Department of Psychiatry, University of Maryland School of Medicine
| | | | | | - Lijuan Fang
- Department of Psychiatry, University of Maryland School of Medicine
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Oswald LM, Wand GS, Wong DF, Brown CH, Kuwabara H, Brašić JR. Risky decision-making and ventral striatal dopamine responses to amphetamine: a positron emission tomography [(11)C]raclopride study in healthy adults. Neuroimage 2015; 113:26-36. [PMID: 25795343 PMCID: PMC4433778 DOI: 10.1016/j.neuroimage.2015.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/05/2015] [Accepted: 03/10/2015] [Indexed: 02/06/2023] Open
Abstract
Recent functional magnetic resonance imaging (fMRI) studies have provided compelling evidence that corticolimbic brain regions are integrally involved in human decision-making. Although much less is known about molecular mechanisms, there is growing evidence that the mesolimbic dopamine (DA) neurotransmitter system may be an important neural substrate. Thus far, direct examination of DA signaling in human risk-taking has centered on gambling disorder. Findings from several positron emission tomography (PET) studies suggest that dysfunctions in mesolimbic DA circuits may play an important role in gambling behavior. Nevertheless, interpretation of these findings is currently hampered by a need for better understanding of how individual differences in regional DA function influence normative decision-making in humans. To further our understanding of these processes, we used [(11)C]raclopride PET to examine associations between ventral striatal (VS) DA responses to amphetamine (AMPH) and risky decision-making in a sample of healthy young adults with no history of psychiatric disorder, Forty-five male and female subjects, ages 18-29 years, completed a computerized version of the Iowa Gambling Task. Participants then underwent two 90-minute PET studies with high specific activity [(11)C]raclopride. The first scan was preceded by intravenous saline; the second, by intravenous AMPH (0.3mg/kg). Findings of primary analyses showed that less advantageous decision-making was associated with greater right VS DA release; the relationship did not differ as a function of gender. No associations were observed between risk-taking and left VS DA release or baseline D2/D3 receptor availability in either hemisphere. Overall, the results support notions that variability in striatal DA function may mediate inter-individual differences in risky decision-making in healthy adults, further suggesting that hypersensitive DA circuits may represent a risk pathway in this population.
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Affiliation(s)
- Lynn M Oswald
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA; Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Gary S Wand
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Dean F Wong
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Environmental Health Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Hiroto Kuwabara
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - James R Brašić
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Bennett ME, Brown CH, Li L, Himelhoch S, Bellack A, Dixon L. Smoking Cessation in Individuals With Serious Mental Illness: A Randomized Controlled Trial of Two Psychosocial Interventions. J Dual Diagn 2015; 11:161-73. [PMID: 26457385 PMCID: PMC7258306 DOI: 10.1080/15504263.2015.1104481] [Citation(s) in RCA: 9] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Smoking among individuals with serious mental illness is a critical public health problem. Although guidelines recommend bupropion for these smokers, many do not want to use medications for smoking cessation, express ambivalence about identifying a "quit date," and do not have access to behavioral smoking cessation services integrated with mental health care. METHODS Individuals with serious mental illness who smoked 10 or more cigarettes per day (N = 178) were randomized to either a multifaceted behavioral group intervention or a supportive group intervention, both of which were integrated within outpatient mental health services at three VA medical centers. Participants attended twice-weekly meetings for 12 weeks, provided information on their smoking at each meeting, and completed baseline and post-treatment assessments conducted by an assessor who was blind to condition. Primary outcomes collected at post-treatment included 1-week abstinence, number of cigarettes smoked per day during the last week, and number of quit attempts during the treatment period. Outcomes examined for a subset of participants who attended at least one intervention meeting (n = 152) included smoking abstinence for 1-, 2-, and 4-week blocks during the treatment period. Analyses conducted on those participants who attended three or more intervention meetings (n = 127) included time to 50% reduction in the number of cigarettes smoked and time to first quit attempt. RESULTS Sixteen participants achieved abstinence (11.8%), smoking quantity was significantly reduced (baseline M = 15.2, SD = 9.8 to post-treatment M = 7.5, SD = 7.7, p <.0001), and most reported making a quit attempt (n = 88, 72.7%). There were no differences by study condition on any abstinence or reduction outcomes. Significant reductions in number of cigarettes smoked generally took place within the first two weeks; however, these reductions did not often translate into abstinence. CONCLUSIONS Many participants reduced their smoking and sampled quitting during the study. Implementing smoking cessation services in mental health treatment settings is feasible and, if delivered in line with best practices, either a behavioral or a supportive approach can be helpful. Future research should examine ways to facilitate the transition from reduction to abstinence. This study was part of a clinical trial registered as NCT #00960375 at www.clinicaltrials.gov.
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Affiliation(s)
- Melanie E Bennett
- a VA VISN 5 Mental Illness Research, Education, and Clinical Center , Baltimore , Maryland , USA.,b Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Clayton H Brown
- a VA VISN 5 Mental Illness Research, Education, and Clinical Center , Baltimore , Maryland , USA.,d Department of Epidemiology and Public Health , University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Lan Li
- b Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Seth Himelhoch
- a VA VISN 5 Mental Illness Research, Education, and Clinical Center , Baltimore , Maryland , USA.,b Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Alan Bellack
- b Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Lisa Dixon
- a VA VISN 5 Mental Illness Research, Education, and Clinical Center , Baltimore , Maryland , USA.,c Columbia University Medical Center , New York , New York , USA
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Brown CH, Medoff D, Dickerson FB, Fang LJ, Lucksted A, Goldberg RW, Kreyenbuhl J, Himelhoch S, Dixon LB. Factors influencing implementation of smoking cessation treatment within community mental health centers. J Dual Diagn 2015; 11:145-50. [PMID: 25985201 PMCID: PMC4727176 DOI: 10.1080/15504263.2015.1025025] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Consumers with serious mental illness smoke more and are at higher risk for smoking-related illness. We examined provider and consumer factors influencing the implementation of the evidence-based "5 A's" (ask, advise, assess, assist, arrange) in six community mental health centers in greater Baltimore. METHODS Data collected as part of a larger study examining the effectiveness of delivery of the 5 A's at patient visits. First, we examined responses to a survey administered to 49 clinicians on barriers and attitudes toward delivering the 5 A's. Second, we used multilevel models to examine variance between patients (n = 228), patient factors, and variance between their psychiatrists (n = 28) in the delivery of the 5 A's (and first 3 A's). RESULTS The most strongly endorsed barrier was perceived lack of patient interest in smoking cessation. Psychiatrists and patients both accounted for significant variance in the delivery of the 5 A's and 3 A's. Patient "readiness to change" predicted delivery of the full 5 A's, while smoking severity predicted delivery of the first 3 A's. CONCLUSIONS There is a critical need for creative and collaborative solutions, policies, and clinician training to address actual and perceived obstacles to the delivery of evidence-based smoking cessation treatment in the mental health care setting.
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