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المؤلفون: Colleen Mangeot, Ndidi I. Unaka, Joanna Thomson, Dianna Moeller, Vanessa Wagner, Amanda C. Schondelmeyer, Emelia Ampomah, Angela Y. Choe, Michelle Durling
المصدر: Hosp Pediatr
مصطلحات موضوعية: Patient characteristics, Pediatrics, 03 medical and health sciences, 0302 clinical medicine, Nursing, 030225 pediatrics, Hospital discharge, Medicine, Humans, 030212 general & internal medicine, Family engagement, Child, Research Articles, Language, business.industry, Communication, Communication Barriers, Direct observation, English proficiency, General Medicine, Emergency department, Patient Discharge, Cross-Sectional Studies, Limited English proficiency, Pediatrics, Perinatology and Child Health, business, Discharge instructions
الوصف: OBJECTIVES:Effective communication is critical for safely discharging hospitalized children, including those with limited English proficiency (LEP), who are at high risk of reuse. Our objective was to describe and compare the safety and family centeredness of nurse communication at hospital discharge for English-proficient (EP) and LEP families.METHODS:In this single-center, cross-sectional study, we used direct observation of hospital discharges for EP and LEP children. Observers recorded quantitative and qualitative details of nurse-family communication, focusing on 3 domains: safe discharge, family centeredness, and family engagement. Patient characteristics and percentages of encounters in which all components were discussed within each domain were compared between EP and LEP encounters by using Fisher’s exact tests. We used field notes to supplement quantitative findings.RESULTS:We observed 140 discharge encounters; 49% were with LEP families. Nurses discussed all safe discharge components in 31% of all encounters, most frequently omitting emergency department return precautions. Nurses used all family-centered communication components in 11% and family-engagement components in 89% of all encounters. Nurses were more likely to discuss all components of safe discharge in EP encounters when compared with LEP encounters (53% vs 9%; P < .001; odds ratio: 11.5 [95% confidence interval 4.4–30.1]). There were no differences in family centeredness or family engagement between LEP and EP encounters.CONCLUSIONS:Discharge encounters of LEP patients were less likely to include all safe discharge communication components, compared with EP encounters. Opportunities to improve nurse-family discharge communication include providing written discharge instructions in families’ primary language, ensuring discussion of return precautions, and using teach-back to optimize family engagement and understanding.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1197775dfce5cf37add66bd48919c7c5
https://pubmed.ncbi.nlm.nih.gov/33531376 -
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المؤلفون: Michelle Durling, Sian Cotton, Rachel S. Wasson, Jeffrey R. Strawn, Melissa P. DelBello, Richard W. Sears, Jeffrey A. Welge, Thomas J. Blom, Kristen M. Kraemer, Nina R. McCune
المصدر: Early Interv Psychiatry
مصطلحات موضوعية: Male, Bipolar Disorder, Mindfulness, Adolescent, Waiting Lists, medicine.medical_treatment, Prodromal Symptoms, Pilot Projects, Article, 03 medical and health sciences, 0302 clinical medicine, Child of Impaired Parents, Psychoeducation, Humans, Medicine, Prospective Studies, Bipolar disorder, Biological Psychiatry, Mindfulness-based cognitive therapy, Cognitive Behavioral Therapy, business.industry, Pilot trial, medicine.disease, Anxiety Disorders, Treatment period, 030227 psychiatry, Psychiatry and Mental health, Treatment Outcome, Cognitive therapy, Anxiety, Female, Pshychiatric Mental Health, medicine.symptom, business, 030217 neurology & neurosurgery, Clinical psychology
الوصف: AIM. Previous studies suggest that Mindfulness-Based Cognitive Therapy for Children (MBCT-C) is feasible and may improve anxiety and emotion regulation in youth with anxiety disorders at-risk for bipolar disorder. However, controlled studies are warranted to replicate and extend these findings. METHODS. In the current study, 24 youth with anxiety disorders who have at least one parent with bipolar disorder participated in a MBCT-C treatment period (n = 24; M(age) = 13.6, 75% girls, 79% White) with a subset also participating in a prior psychoeducation waitlist control period (n = 19 M(age) = 13.8, 68% girls, 84% White). Participants in both the waitlist and MBCT-C periods completed independently-rated symptom scales at each time point. Participants in the waitlist period received educational materials 12 weeks prior to the beginning of MBCT-C. RESULTS. There were significantly greater improvements in overall clinical severity in the MBCT-C period compared to the waitlist period, but not in clinician- and child-rated anxiety, emotion regulation or mindfulness. However, increases in mindfulness were associated with improvements in anxiety and emotion regulation in the MBCT-C period, but not the waitlist period. CONCLUSIONS. Findings suggest that MBCT-C may be effective for improving overall clinical severity in youth with anxiety disorders who are at-risk for bipolar disorder. However, waitlist controlled designs may inflate effect sizes so interpret with caution. Larger studies utilizing prospective randomized controlled designs are warranted.
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المؤلفون: Samir S. Shah, Paria M. Wilson, Amanda C. Schondelmeyer, Neera K. Goyal, David B. Haslam, Joshua D Courter, Michelle Durling, Laura Brower, Eileen Murtagh Kurowski
المصدر: Pediatrics. 144
مصطلحات موضوعية: Male, medicine.medical_specialty, Quality management, MEDLINE, Psychological intervention, Acyclovir, Run chart, medicine.disease_cause, Antiviral Agents, Humans, Medicine, Pregnancy Complications, Infectious, Retrospective Studies, business.industry, Incidence (epidemiology), Infant, Newborn, Infant, Herpes Simplex, Retrospective cohort study, Guideline, Hospitals, Pediatric, Quality Improvement, Herpes simplex virus, Practice Guidelines as Topic, Pediatrics, Perinatology and Child Health, Emergency medicine, Female, business
الوصف: OBJECTIVES: Neonatal herpes simplex virus (HSV) infections are associated with high mortality and long-term morbidity. However, incidence is low and acyclovir, the treatment of choice, carries risk of toxicity. We aimed to increase the percentage of patients 0 to 60 days of age who are tested and treated for HSV in accordance with local guideline recommendations from 40% to 80%. METHODS: This quality improvement project took place at 1 freestanding children’s hospital. Multiple plan-do-study-act cycles were focused on interventions aimed at key drivers including provider buy-in, guideline availability, and accurate identification of high-risk patients. A run chart was used to track the effect of interventions on the percentage managed per guideline recommendations over time by using established rules for determining special cause. Pre- and postimplementation acyclovir use was compared by using a χ2 test. In HSV-positive cases, delayed acyclovir initiation, defined as >1 day from presentation, was tracked as a balancing measure. RESULTS: The median percentage of patients managed according to guideline recommendations increased from 40% to 80% within 8 months. Acyclovir use decreased from 26% to 7.9% (P < .001) in non–high-risk patients but did not change significantly in high-risk patients (73%–83%; P = .15). There were no cases of delayed acyclovir initiation in HSV-positive cases. CONCLUSIONS: Point-of-care availability of an evidence-based guideline and interventions targeted at provider engagement improved adherence to a new guideline for neonatal HSV management and decreased acyclovir use in non–high-risk infants. Further study is necessary to confirm the safety of these recommendations in other settings.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1db740f36e596c86287aef31ad60add2
https://doi.org/10.1542/peds.2018-0262 -
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المؤلفون: Jing-Huei Lee, James C. Eliassen, Jonathan Dudley, Thomas J. Blom, Wen-Jang Chu, Michelle Durling, Wade Weber, Jeffrey A. Welge, Caleb M. Adler, Jeffrey R. Strawn, Richard A. Komoroski, Amanda N. Stover, Stephen M. Strakowski, Matthew M. Norris, David E. Fleck, Christina Klein, Melissa P. DelBello
المصدر: Bipolar Disorders. 18:490-501
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Bipolar Disorder, Bipolar I disorder, Emotions, Episode of Care, Lithium, Audiology, Amygdala, Article, Quetiapine Fumarate, 03 medical and health sciences, 0302 clinical medicine, Antimanic Agents, Continuous performance task, Task Performance and Analysis, medicine, Humans, Bipolar disorder, Biological Psychiatry, Psychiatric Status Rating Scales, First episode, medicine.diagnostic_test, medicine.disease, Magnetic Resonance Imaging, 030227 psychiatry, Psychiatry and Mental health, Treatment Outcome, medicine.anatomical_structure, Quetiapine, Female, medicine.symptom, Psychology, Functional magnetic resonance imaging, Mania, 030217 neurology & neurosurgery, Clinical psychology, medicine.drug
الوصف: Objectives We tested the hypothesis that, with treatment, functional magnetic resonance imaging (fMRI) regional brain activation in first-episode mania would normalize – i.e., that differences from healthy subjects would diminish over time, and would be associated with clinical remission status, potentially identifying neuroanatomic treatment response markers. Methods Forty-two participants with bipolar I disorder were recruited during their first manic episode, pseudo-randomized to open-label lithium or quetiapine, and followed for 8 weeks. fMRI scans were obtained at baseline and then after 1 and 8 weeks of treatment, while participants performed a continuous performance task with emotional distracters. Healthy participants received fMRI scans at these same intervals. Specific region-of-interest (ROI) activations within prefrontal emotional networks were assessed as potential measures of treatment response. Results ROI data were reduced using exploratory factor analysis, which identified five factors that were organizationally consistent with functional anatomic models of human emotion modulation. Half of the participants with bipolar disorder achieved remission by Week 8 and were contrasted with the other half that did not. Analyses demonstrated that, in the bipolar disorder group in general, treatment led to decreases in activation across brain regions toward healthy subject values. However, differences in activation changes were observed between subjects with bipolar disorder who did or did not achieve remission in subcortical and amygdala factors. Conclusions These findings provide evidence for potential neuroanatomic treatment response markers in first-episode bipolar disorder.
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المؤلفون: Julie B. Gomez, Angela Choe, Amanda Schondelmeyer, Joanna Thomson, Vanessa Wagner, Michelle Durling, Emelia Ampomah, Ndidi Unaka
المصدر: Pediatrics. 146:239-239
مصطلحات موضوعية: Pediatrics, Perinatology and Child Health
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::0afef6d46083c59f7c740ddbebfae179
https://doi.org/10.1542/peds.146.1ma3.239 -
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المؤلفون: Melissa P. DelBello, Caleb M. Adler, Thomas J. Blom, Lawson R. Wulsin, Jeffrey A. Welge, Robert K. McNamara, Michelle Durling, Stephen M. Strakowski
المصدر: Bipolar disorders. 20(7)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Bipolar I disorder, Bipolar Disorder, Young Mania Rating Scale, Body Mass Index, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, mental disorders, Fatty Acids, Omega-3, medicine, Humans, Bipolar disorder, Biological Psychiatry, Depression (differential diagnoses), Triglycerides, Metabolic Syndrome, Psychiatric Status Rating Scales, Psychotropic Drugs, business.industry, Middle Aged, medicine.disease, Lipid Metabolism, 030227 psychiatry, Psychiatry and Mental health, Mood, Cohort, Female, Metabolic syndrome, business, Body mass index, 030217 neurology & neurosurgery
الوصف: OBJECTIVES The aims of the present study were to characterize cardiometabolic risk factors in a cohort of bipolar disorder patients with limited exposure to psychotropic medications, and to evaluate their associations with mood symptoms and omega-3 polyunsaturated fatty acid (PUFA) blood levels. METHODS Cardiometabolic risk assessments were compared in individuals with bipolar I disorder experiencing a first manic or mixed episode or an early depressive episode (n=117) and healthy subjects (n=56). Patients were medication free at assessment and had no or limited exposure to mood-stabilizer or antipsychotic medications prior to the current admission. Associations among cardiometabolic parameters and Clinical Global Impression-Severity scale (CGI-S), manic (Young Mania Rating Scale [YMRS]), and depressive (Hamilton Depression Rating Scale [HDRS]) symptom ratings were evaluated within the bipolar group. RESULTS Following adjustment for demographic variables (i.e., age, gender, and parental education), significantly higher fasting triglyceride levels were observed in the bipolar group compared to the healthy group (121.7 mg/dL vs 87.0 mg/dL; P
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المؤلفون: Blair Simpson, Karen E. Jerardi, Ndidi Unaka, Brianna Liberio, Randi Mullaney, Joan Morris, Jodi Kelley, Michelle Durling, Patrick W. Brady, Jennifer Shafer, Devesh Dahale, Ashley Jenkins, Angela M. Statile
المصدر: Journal of hospital medicine. 12(7)
مصطلحات موضوعية: Male, medicine.medical_specialty, Quality management, Standardization, Leadership and Management, media_common.quotation_subject, MEDLINE, Psychological intervention, Assessment and Diagnosis, Pediatrics, Literacy, 03 medical and health sciences, 0302 clinical medicine, Hospitals, Urban, 030225 pediatrics, medicine, Electronic Health Records, Humans, 030212 general & internal medicine, Child, Care Planning, media_common, business.industry, Health Policy, Infant, General Medicine, medicine.disease, Readability, Patient Discharge, Hospital medicine, Health Literacy, Caregivers, Reading, Preparedness, Family medicine, Child, Preschool, Fundamentals and skills, Female, Medical emergency, business
الوصف: Background Readable discharge instructions may help caregivers understand and implement care plans following hospitalization. Many caregivers of hospitalized children, however, have limited literacy. We aimed to increase the percentage of discharge instructions written at 7th grade level or lower for hospital medicine patients from 13% to 80% in 6 months. Methods Quality improvement efforts targeted a 42-bed unit at the community satellite of our large, urban academic hospital. A multidisciplinary team of physicians, nurses, and parents focused on key drivers: family engagement in discharge process, standardization of discharge instructions, staff engagement in discharge preparedness, and audit and feedback of data. Improvement cycles included 1) education and implementation of a general discharge instruction template in the electronic health record (EHR); 2) visible reminders and tips for writing readable discharge instructions; 3) implementation of disease-specific discharge instruction templates in the EHR; and 4) individualized feedback to staff on readability and content of their written discharge instructions. Instructions were individually scored for readability using an online platform. An annotated control chart assessed the impact of interventions over time. Results Through sequential interventions over 6 months, the percentage of discharge instructions written at 7th grade or lower readability level increased from 13% to 98% and has been sustained for 4 months. The reliable use of the EHR templates was associated with our largest improvements. Conclusion Use of standardized discharge instruction templates and rapid feedback to staff improved the readability of instructions. Next steps include adaptation and spread to other patient populations.
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المؤلفون: Melissa P. DelBello, Paula K. Shear, Stephen M. Strakowski, Jing-Huei Lee, Caleb M. Adler, Michelle Durling, James C. Eliassen, Michael A. Cerullo, David E. Fleck, Martine Lamy
المصدر: Molecular psychiatry
مصطلحات موضوعية: Adult, Male, Bipolar Disorder, Time Factors, media_common.quotation_subject, Emotions, Models, Neurological, Prefrontal Cortex, Models, Psychological, Neuropsychological Tests, Amygdala, Article, Cellular and Molecular Neuroscience, Young Adult, Thalamus, Continuous performance task, Interview, Psychological, medicine, Image Processing, Computer-Assisted, Limbic System, Humans, Attention, Bipolar disorder, Prefrontal cortex, Molecular Biology, media_common, Brain Mapping, medicine.diagnostic_test, fMRI, amygdala, medicine.disease, frontal lobe, Magnetic Resonance Imaging, Corpus Striatum, Dorsolateral prefrontal cortex, Psychiatry and Mental health, medicine.anatomical_structure, Female, CPT, medicine.symptom, Psychology, Functional magnetic resonance imaging, Mania, Neuroscience, Vigilance (psychology)
الوصف: We examined sustained attention deficits in bipolar disorder and associated changes in brain activation assessed by functional magnetic resonance imaging (fMRI). We hypothesized that relative to healthy participants, those with mania or mixed mania would (1) exhibit incremental decrements in sustained attention over time, (2) overactivate brain regions required for emotional processing and (3) progressively underactivate attentional regions of prefrontal cortex. Fifty participants with manic/mixed bipolar disorder (BP group) and 34 healthy comparison subjects (HC group) received an fMRI scan while performing a 15-min continuous performance task (CPT). The data were divided into three consecutive 5-min vigilance periods to analyze sustained attention. Composite brain activation maps indicated that both groups activated dorsal and ventral regions of an anterior-limbic network, but the BP group exhibited less activation over time relative to baseline. Consistent with hypotheses 1 and 2, the BP group showed a marginally greater behavioral CPT sustained attention decrement and more bilateral amygdala activation than the HC group, respectively. Instead of differential activation in prefrontal cortex over time, as predicted in hypothesis 3, the BP group progressively decreased activation in subcortical regions of striatum and thalamus relative to the HC group. These results suggest that regional activation decrements in dorsolateral prefrontal cortex accompany sustained attention decrements in both bipolar and healthy individuals. Stable amygdala overactivation across prolonged vigils may interfere with sustained attention and exacerbate attentional deficits in bipolar disorder. Differential striatal and thalamic deactivation in bipolar disorder is interpreted as a loss of amygdala (emotional brain) modulation by the ventrolateral prefrontal-subcortical circuit, which interferes with attentional maintenance.
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المؤلفون: James C. Eliassen, Jing-Huei Lee, Jonathan Dudley, Michelle Durling, Stephen M. Strakowski
المصدر: Journal of affective disorders. 175
مصطلحات موضوعية: High-energy phosphate, Adult, Male, medicine.medical_specialty, Longitudinal study, Aging, Bipolar I disorder, Bipolar Disorder, Magnetic Resonance Spectroscopy, Phosphocreatine, Phosphates, White matter, chemistry.chemical_compound, Adenosine Triphosphate, Internal medicine, medicine, Humans, Bipolar disorder, Gray Matter, Cerebral Cortex, Confounding, Magnetic resonance spectroscopic imaging, Phosphorus, Middle Aged, medicine.disease, Magnetic Resonance Imaging, White Matter, Psychiatry and Mental health, Clinical Psychology, Endocrinology, medicine.anatomical_structure, Cross-Sectional Studies, chemistry, Female, Psychology, Neuroscience
الوصف: Objectives To identify abnormalities in high energy phosphate cerebral metabolism in euthymic bipolar disorder. Methods Phosphorus-31 magnetic resonance spectroscopic imaging (31P MRSI) data were acquired from the entire brain of 9 euthymic adults with bipolar disorder and 13 healthy adults. Estimates of phosphocreatine (PCr) and adenosine triphosphate (ATP) in homogeneous gray and white matter were obtained by tissue regression analysis. Results Analyses of covariance revealed the effect of age to be significantly different between bipolar and healthy groups for concentrations of PCr (p=0.0018) and ATP (p=0.013) in gray matter. These metabolites were negatively correlated with age in gray matter in bipolar subjects while PCr was positively correlated with age in gray matter of healthy subjects. Additionally, age-corrected concentrations of PCr in gray matter were significantly elevated in bipolar subjects (p=0.0048). Limitations Given that this cross-sectional study possessed a small sample and potentially confounding effects of medication status, we recommend a larger, longitudinal study to more robustly study relationships between bioenergetic impairment and duration of disease. Conclusions Our results suggest bioenergetic impairment related to mitochondrial function may be progressive in multi-episode bipolar subjects as they age.
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المؤلفون: David E. Fleck, Michael A. Cerullo, Stephen M. Strakowski, Michelle Durling, Martine Lamy, Renu Kotwal, James C. Eliassen, Melissa P. DelBello, Caleb M. Adler
المصدر: Journal of affective disorders. 133(1-2)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Bipolar Disorder, Psychomotor agitation, Suicide, Attempted, Affect (psychology), Impulsivity, behavioral disciplines and activities, Amygdala, Article, Risk Factors, mental disorders, Task Performance and Analysis, medicine, Humans, Bipolar disorder, Psychiatry, Psychomotor Agitation, Neural correlates of consciousness, Depression, Brain, medicine.disease, Magnetic Resonance Imaging, Psychiatry and Mental health, Clinical Psychology, Affect, Mood, medicine.anatomical_structure, Impulsive Behavior, Female, medicine.symptom, Psychology, Mania
الوصف: Of all mood states, patients in mixed episodes of bipolar disorder are at the greatest risk for impulsive behaviors including attempted suicide. The aim of this study was to examine whether the neural correlates of motor impulsivity are distinct in patients with mixed mania.Ten patients with bipolar disorder in a mixed episode (BP-M), 10 bipolar comparison participants in a depressed episode (BP-D), and 10 healthy comparison (HC) participants underwent functional MRI while performing a Go/No-Go task of motor impulsivity.Both patient groups had elevated, self-rated motor impulsiveness scores. The BP-M group also had a trend-level increase in commission errors relative to the HC group on the Go/No-Go task. While the full sample strongly activated a ventrolateral prefrontal-subcortical brain network, the BP-M group activated the amygdala and frontal cortex more strongly than the HC group, and the thalamus, cerebellum, and frontal cortex more strongly than the BP-D group.This study is primarily limited by a relatively small sample size.Higher commission error rates on the Go/No-Go task suggest increased vulnerability to impulsive responding during mixed episodes of bipolar disorder. Moreover, the distinct pattern of increased brain activation during mixed mania may indicate a connection between behavioral impulsivity and a failure of neurophysiological "inhibition", especially in the amygdala.
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