Dissemination of exposure therapy in the treatment of posttraumatic stress disorder

Since the introduction of posttraumatic stress disorder (PTSD) into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980), considerable research has demonstrated the efficacy of several cognitive-behavioral therapy (CBT) programs in the treatment of chronic PTSD. Among these efficacious treatments is exposure therapy. Despite all the evidence for the efficacy of exposure therapy and other CBT programs, few therapists are trained in these treatments and few patients receive them. In this article, the authors review extant evidence on the reasons that therapists do not use these treatments and recent research on the dissemination of efficacious treatments of PTSD.     

Complicated Grief,Depression, Health and Attachment Style in First Degree Relatives of Individuals with a Chronic Psychotic Disorders

Complicated grief (CG) is a form of unrelenting grief after the death of a loved one. However, family members of individuals who suffer from Schizophrenia, Schizoaffective disorders and Bipolar disorder may experience symptoms of CG even though their loved one is still alive. The present study assessed CG and risk factors for CG in first degree relatives of individuals with severe chronic mental illness. The incidence of CG was examined in 78 parents, siblings, adult children and spouses recruited through organizations and social media that provide support services for individuals suffering from mental illness and their families. High rates of CG (39.7%) were found in this group. CG was associated with a higher prevalence of posttraumatic and depression symptoms and poorer physical health. These findings may contribute to heightening therapists' awareness of the importance of assessing, acknowledging and resolving CG in the family members of patients with chronic psychotic disorders.

     

Radiology department,human factors and organizational perspectives: using action research to improve patient safety

Background

Action research is a participatory research method based on active cooperation between researchers and subjects. In clinical practice, action research enables active involvement of workers in developing and implementing actions promoting patient safety. This article describes a participatory action research project that was conducted in the radiology department of a tertiary care university hospital. The main objectives were: identifying potential adverse events in the department of radiology, and offering a proactive approach to improving patient safety.

Methods

Phase one of the study included observing 100 patients in three units of the department and identifying potential adverse events using an observation form. According to the data obtained from the observations, multidisciplinary research teams developed and initiated, together with front-line workers, four types of interventions: ergonomic interventions in work environment design, interventions in work procedure and task design, training and guidance, and managerial interventions. Phase two included evaluation of the interventions after six months of implementation.

Results

Results showed different weaknesses in each of the three radiology units tested, including incomplete medical information necessary for performing the radiological procedure, and discontinuity of care. Post-intervention observations showed a significant reduction in the prevalence of potential adverse events. At the Angiography unit, potential adverse events related to incomplete medical information dropped from 50% to 32%, and at the CT unit they dropped from 70% to 23%. At the MRI unit potential adverse events related to discontinuity of care dropped from 61% to 19%.

Conclusions

The current study demonstrates the value of action research in non-hospitalizing health units and the benefits of cooperation between medical teams and human factor professionals in promoting patient safety. Methods similar to those described in the current paper are applicable to medical work teams in a broad range of practices.

     

Translation of Hecker's 1922 “the occipital–atlanto–axial ligament system”: A study in comparative anatomy

In 1922, Paul Hecker, a French physician and Head of Anatomy at the Medical College of Strasbourg, published a sentinel thesis on the ligaments of the craniocervical junction based on a study of comparative anatomy. Unfortunately, this dissertation has been lost to history and until now, was unavailable in the English language. Herein, we present a translation of Hecker's work with an update in its nomenclature, which with modern imaging capabilities of the craniocervical junction is germane and timely. Clin. Anat. 30:322–329, 2017. © 2017 Wiley Periodicals, Inc.     

Glucose tolerance factor extracted from yeast: oral insulin-mimetic and insulin-potentiating agent: in vivo and in vitro studies

In search for an effective oral treatment for diabetes, we examined the capacity of glucose tolerance factor (GTF) extracted from yeast and administered orally to reduce hyperglycaemia in rat models exhibiting insulin deficiency. The cellular effect of GTF on the insulin signalling pathway was investigated in vitro. GTF (oral bolus), insulin (intraperitoneal) or their combination was administered to streptozotocin-diabetic (STZ) or hyperglycaemic Cohen diabetic-sensitive (hyp-CDs) rats. Blood glucose (BG) and insulin levels were measured in the postprandial (PP) state and during an oral glucose tolerance test. Deoxy-glucose transport and insulin signal transduction were assessed in 3T3-L1 adipocytes and myoblasts incubated with the GTF. Low dose of insulin produced a 34 and 12·5?% reduction in the PP-BG levels of hyp-CDs and STZ rats, respectively. GTF induced a 33 and 17?% reduction in the PP-BG levels of hyp-CDs and STZ rats, respectively. When combined with insulin, a respective decrease (58 and 42?%) in BG levels was observed, suggesting a partially additive (hyp-CDs) or synergistic (STZ rats) effect of the GTF and insulin. GTF did not induce insulin secretion in hyp-CDs rats, yet it lowered their BG levels, proposing an effect on glucose clearance by peripheral tissues. GTF induced a dose-dependent increase in deoxy-glucose transport into myoblasts and fat cells similar to insulin, while the combined treatment resulted in augmented transport rate. GTF induced a dose- and time-dependent phosphorylation of insulin receptor substrate 1, Akt and mitogen-activated protein kinase independent of insulin receptor phosphorylation. GTF exerts remarkable insulin-mimetic and insulin-potentiating effects, both in vivo and in vitro. It produces an insulin-like effect by acting on cellular signals downstream of the insulin receptor. These results demonstrate a potential source for a novel oral medication for diabetes.     

Ecoepidemiology of cutaneous leishmaniasis outbreak, Israel

A total of 161 cases of cutaneous leishmaniasis caused by Leishmania tropica occurred in the Jerusalem district during 2004-2005; 127 (79%) cases were in a town just outside Jerusalem. Environmental models suggest that in the context of global warming, this outbreak has the potential to extend into Jerusalem.     

Novel fluorescent oxygen indicator for intracellular oxygen measurements

Intracellular oxygen concentration is of primary importance in determining numerous physiological and pathological processes in biological systems. In this paper, we describe the application of the oxygen sensing indicator, ruthenium dibipyridine 4-(1"-pyrenyl)-2,2'-bipyridine chloride [Ru(bpy-pyr)(bpy)(2)], for molecular oxygen measurement in J774 murine macrophages. Ru(bpy-pyr)(bpy)(2) exhibits strong visible absorption, efficient fluorescence, long excited state lifetime, large Stokes shift, and high photo- and chemical stability. The fluorescence of Ru(bpy-pyr)(bpy)2 is efficiently quenched by molecular oxygen. It is 13 fold higher in a nitrogenated solution than in an oxygenated one. The dye passively permeates into cells and maintains its oxygen sensitivity for at least 5 h when the cells are stored in a phosphate buffered saline solution at pH 7.4. The oxygen sensitivity, photostability, and chemical stability of the indicator and the effect of hypoxia and hyperoxia on the intracellular oxygen level in single macrophages are discussed.     

First polar body and nucleolar precursor body morphology is related to the ovarian reserve of infertile women

This study was undertaken in order to gain insight into the morphology of the first polar body (PB1) and the two pronuclei (2PN) in ICSI patients, specifically the nucleolar precursor bodies (NPB). Whether early abnormalities in these structures are related to the ovarian reserve of infertile women was also studied. Eighty consecutive infertile women were prospectively investigated throughout their first ICSI cycles. Basal ovarian reserve studies were performed in all women. Cycles were evaluated with respect to PB1 and 2PN morphology of the transferred embryos. Cycles that had at least one transferred embryo with normal PB1 and 2PN morphology had significantly better basal ovarian reserve parameters compared with cycles in which all transferred embryos had abnormal PB1 and 2PN morphology. Moreover, the normal morphology group performed significantly better throughout the ovarian stimulation, compared with the abnormal morphology group. Furthermore, the clinical implantation and pregnancy rates were significantly higher in the normal compared with the abnormal morphology group, corresponding to 20.7% versus 10.6% and 42.4% versus 18.2%, respectively. The study concluded that the morphology of the PB1 in metaphase II oocytes as well as that of the NPB within the 2PN zygotes seems to be related to the ovarian reserve in infertile women.