2200 Unity Ave N
Golden Valley MN 55422
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License #: 5357
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A Meta-Analysis of Depressive Symptom Outcomes in Randomized, Controlled Trials for PTSD. - The Journal of nervous and mental disease
Posttraumatic stress disorder (PTSD) often co-occurs with depression. Current PTSD practice guidelines lack specific guidance for clinicians regarding the treatment of depressive symptoms. We conducted a meta-analysis of all randomized, placebo-controlled trials for PTSD therapies focusing on depression outcomes to inform clinicians about effective treatment options for depressive symptoms associated with PTSD. We searched literature databases for randomized, controlled clinical trials of any treatment for PTSD published between 1980 and 2013. We selected articles in which all subjects were adults with a diagnosis of PTSD based on the Diagnostic and Statistical Manual of Mental Disorders criteria, and valid PTSD and depressive symptom measures were reported. The sample consisted of 116 treatment comparisons drawn from 93 manuscripts. Evidence-based PTSD treatments are effective for comorbid depressive symptoms. Existing PTSD treatments work as well for comorbid depressive symptoms as they do for PTSD symptoms.
Evaluation of Veterans' Suicide Risk With the Use of Linguistic Detection Methods. - Psychiatric services (Washington, D.C.)
Many people who die from suicide received recent medical care prior to their death. Suicide risk assessment tools for health care settings focus on a variety of clinical and demographic factors but generally do not examine the text of notes written by clinicians about patients who later die from suicide. This study examined whether clinicians' notes indicated increased use of distancing language during the year preceding patients' suicide.The linguistic content of clinicians' notes for outpatients of U.S. Department of Veterans Affairs (VA) medical centers was examined in the year preceding suicide of 63 veterans. Approximately half of the veterans had received mental health services. They were matched based on mental health service use with living VA outpatients. Linguistics software was used to construct quantitative theme-based categories related to distancing language and to examine temporal trends via keyword analysis.Analysis of clinical notes for outpatients who died from suicide and those who did not revealed a significant difference in clinicians' distancing language. Multiple keywords emerged that also were related to distancing language, and their relative frequency increased in the time approaching the suicide.Linguistic analysis is a promising approach to identify use of distancing language by clinicians, which appears to be a marker of suicide risk. This pilot work indicates that additional analysis and validation with larger cohorts are warranted.
Clinicians' Perception of Patient Readiness for Treatment: An Emerging Theme in Implementation Science? - Administration and policy in mental health
Despite a training program to help veterans administration (VA) clinicians implement evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), uptake has been limited. To understand clinicians' implementation challenges, we performed thematic analysis of semi-structured telephone interviews guided by the Promoting Action on Research Implementation in Health Services framework. Our sample included 22 psychotherapists in VA PTSD clinics in one region. We identified a theme not captured by our implementation framework: clinicians' perceptions about their patients' readiness for treatment. Clinician perception of patient readiness may be important to the uptake of EBPs and should be considered in mental health implementation work.
A comparison of longitudinal and block rotations for a psychiatric resident consultation-liaison experience. - Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
Consultation-liaison psychiatry (CLPsych) is a required experience for psychiatry residents. There is considerable variation in the structure of the experience. We sought to compare a longitudinal and block design for a CLPsych residency experience.This research was conducted in the context of a naturalist transition from a longitudinal CLPsych rotation design to a block rotation design. We surveyed residents from both models regarding their views of the CLPsych psychiatry experience. We also compared the scores on the Psychiatric Resident in Training Examination (PRITE). Lastly, we surveyed physicians who requested and received psychiatric consultations.Residents trained in the block CLPsych model reported a better education and clinical care compared longitudinal model. They also had better scores on the CLPsych section of the PRITE exam. Physicians receiving psychiatric consultations reported better overall quality of consults in the block model.It appears that block CL psychiatry experiences may be better than longitudinal ones. Programs should consider this design in psychiatry residency education.
A randomized controlled clinical trial of a patient decision aid for posttraumatic stress disorder. - Psychiatric services (Washington, D.C.)
Patient decision aids have been used in many clinical situations to improve the patient centeredness of care. A patient decision aid for patients with posttraumatic stress disorder (PTSD) has not been developed or tested. The authors evaluated the effects of a patient decision aid on the patient centeredness of PTSD treatment.The study was a randomized trial of a patient decision aid for PTSD versus treatment as usual (control group). The participants were 132 male and female veterans who presented to a single U.S. Department of Veterans Affairs hospital with a new diagnosis of PTSD. Patient centeredness was assessed by knowledge of PTSD and its treatment, level of decisional uncertainty, and ability to state a preferred treatment option. Secondary outcomes included treatments received and PTSD symptoms in the six months after study entry.Compared with the control group (N=65), participants who reviewed the patient decision aid (N=63) had higher scores for PTSD knowledge (p=.002) and less conflict about their choice of treatment (p=.003). In addition, participants who reviewed the patient decision aid were more likely to select and receive an evidence-based treatment for PTSD (p=.04) and had superior PTSD outcomes (p=.004) compared with the control group.Use of a patient decision aid was associated with improvements in patient-centered PTSD treatment. The patient decision aid was also associated with greater use of evidence-based treatments and improvement of PTSD symptoms. This study suggests that clinics should consider using a patient decision aid for patients with PTSD.
The provision of mental health treatment after screening: exploring the relationship between treatment setting and treatment intensity. - General hospital psychiatry
Primary care screening programs for mental health disorders are designed to detect patients who might benefit from treatment. As such, the utility of these programs is predicated on the actions that take place in response to a positive screen. Our objective was to characterize the cascade of care delivery steps following a positive screen for a mental health disorder.We examined the care received by primary care patients over the year following a new positive screen for depression, posttraumatic stress disorder (PTSD) or alcohol misuse. We characterized whether the care adhered to practice guidelines for related mental health disorders and whether involvement of mental health specialists led to higher use of guideline-adherent practices.Many patients received appropriate treatment in the primary care setting and those whose scores were consistent with more severe illness were more likely to receive care in a mental health setting. Patients with positive screens for depression and PTSD who went on to be seen in mental health clinics received care that was consistent with treatment guidelines for the related disorder most of the time. In the case of patients with positive screens for alcohol misuse, few received guideline-recommended medications in any setting. However, a substantial portion of patients received some alcohol-related counseling from their primary care physicians during the visit in which their alcohol misuse was detected.It appears that the treatment system for mental health problems, which extends from primary care settings to mental health subspecialty settings, can provide adequate care when patients' mental health problems are identified through screening. The care provided in all settings can be improved, and additional steps to enhance the quality of care are warranted. This should include additional efforts to align screening and treatment.Published by Elsevier Inc.
Reevaluating the role of antidepressants in cancer-related depression: a systematic review and meta-analysis. - General hospital psychiatry
Prior reviews evaluating the role of antidepressants in cancer-related depression have drawn conflicting conclusions. These reviews have also not explored differences in efficacy and tolerability between antidepressants. We conducted a meta-analysis to address these limitations.We searched Medline (1948-2013), the Cochrane Library (1800-2013), the Cumulative Index to Nursing and Allied Health Literature (1986-2013), ClinicalTrials.gov (2013) and meeting abstracts. We included randomized trials comparing antidepressants to placebo or no treatment for cancer-related depression. We used random effects to calculate standardized mean differences (SMD).Of 5178 potentially eligible citations, 9 trials (1169 subjects) met inclusion criteria. Trials of mianserin found a robust reduction in depression scores at â‰¥4 weeks of treatment (SMD: 0.60, 95% confidence interval (CI): 0.24-0.95). Similar, but less robust, results were observed with paroxetine (SMD: 0.22, 95% CI: 0.01-0.42) and fluoxetine (SMD 0.34, 95% CI: 0.02-0.66). Conversely, there was no advantage with amitriptyline or desipramine. Compared to placebo, the odds of dropping out due to side effect were higher with fluoxetine and paroxetine and lower with mianserin. Methodological quality was moderate.Paroxetine, fluoxetine and mianserin improve cancer-related depression but may vary in efficacy and tolerability. High-quality, randomized trials of newer antidepressant agents are needed to identify optimal treatments for managing cancer-related depression.Copyright Â© 2014 Elsevier Inc. All rights reserved.
Preliminary findings for a brief posttraumatic stress intervention in primary mental health care. - Psychological services
A team of clinicians at a small rural Veterans' Health Administration (VHA) medical center piloted a brief psychological intervention for posttraumatic stress in a primary mental health care setting. Symptom measures were completed by veterans before and after receiving the brief trauma treatment (BTT), and were then analyzed using paired t tests. In our uncontrolled study, we found a statistically insignificant improvement in symptoms of posttraumatic stress disorder, though there were statistically significant, but not clinically significant, improvements in depression and general anxiety. The intervention may enhance subsequent specialty mental health engagement. Fifty-one veterans (62.20%) went on to receive psychotherapy in a specialty mental health setting, which represents a substantial increase in specialty psychotherapy engagement compared to reports elsewhere in the literature. Lack of controlled comparison precludes definitive conclusions, but the current preliminary results support future studies of brief psychological interventions in primary care settings, including randomized controlled comparisons.
Health systems engineering fellowship: curriculum and program development. - American journal of medical quality : the official journal of the American College of Medical Quality
Industrial engineering and related disciplines have been used widely in improvement efforts in many industries. These approaches have been less commonly attempted in health care. One factor limiting application is the limited workforce resulting from a lack of specific education and professional development in health systems engineering (HSE). The authors describe the development of an HSE fellowship within the United States Department of Veterans Affairs, Veterans Health Administration (VA). This fellowship includes a novel curriculum based on specifically established competencies for HSE. A 1-year HSE curriculum was developed and delivered to fellows at several VA engineering resource centers over several years. On graduation, a majority of the fellows accepted positions in the health care field. Challenges faced in developing the fellowship are discussed. Advanced educational opportunities in applied HSE have the potential to develop the workforce capacity needed to improve the quality of health care.Â© 2014 by the American College of Medical Quality.
In-person and video-based post-traumatic stress disorder treatment for veterans: a location-allocation model. - Military medicine
Post-traumatic stress disorder (PTSD) is associated with poor health but there is a gap between need and receipt of care. It is useful to understand where to optimally locate in-person care and where video-based PTSD care would be most useful to minimize access to care barriers, care outside the Veterans Affairs system, and total costs. We developed a service location systems engineering model based on 2010 to 2020 projected care needs for veterans across New England to help determine where to best locate and use in-person and video-based care. This analysis determined specific locations and capacities of each type of PTSD care relative to patient home locations to help inform allocation of mental health resources. Not surprisingly Massachusetts, Connecticut, and Rhode Island are well suited for in-person care, whereas some rural areas of Maine, Vermont, and New Hampshire where in-patient services are infeasible could be better served by video-based care than external care, if the latter is even available. Results in New England alone suggest a potential $3,655,387 reduction in average annual total costs by shifting 9.73% of care to video-based treatment, with an average 12.6 miles travel distance for the remaining in-person care.Reprint & Copyright Â© 2014 Association of Military Surgeons of the U.S.
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2200 Unity Ave N Golden Valley, MN 55422
1415 Lilac Dr N Suite 190
Golden Valley, MN 55422
3300 Oakdale Ave N
1405 Lilac Dr N Ste 160J
Golden Valley, MN 55422