Testing the relationship between a self-management intervention for recurrent depression and health outcomes

BackgroundDepression is a leading cause of disability globally. It is a recurrent chronic illness that affects over three million people worldwide. Self-management has been found to positively impact depression outcomes but few techniques or interventions are theory-based and can be used either with or without the support of mental health care providers.ObjectivesThis study aimed to test the relationship between a self-management intervention called the Self-Regulated Illness Management of Depression (SRIM-D) intervention and specific health outcomes (depression, self-efficacy, social support and quality of life). SRIM-D was developed using metacognition and self-regulation theories.Sample and settingTwenty-three individuals with major depressive disorder (MDD) participated in the study. Individuals over 21 years of age without a diagnosis of bipolar disorder, current substance abuse problem or suicidal ideations who suffered from MDD (BDI-II < 19) were considered for the study.MethodsThe intervention was delivered over three consecutive weeks of 1 ½ hour sessions by two PhD prepared nurses with psychiatric experience. Participants were given a workbook manual with corresponding power point presentations conferring information about depression, and were led through a series of workbook activities designed to teach the self-regulation process as applied to their recurrent depression. Health outcomes were assessed via self-report survey prior to and six-month post-intervention.ResultsSix months post-intervention depressive symptoms decreased significantly (M = 6.62, SD = 14.76, t(15) = 5.60, p < .0001). Self-efficacy (M = 161.67, SD = 25.27); t(20) = −2.89, p < .01) and quality of life (13.25, SD = 3.61; t(19) = 2.62, p > .01) both improved significantly.Social support had a negligible, insignificant decrease from pre-intervention (M = 53.05, SD = 19.81) to six months post-intervention (M = 42.14, SD = 19.53).ConclusionsOverall, the SRIM-D intervention improved health outcomes in this study. The intervention demonstrated applicability to people with recurrent, chronic depression who might or might not have access to care.     

Coronary artery calcium scoring in patients with statin associated muscle symptoms: Prescribing statins for those most likely to benefit

For primary prevention, statin therapy reduces the incidence of atherosclerotic cardiovascular disease (ASCVD) events in adults with intermediate or high estimated 10-year risk using traditional population-based risk calculators. While a variety of reported symptoms may limit statin adherence, muscle complaints, whether typical or atypical of that associated with statin therapy, are the most common reported by patients. Because additional testing, alteration in the patient's medical regimen and subsequent medical visits are often required, an informed clinician-patient discussion and shared decision making are necessary to achieve the best outcomes. The authors provide support for the perspective that coronary calcium scoring, by individualizing estimated risk and helping to identify those most likely to benefit, plays a vital role in preventive therapy decision-making for the primary prevention patient with troublesome muscle complaints attributed to statin therapy.     

Community-dwelling older adults who are low-income and disabled weathering financial challenges

Despite interventions aiming to improve outcomes among older adults experiencing financial challenges, the challenges and strategies employed to handle them are poorly understood. This study examined the experiences of financial challenges among low-income adults aged ≥65 years. Eleven semi-structured interviews were analyzed using thematic analyses. An overarching theme was “I guess it balances”, capturing attempts to maintain hope and proactively address challenges despite stress, uncertainty and limitations. Balancing was demonstrated within four domains, including cognitive bandwidth (“think a lot” versus “I don't dwell on that”), emotional experience (“depressing” versus “be thankful”), learned resilience (“that was a shock” versus “there's always a way”), and meeting daily needs (“we learned to do without” versus “take a dollar and stretch it”). Participants described being weathered by challenges and using predominately high-effort coping strategies to weather the challenges. These findings call for strengthening the safety net for older adults facing financial challenges.     

“Impact of Nociception Level (NOL) index intraoperative guidance of fentanyl administration on opioid consumption,postoperative pain scores and recovery in patients undergoing gynecological laparoscopic surgery. A randomized controlled trial”

Study objectiveThe Nociception Level (NOL) index uses a multiparametric approach to measure the balance between sympathetic and parasympathetic systems activity. Recently, a strong correlation between the NOL index response to nociceptive stimuli and the level of opioid analgesia during surgery was reported. Others observed that intraoperative doses of remifentanil and sufentanil were reduced when the NOL index was used. So far, no study has evaluated the impact of NOL-guided fentanyl antinociception in laparoscopic gynecological surgery. The primary hypothesis of this present study was to evaluate whether intraoperative NOL-guided fentanyl administration would reduce intra-operative opioid consumption. Secondary hypotheses were to assess whether this would lead to lower postoperative opioid consumption and pain scores, as well as improved postoperative outcomes.SettingUniversity hospital, operating room.Patients70 adult patients, ASA 1–3, scheduled for total laparoscopic hysterectomy.InterventionsPatients were randomized into 2 groups: SOC (standardization of care) and NOL (using the NOL index to guide the administration of fentanyl). The depth of anesthesia was monitored with BIS™. Intraoperative fentanyl boluses were administered based on heart rate and mean arterial pressure variations in the SOC group, and NOL index for the NOL group.MeasurementsFentanyl total intraoperative dose administered was collected and also averaged per hour. Pain scores and hydromorphone consumption were assessed in the post-anesthesia care unit and up to 24 h.Main resultsSixty-six patients completed the study, 33 in each group. Total intraoperative fentanyl administration was not different between the two groups (217 (70) in the NOL group vs 280 (210) in the SOC group (P = 0.11)). Nevertheless, intraoperative fentanyl administration per hour was reduced by 25% in the NOL-guided group compared to the SOC group: 81 (24) vs 108 (66) μg.h⁻¹, respectively (P = 0.03). Hydromorphone consumption and pain scores in the post-anesthesia care unit and at 24 h were not significantly different between the two groups.ConclusionNOL-guided analgesia allowed for a 22% reduction of the total amount of intraoperative fentanyl which was not significant. Nevertheless, results reported a significant reduction by 25% in the doses of fentanyl averaged per hour of surgery and administered in the NOL-guided group compared with the standardized practice in laparoscopic gynecological surgery. The pain measured postoperatively was similar in the two groups while the average postoperative consumption of opioids to achieve the same level of pain scores in post-anesthesia care unit and at 24 h was not significantly reduced. Further larger multicenter studies centered towards postoperative outcomes are needed.     

Natural history and risk factors of long-term mortality in acute coronary syndrome patients with cardiogenic shock

PurposeCardiogenic shock (CS) is a severe complication of acute coronary syndromes (ACS). Intra-aortic balloon pump (IABP) is considered important mechanical therapy for acute CS. We aimed to analyze the natural history and possible prognostic factors in patients with CS complicating ACS.Patients/methodsAll 126 patients (mean age 65.8 ± 12.5 years), who were hospitalized in single center due to an episode of CS in the course of ACS, had IABP and were scheduled for coronary angiography. The assessed end-point was 5-year death from any cause.ResultsMedian left ventricle ejection fraction (LVEF) 28% (interquartile range (IQR) 23–35%), 39 patients (31%) were female, in 91 (72%) the initial diagnosis was ST-elevation myocardial infarction (STEMI). Mean time on the IABP was 3.8 ± 3 days. During index hospitalization there were 56 deaths (44%). Other 27 patients (out of 70 discharged – 38.5%) died during 5-year follow-up. In univariate logistic regression, the significant effect on long term mortality had age, female gender, reduced ejection fraction below 31% and hypotension on admission. The out of hospital survival was also determined by age, gender and hypotension, while LVEF lost its predictive value The multivariate survival analysis both in whole group and in patients discharged from hospital was independently affected by age and hypotension on the admission.ConclusionsThe mortality of patients with CS despite treatment with IABP remains very high, especially during the in-hospital period and early after discharge. Among assessed parameters age and hypotension on the admission are the most important predictors of adverse long term prognosis.     

Complementary and alternative medicine among hospitalized pediatric patients

ObjectivesTo estimate the prevalence and describe the characteristics of complementary and alternative medicine (CAM) use among hospitalized children, and to discover the awareness of medical staff regarding CAM use.Design/SettingParents of children aged 0–18 years admitted to the Pediatric Division at Assaf Harofeh Medical Center in Israel between January and July of 2015 (n = 146) were provided a questionnaire regarding socio-economic status and evaluating the CAM use. The medical charts of the participants were reviewed in order to establish whether or not CAM use was documented.ResultsOf those who completed the questionnaire, 78 (54.3%) were using CAM. The major indications for CAM use were colic and teething. CAM use was advised by the family in 44.9%, physician 34.6%, pharmacist 34.6%, friends 30.8%, previous experience 23.1, advertisements 18%, nurses 6.4%, and homeopaths 2.6%. The family physician was aware of CAM use was in 42%. During the admission, only 5 patients were asked about CAM use (3.4%) by the medical staff. Reviewing the medical charts revealed there was no documentation of CAM use in any of the participants. Socio-demographic analysis of our population revealed no differences between users and non users of CAM, but significant differences in belief in CAM (p = 0.018) were found. CAM use was age related; the older the child the less the use (p = 0.010).ConclusionCAM use is common among hospitalized pediatric patients and is often overlooked by the medical staff. CAM use should be included in the medical history.