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Venous thromboembolism risk and prophylaxis in the acute hospital care setting: the Irish results of the ENDORSE study

Wed, 01/07/2015 - 11:15am

ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), is a multinational, cross-sectional survey of venous thromboembolism (VTE) risk prevalence and effective prophylaxis in the acute hospital care setting. Three Irish hospitals enrolled in the study. The American College of Chest Physicians (ACCP) guidelines were employed to evaluate VTE risk and prophylaxis. Of 552 patients, 297 (53.8%) and 255 (46.2%) were categorised as surgical or medical, respectively, with 175 (59%) surgical and 109 (43%) medical patients deemed to be at risk for VTE. Of these, only 112 (64%) and 51 (47%) received recommended VTE prophylaxis, respectively. The results are consistent with those observed in other countries and demonstrate a high prevalence of risk for VTE and a low rate of prophylaxis use, particularly in medical patients. Awareness of VTE guidelines should be an integral component of health policy.

Venous thromboembolism risk and prophylaxis in the acute hospital care setting: report from the ENDORSE study in Egypt

Wed, 01/07/2015 - 11:15am

BACKGROUND: Venous thromboembolism (VTE) is a leading cause of hospital-related deaths worldwide. However, the proportion of patients at risk of VTE who receive appropriate prophylaxis in Egypt is unknown. The ENDORSE study in Egypt is part of a global initiative to uncover the incidence of high-risk surgical and medical patients and determine what proportion of these patients receive appropriate VTE prophylaxis.

METHODS: Ten Egyptian hospitals participated in this observational study, enrolling all surgical and medical patients that met the study criteria. This resulted in a cohort of 1,008 patients in acute care facilities who underwent a retrospective chart review. Each patient's VTE risk status and the presence or absence of appropriate prophylactic care was assessed according to the American College of Chest Physicians (ACCP) guidelines 2004.

RESULTS: Of the 1,008 patients enrolled, 395 (39.2%) were found to be at high-risk for VTE. Overall, 227 surgical patients were at high-risk, although only 80 (35.2%) received ACCP-recommended prophylaxis. Similarly, 55/268 (32.75%) of high-risk medical patients received appropriate VTE prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant, while mechanical prophylactic use was quite low (1.5%) in high-risk patients.

CONCLUSIONS: In Egypt, more than one-third of all patients hospitalized for surgery or acute medical conditions are at high risk for developing VTE. However, only a small fraction of these patients receive appropriate VTE prophylaxis. Corrective measures are necessary for preventing VTE morbidity and mortality in these high risk patients.

Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE), a multinational cross-sectional study: results from the Indian subset data

Wed, 01/07/2015 - 11:15am

BACKGROUND and OBJECTIVES: Venous thromboembolism (VTE) is a major health problem with substantial morbidity and mortality. It is often underdiagnosed due to lack of information on VTE risk and prophylaxis. The ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study aimed to assess the prevalence of VTE risk in acute hospital care setting and proportion of at-risk patients receiving effective prophylaxis. We present here the risk factor profile and prophylaxis pattern of hospitalized patients who participated in ENDORSE study in India.

METHODS: In this cross-sectional study in India, all patients (surgical >18 yr, medical >40 yr) from 10 hospitals were retrospectively studied. Demographics, VTE risk factors and prophylaxis patterns were assessed according to the 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines.

RESULTS: We recruited 2058 patients (1110 surgical, 948 medical) from 10 randomly selected hospitals in India between August 2006 and January 2007. According to the ACCP criteria, 1104 (53.6%) patients [surgical 680 (61.3%), medical 424 (44.7%)] were at-risk for VTE. Chronic pulmonary disease/heart failure and complete immobilization were the most common risk factors before and during hospitalization, respectively. In India, 16.3 per cent surgical and 19.1 per cent medical at-risk patients received ACCP-recommended thromboprophylaxis.

INTERPRETATION and CONCLUSIONS: Despite a similar proportion of at-risk hospitalized patients in India and other participating countries, there was major underutilization of prophylaxis in India. It necessitates increasing awareness about VTE risk and ensuring appropriate thromboprophylaxis.

AHA 19th Spring Meeting: May 2-4, 2013, Hartford, Connecticut

Tue, 01/06/2015 - 10:56am

Announcing the 19th Spring Meeting of the Anesthesia History Association – May 2-4, 2013, Hartford, Connecticut.

A Review of the Korean Cultural Syndrome Hwa-Byung: Suggestions for Theory and Intervention

Mon, 01/05/2015 - 7:09pm

The purpose of this paper is to review Hwa-Byung, a cultural syndrome specific to Koreans and Korean immigrants. Hwa-Byung is a unique diagnosis and differs from other DSM disorders. However, Hwa-Byung has frequent comorbidity with other DSM disorders such as anger disorders, generalized anxiety disorder, and major depressive disorder. There are several risk factors for Hwa-Byung including psychosocial stress caused by marital conflicts and conflicts with their in-laws. Previous interventions of the Hwa-Byung syndrome were based primarily on the medical model. Therefore, based on previous research, we present a new ecological model of Hwa-Byung. We also recommend some areas of future research as well as present some limitations of our ecological model. Finally, we discuss some treatment issues, particularly for Korean women in the United States.

Brief Meditation Training for Migraineurs Affects Emotional and Physiological Stress Reactivity

Mon, 01/05/2015 - 7:09pm

Migraines result in a significant amount of pain and reduce the quality of life for more than 13 percent of the U.S. population. 90 They are related to increases in emotional and physiological stress. Reducing stress may, therefore, lead to fewer headaches. Dr. Wachholtz and her colleagues designed a specific SM program involving meditation to test the hypothesis that decreased reactivity to stressors might reduce the number and intensity of migraines. The study cohort included 88 patients with migraine who had never practiced meditation. Of these patients, 80.7 percent were female, matching the epidemiological profile of migraine. Participants were randomized to the meditation or education control groups. Treatment included 4 weekly 90-minute group sessions with meditation training and meditation practice for 20 minutes per day. Education controls were given information on migraine demographics and treatment options. Anxiety levels were assessed by the State Anxiety Inventory and galvanic skin response; migraines were assessed in a headache journal. Outcomes were measured at baseline, post-trial period, and 4 weeks post-trial period. Meditation significantly reduced the number of headaches by 50 percent. This effect was maintained 4 weeks post trial. Meditation reduced emotional and physiological stress reactivity by 10 percent and 40 percent, respectively, and was sustained during the post-trial period. Patients in the education control group actually experienced a transitory increase in state anxiety at the immediate post-trial evaluation, possibly because of focusing on their disability during the intervention. These results indicate that meditation is a useful and cost-effective tool in the management of chronic migraine pain. Interesting avenues of future research include examining different kinds of meditation, whether there are gender differences, and how long meditation-mediated outcomes can be sustained.

The relationship between spirituality and burnout among medical students

Mon, 01/05/2015 - 7:09pm

Medical student burnout has been associated with depression, loss of empathy, and suicidal ideation. Spirituality has been identified in previous studies as a protective factor in coping with the stress but has not been examined as a factor in medical student burnout. An internet link to an anonymous survey was sent via email to medical students at a public northeastern medical school; 259/469 (55.2%) completed it. The survey included measures of spirituality, burnout, psychological distress, coping, and general happiness. A Pearson-r correlation showed significant inverse correlations between measures of spirituality and measures of psychological distress/burnout (r's ranging from -.62 to -.14; p's < .01). In contrast, a positive correlation was found between life satisfaction and spirituality (r's .53 to .12; p < .05). Using hierarchical multiple regression with demographics (Step 1), mental health variables (Step 2), and satisfaction and Adaptive coping (Step 3), burnout remained significantly related to lower scores on both spirituality measures (FACIT-SP p < .00 and DSE p < .05). Students having higher levels of spiritual well being and daily spiritual experiences described themselves as more satisfied with their life in general, while students with low scores on spiritual well being and daily spiritual experiences had higher levels of psychological distress and burnout. Spirituality may therefore be a protective factor against burnout in medical students and future studies should explore potential causal relationships.

The Religious Dimension of Coping: Advances in Theory, Research, and Practice

Mon, 01/05/2015 - 7:09pm

In this chapter, we review the current theoretical and empirical status of the psychology of religion and coping, the practical interventions that have grown out of this body of work, and future directions for research and practice.

Comorbidity

Mon, 01/05/2015 - 7:09pm

Comorbidity occurs when an individual experiences two or more disorders at the same time (Eaton, 2006). Comorbidities can occur sequentially, or they can become symptomatic simultaneously. Disorders that are considered comorbidities can be either physical or psychological in nature. It is a common occurrence that a disorder in one domain (e.g., a physical disorder of spinal cord injury) will trigger or exacerbate a disorder in another domain (e.g., a psychological disorder of depression). Two disorders within the same domain are also considered comorbidities (e.g., depression and anxiety, or chronic obstructive pulmonary disorder and ischemic heart disease). There are some disorders that are such frequent comorbidities that they may eventually be combined under a single label and treated as a single syndrome (e.g., metabolic syndrome which often includes high blood pressure, Type 2 diabetes, obesity, hypercholesterolemia, and dyslipidemia) ...

Unipolar Depression

Mon, 01/05/2015 - 7:09pm

Unipolar depression is characterized by a combination of two types of symptoms: neurovegetative and emotional-cognitive. Neurovegetative symptoms are those symptoms that are directly related to the body (e.g., insomnia/hypersomnia, dysregulated eating, fatigue, and decreased energy). Emotional-cognitive symptoms involve those symptoms that are related to how a person processes information (e.g., suicidal ideation, decreased concentration, feeling worthless, anhedonia, and depressed mood). A combination of these depression symptoms must be unremitting for more than 2 weeks in order to be diagnosed with depression. Common treatments for depression include cognitive-behavioral psychotherapy, antidepressant medications, or a combination of these treatments. There are also a number of complementary treatments that are gaining empirical research support for use in combination with traditional approaches to enhance treatment outcome ...

Psychosomatic Health Care

Mon, 01/05/2015 - 7:09pm

Guided Imagery

Mon, 01/05/2015 - 7:09pm

A Review of "The Transformed Library: E-Books, Expertise, and Evolution"

Mon, 01/05/2015 - 4:02pm

This is a review of the book, The Transformed Library: E-Books, Expertise, and Evolution, by Jeannette Woodward. Published by American Library Association, 2013.

Internal consistency and factor structure of the Revised Conflict Tactics Scales in a sample of deaf female college students

Mon, 01/05/2015 - 12:39pm

The Revised Conflict Tactics Scales (CTS2) is currently the most widely used measure for identifying cases of intimate partner violence within the hearing population. The CTS2 has been used successfully with individuals from various countries and cultural backgrounds. However, the CTS2 had not yet been used with Deaf individuals. The goal of the present study was to investigate the internal consistency reliability and the factor structure of the CTS2 within a sample of Deaf female college students. Psychometric analyses indicated that subscales measuring Victimization of Negotiation, Psychological Aggression, Physical Assault, and Injury proved both reliable and valid in the current sample. Three subscales did not evidence reliability and the factor structure was not valid for Perpetration items.

Deaf individuals’ bilingual abilities: American Sign Language proficiency, reading skills, and family characteristics

Mon, 01/05/2015 - 12:39pm

The current study investigated the bilingual abilities of 55 Deaf individuals, examining both American Sign Language (ASL) competency and English reading skills. Results revealed a positive relationship between ASL competency and English skills, with highly competent signers scoring higher on a measure of reading comprehension. Additionally, family characteristics (e.g., parental education level, family hearing status) were entered into the analysis to ascertain their effect on Deaf individuals’ bilingual abilities. The findings support the theory that competency in ASL may serve as a bridge to the acquisition of English print. Moreover, the findings provide support for the critical period hypothesis for first language acquisition and its later impact on other cognitive and academic skills.

Morphological knowledge and decoding skills of deaf readers

Mon, 01/05/2015 - 12:39pm

Many studies have reported the necessity of phonological awareness to become a skilled reader, citing barriers to phonological information as the cause for reading difficulties experienced by deaf individuals. In contrast, other research suggests that phonological awareness is not necessary for reading acquisition, citing the importance of higher levels of syntactic and semantic knowledge. To determine if deaf students with higher language skills have better word decoding strategies, students responded to a morphological test, where monomorphemic words and multimorphemic words were matched to their definitions. Two studies are reported, one focusing on English placement levels and a second with formal measures of both ASL and English language proficiency. Results in-dicated that performance on the morphological decoding test was related to language proficiency scores, but not to phonological awareness scores.

Intimate partner violence against deaf women: A review

Mon, 01/05/2015 - 12:39pm

A common theme among writings on intimate partner violence against Deaf women is the concern that there is little empirical work conducted in this field in comparison to research conducted with hearing populations. However, it is important to acknowledge that an increased amount of research has been conducted in recent years and that a foundation of research has been established, on which future researchers can build and expand. The goal of the current review is to summarize and synthesize the recent work in this area, as well as identify remaining gaps and needs for future empirical work. While there are substantial issues and gaps in the current research base, the most critical issue is that of dissemination and networking—many of the studies in the current review remain unpublished, making this information difficult to obtain. As such, it is similarly difficult to locate other investigators in the field, hindering our ability to build on one another's work, as well as develop effective research collaborations. The foundation has been established. The researchers are out there. The next step is to work together to expand our knowledge of intimate partner violence against Deaf women.

Do deaf individuals’ dating scripts follow the traditional sexual script?

Mon, 01/05/2015 - 12:39pm

The current study investigated Deaf individuals’ dating expectations. Prior research on dating expectations has identified three common scenes: initiation/meeting, activities, and outcomes/conclusions. Participants were asked to report their expectations for each scene on a typical date. Talking was the most frequently occurring initiation activity. Dinner and a movie were among the top date activities in the activities scene. Activities were often reported as group gatherings. Dating outcomes included a good night kiss and making plans for another date. These expectations do not match prior research with hearing participants where the Traditional Sexual Script could be identified. Comparisons and suggestions for future research are discussed.

An Outcome Study of Seeking Safety With Rural Community-Based Women

Mon, 01/05/2015 - 12:39pm

This pilot study investigated the impact of Seeking Safety (SS) on rural women with comorbid substance abuse and trauma problems. SS is an evidence-based, present-focused therapy that provides coping skills and psychoeducation. Despite its demonstrated effectiveness, this is the first known study using SS with rural women. Investigating the efficacy of evidence-based treatments with rural populations is especially important because, compared with urban residents, they are more likely to meet criteria for comorbid mental illness and substance abuse, exhibit more severe symptoms of both disorders, but are much less likely to receive formal treatment. Such disparities highlight the need for effective treatments to enhance coping skills and reduce unsafe behavior within this population. Data were collected from 23 community-based rural women who voluntarily participated in SS treatment groups twice weekly (a total of 24 1.5-hr sessions were offered). The Trauma Symptom Inventory (TSI) was administered pre- and posttreatment. Results showed reductions on all 10 TSI subscales. Effect sizes were large across all subscales, except sexual concerns, which was medium to large. Our findings align with previous SS outcome studies, which report consistent positive results among vulnerable populations with trauma symptoms and substance abuse. (PsycINFO Database Record (c) 2014 APA, all rights reserved)